Australian Critical Care最新文献

{"title":"Implementation of a risk-stratified intervention bundle to prevent pressure injury in intensive care: A before-after study.","authors":"Angel Cobos-Vargas, Paul Fulbrook, Josephine Lovegrove, María Acosta-Romero, Luís Camado-Sojo, Manuel Colmenero","doi":"10.1016/j.aucc.2024.09.008","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.008","url":null,"abstract":"<p><strong>Background: </strong>Hospital-acquired pressure injury is an enduring problem in intensive care. Several intensive care-specific pressure injury risk assessment tools have been developed, but to date, only the COMHON Index has been aligned with risk-stratified preventative interventions.</p><p><strong>Objectives: </strong>The aim of this study was to evaluate the effectiveness of a risk-stratified intervention bundle to reduce pressure injury in intensive care and to assess compliance with bundled interventions.</p><p><strong>Methods: </strong>A controlled before-after study was undertaken. All patients admitted to a single intensive care unit were included. Standard care was provided in the before phase, and the risk-stratified intervention bundle was implemented in the after phase. The primary outcome measure was pressure injury incidence.</p><p><strong>Results: </strong>The sample comprised 761 intensive care admissions. In the after phase, pressure injury incidence was reduced (2.1% vs 3.9%; 46% relative risk reduction), injury severity was lower, and there were fewer pressure injuries on the sacrum, buttocks, and heels. Logistic regression modelling identified three significant factors associated with pressure injury development: intensive care length of stay (odds ratio: 1.2); COMHON Index admission score (odds ratio: 1.2), and the before phase (odds ratio: 4.2). In the after phase, individual intervention compliance was variable (range: 40%-100%), but the all-or-nothing compliance was poor (33%).</p><p><strong>Conclusions: </strong>Implementation of bundled preventive measures associated with COMHON Index risk level reduced pressure injury incidence. Likewise, injury severity decreased, and the location of pressure injuries changed following the intervention. The results from this study support the use of risk-stratified interventions to prevent pressure injury in intensive care. However, further research is needed to examine the effectiveness of the COMHON Index bundle before it can be recommended for widespread clinical practice.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101123"},"PeriodicalIF":2.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic resonance imaging in comatose adults resuscitated after out-of-hospital cardiac arrest: A posthoc study of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest trial.","authors":"Glenn M Eastwood, Michael Bailey, Alistair D Nichol, Josef Dankiewicz, Niklas Nielsen, Rachael Parke, Tobias Cronberg, Theresa Olasveengen, Anders M Grejs, Manuela Iten, Matthias Haenggi, Peter McGuigan, Franca Wagner, Marion Moseby-Knappe, Margareta Lang, Rinaldo Bellomo","doi":"10.1016/j.aucc.2024.09.015","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.015","url":null,"abstract":"<p><strong>Background: </strong>Neuroimaging with magnetic resonance imaging (MRI) may assist clinicians in evaluating brain injury and optimising care in comatose adults resuscitated after out-of-hospital cardiac arrest (OHCA). However, contemporary international data on its use are lacking.</p><p><strong>Aim: </strong>The primary aim was to compare the patient characteristics, early postresuscitation care, and neurological outcomes of patients according to MRI use.</p><p><strong>Methods: </strong>We performed a posthoc analysis of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) trial, a multinational randomised trial comparing targeted mild hypercapnia or normocapnia in comatose adults after OHCA.</p><p><strong>Results: </strong>After exclusions, 1639 patients enrolled in the TAME trial were analysed. Of these, 149 (9%) had an MRI. Compared to non-MRI patients, MRI patients were younger (58.9 versus 61.7 years, p: 0.02), had a longer median time from OHCA to return of spontaneous circulation (30 versus 25 min, p < 0.0001), and had a higher average arterial lactate level (8.78 versus 6.74 mmol/L, p < 0.0001) on admission to hospital. MRI patients were more likely to receive additional advanced diagnostic assessments during intensive care unit admission (p < 0.0001). At 6 months, 23 of 140 patients (16.4%) in the MRI group had a favourable neurological outcome, compared with 659 of 1399 patients (47.1%) in the no-MRI group (p < 0.001). On multivariable modelling, country of enrolment was the dominating predictor in the likelihood of an MRI being performed.</p><p><strong>Conclusions: </strong>In the TAME trial, 9% of patients had an MRI during their intensive care unit admission. Among these patients, only 16% had a favourable neurological outcome at 6 months.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101130"},"PeriodicalIF":2.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing unnecessary use of intermittent pneumatic compression in intensive care: A before-and-after pilot study with environmental perspective.","authors":"Louise Hansell, Anthony Delaney, Maree Milross, Elise Henderson","doi":"10.1016/j.aucc.2024.09.010","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.010","url":null,"abstract":"<p><strong>Background: </strong>The healthcare sector in Australia has committed to reducing carbon emissions associated with care delivery. Thirty percent of care delivered in the Australian hospital sector is considered low-value care. Intensive care uses chemical prophylaxis to reduce risk of venous thromboembolism (VTE). Mechanical prophylaxis methods, which include intermittent pneumatic compression (IPC), are often used as an adjunct to chemical prophylaxis but can also be used in patients where chemical prophylaxis is contraindicated. Recent literature demonstrates, however, that there is no additional benefit to the routine use of IPC, in reducing VTE risk when used as an adjunct to chemical VTE prophylaxis.</p><p><strong>Objective: </strong>The aims of this study were to assess the effect of the implementation of an education package on the use of single-use IPC devices in the intensive care unit to determine the carbon footprint of a pair of IPC devices, and to determine change in waste production, greenhouse gas emissions, and the financial cost associated with change in IPC use.</p><p><strong>Methods: </strong>A before-and-after pilot study was undertaken in a single, level III intensive care unit. An audit was conducted to determine the appropriate use of IPC over a 3-month period before and after the delivery of an education package to guide prescription and use of IPC.</p><p><strong>Results: </strong>Unnecessary use of IPC reduced from 33/58 (56.9%) to 3/31 (9.7%) after delivery of an education package. According to a bottom-up carbon footprinting analysis, embodied carbon of a single pair of IPC devices was 432.2 g carbon dioxide equivalent (CO₂e). This study represents a minimum annual saving of $7682.40, 14.9 Kg waste and 51.8 KgCO₂e associated with reduced unnecessary use of IPC.</p><p><strong>Conclusion: </strong>Staff education and behaviour change reduced the number of IPC devices used. The number of IPC devices applied inappropriately also reduced, as did associated greenhouse gas emissions and financial cost.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101125"},"PeriodicalIF":2.6,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methods of functional outcome assessment in neurocritical care trials: A systematic review and meta-analysis.","authors":"Emily Fitzgerald, Lachlan Donaldson, Naomi Hammond, Breannan Johnson, Kwan Yee Leung, Rachel McBain, Gabrielle McDonald, Kirsten Rowcliff, Ruan Vlok, Anthony Delaney","doi":"10.1016/j.aucc.2024.09.009","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.009","url":null,"abstract":"<p><strong>Background: </strong>Acute brain injury due to conditions such as subarachnoid haemorrhage and traumatic brain injury are associated with physical, psychological, cognitive, emotional, and social deficits. Despite reductions in morbidity and mortality, there have been few significant changes in clinical practice. It has been suggested that heterogeneity in outcome assessment in studies has contributed to this limited progress.</p><p><strong>Objectives: </strong>The objectives of this study were to describe current methods of outcome assessment in aneurysmal subarachnoid haemorrhage and traumatic brain injury studies and to examine the relationship between methods of outcome assessment and reported outcomes.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of randomised controlled trials and cohort studies enrolling an adult aneurysmal subarachnoid haemorrhage or traumatic brain injury population and reporting at least one functional outcome measure.</p><p><strong>Results: </strong>We identified 176 studies, including 60 494 participants. The Glasgow Outcome Scale or the Glasgow Outcome Scale Extended was used in 68% (N = 120) of studies and the Modified Rankin Scale in 38% (N = 67) of studies. Outcome assessment was reported at different timepoints, using different methods of application, and often dichotomised using different ranges. Many studies did not report key details on methods of outcome assessment. Outcome assessment using the Modified Rankin Scale was associated with a higher proportion of patients reported as having a favourable outcome 0.62 (95% confidence interval [CI]: 0.58-0.67) than the Glasgow Outcome Scale 0.48 (95% CI: 0.43-0.53) or the Glasgow Outcome Scale Extended 0.42 (95% CI: 0.37-0.48, p < 0.01). In-person assessment was associated with an increased proportion of patients achieving a favourable outcome 0.55 (95% CI: 0.55-0.45) compared to telephone assessment 0.46 (95% CI: 0.40-0.52).</p><p><strong>Conclusion: </strong>There is significant heterogeneity and incomplete reporting of methods of outcome assessment in critical care studies enrolling aneurysmal subarachnoid haemorrhage and traumatic brain injury patient populations. Our study identified an association between the methods of outcome assessment and reported outcomes. Our study supports initiatives to standardise outcome assessment in neurocritical care research to ensure the quality of outcome data.</p><p><strong>Registration: </strong>The International Prospective Register of Systematic Reviews (CRD42023072206).</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101124"},"PeriodicalIF":2.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The interplay between frailty status and persistent critical illness on the outcomes of patients with critical COVID-19: A population-based retrospective cohort study.","authors":"William Bonavia, Ryan Ruiyang Ling, Ravindranath Tiruvoipati, Mallikarjuna Ponnapa Reddy, David Pilcher, Ashwin Subramaniam","doi":"10.1016/j.aucc.2024.09.013","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.013","url":null,"abstract":"<p><strong>Objectives: </strong>Persistent critical illness (PerCI) occurs when the patient's prolonged intensive care unit (ICU) stay results in complications that become the primary drivers of their condition, rather than the initial reason for their admission. Patients with frailty have a higher risk of developing and dying from PerCI. We aimed to investigate the interplay of frailty and PerCI in critically ill patients with COVID-19.</p><p><strong>Method: </strong>We conducted a retrospective multicentre cohort study including 103 Australian and New Zealand ICUs over the period of January 2020 to December 2021. We included all adult patients with COVID-19 and documented the Clinical Frailty Scale (frail ≥ 5). PerCI is defined as an ICU length of stay of ≥10 days. We aimed to investigate the hospital mortality with and without PerCI across varying degrees of frailty and examined the potential interaction effect between frailty status and PerCI.</p><p><strong>Results: </strong>The prevalence of PerCI was similar between patients with and without frailty (25.4% vs. 27.9%; p = 0.44). Hospital mortality was higher in patients with PerCI than in those without (28.8% vs. 9.3%; p < 0.001). Mortality in patients with PerCI also increased with increasing frailty (p < 0.001). Frailty independently predicted hospital mortality. When adjusted for Australia and New Zealand risk of death mortality prediction model and sex, the impact of frailty was no different in patients with and without PerCI (odds ratio = 1.30 [95% confidence interval: 1.14-1.49] vs. (odds ratio = 1.46 [95% confidence interval: 1.29-1.64]). Furthermore, increasing frailty did not influence mortality in patients with PerCI more (or less) than in those without PerCI (p_interaction = 0.82).</p><p><strong>Conclusions: </strong>The presence of frailty independently predicted hospital mortality in patients with PerCI with COVID-19, but the impact of frailty on mortality was no different in those who developed PerCI from those without PerCI.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101128"},"PeriodicalIF":2.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bereaved family members' perspectives of their organ donation decision at 3 months post death of the donor-eligible patient in critical care: A dual-method study.","authors":"Julie E Potter, Lin Perry, Rosalind M Elliott","doi":"10.1016/j.aucc.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.10.001","url":null,"abstract":"<p><strong>Background: </strong>Offering organ donation is part of routine end-of-life care in critical care. Families describe feeling emotionally overwhelmed, which reduces their ability to understand complex medical information necessary to make informed decisions about organ donation. Late decisional regret is more common among families who decline donation. Thus, it is vital to investigate whether the organ donation decision choices that families make in hospital endure unchanged and what factors affect their perspectives.</p><p><strong>Objectives: </strong>The objective of this study was to explore family members' perspectives of their final organ donation decision in hospital, either to consent or to decline donation, at around 90 d later.</p><p><strong>Methods: </strong>This dual-method study comprised semistructured interviews of family members of donor-eligible patients who experienced care in seven metropolitan teaching hospitals, a tertiary paediatric hospital, and a major regional hospital in New South Wales, Australia. Interviews were audio recorded and transcribed verbatim. Descriptive quantitative analysis and thematic analysis were used.</p><p><strong>Findings: </strong>Participants overwhelmingly agreed that their organ donation decision remained unchanged at 3 months after the death of their relative (n = 127, 97%). The remainder (n = 3, 2%) were unsure or stated \"possibly not\" (n = 1, 1%); in these cases, the eligible donor was certified dead via circulatory criteria. Five themes were synthesised in relation to the organ donation decision: Knowledge of the donor-eligible patient's prior wishes, Family members' prior decision to donate their own organs, Solace in the decision, Altruism, and Reality of the process.</p><p><strong>Conclusions: </strong>The organ donation decision choice remained unchanged for the large majority. Further research is required to ascertain how people can be assisted to understand the organ donation process, particularly in the setting of certification of death by circulatory criteria, and how best to positively influence consent rates.</p><p><strong>Clinical trial registry number: </strong>Australian and New Zealand Clinical Trial Registration ACTRN12613000815763.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101132"},"PeriodicalIF":2.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of implementing the critical-care pain observation tool in the adult intensive care unit: A nonrandomised stepped-wedge trial.","authors":"Majid A Alotni, Jenny Sim, Ginger Chu, Michelle Guilhermino, Daniel Barker, Stuart Szwec, Ritin Fernandez","doi":"10.1016/j.aucc.2024.09.014","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.014","url":null,"abstract":"<p><strong>Background: </strong>Approximately 70% of patients in intensive care units (ICUs) experience untreated pain, often due to severe patient conditions and communication barriers.</p><p><strong>Aim: </strong>The aim of this study was to implement the Critical-Care Pain Observation Tool (CPOT) to improve pain assessment in patients unable to self-report pain in the ICU.</p><p><strong>Method: </strong>A stepped-wedge trial was conducted in six adult ICUs in Saudi Arabia between February and June 2022. The sequential transition of ICU clusters occurred in February 2022, from control to intervention, until all ICUs were exposed to the intervention. The primary outcome was the number of pain assessments, whereas the secondary outcomes were reassessments. Other outcomes were length of stay, mechanical ventilation duration, and administered doses of sedatives and analgesic agents. Statistical analyses were performed using the Statistical Analysis Software v9.4.</p><p><strong>Results: </strong>A total of 725 patients unable to self-report pain were included; 65% (n = 469) were male with an average age of 55 years. Implementing CPOT showed a significant increase in the number of pain assessments (rate ratio: 1.77, 95% confidence interval: 1.45, 2.16, p < 0.001) and reassessments (rate ratio: 13.99, 95% confidence interval: 8.14, 24.02, p < 0.001) between intervention and control conditions. There was no significant effect on the ICU length of stay, mechanical ventilation duration, and the amount of sedation (midazolam, propofol, and ketamine) and analgesia (fentanyl) administered.</p><p><strong>Conclusion: </strong>The study indicates that the implementation of the CPOT increased the frequency of pain assessment and reassessment. However, the impact on patient outcomes remains inconclusive. Further investigations focussing on CPOT as the primary pain scale are necessary to determine its holistic impact on patient outcomes over the long term.</p><p><strong>Trial registration: </strong>NCT05488834.</p><p><strong>Clinical trial registration number: </strong>This study was registered with the U.S. National Library of Medicine (ClinicalTrial.gov, NCT05488834).</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101129"},"PeriodicalIF":2.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications associated with prone positioning in mechanically ventilated COVID-19 patients: A multicentre, retrospective observational study.","authors":"Thomas C Rollinson, Luke A McDonald, Joleen Rose, Glenn Eastwood, Rahul Costa-Pinto, Lucy Modra, Maeda Akinori, Zoe Bacolas, James Anstey, Samantha Bates, Scott Bradley, Jodi Dumbrell, Craig French, Angaj Ghosh, Kimberley Haines, Tim Haydon, Carol L Hodgson, Jennifer Holmes, Nina Leggett, Forbes McGain, Cara Moore, Kathleen Nelson, Jeffrey Presneill, Hannah Rotherham, Simone Said, Meredith Young, Peinan Zhao, Andrew Udy, Ary Serpa Neto, Anis Chaba, Rinaldo Bellomo","doi":"10.1016/j.aucc.2024.09.002","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.002","url":null,"abstract":"<p><strong>Background and aims: </strong>Prone positioning is commonly applied to improve gas exchange in mechanically ventilated patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Whilst prone positioning is effective, specific complications may arise. We aimed to assess the prevalence of specific complications related to prone positioning in patients mechanically ventilated for COVID-19-related ARDS.</p><p><strong>Design: </strong>Multicentre, retrospective observational study.</p><p><strong>Methods: </strong>Multi-centre observational study of mechanically ventilated patients with COVID-19-related ARDS admitted to intensive care units in Melbourne, Australia, from August to November 2021. Data on baseline characteristics, prone positioning, complications, and patient outcomes were collected.</p><p><strong>Results: </strong>We assessed 553 prone episodes in 220 patients across seven sites (mean ± standard deviation age: 54 ± 13 years, 61% male). Overall, 58% (127/220) of patients experienced at least one prone-positioning-related complication. Pressure injury was the most prevalent (n = 92/220, 42%) complication reported. Factors associated with increased risk of pressure injury were male sex (adjusted odds ratio = 1.15, 95% confidence interval: [1.02-1.31]) and the total number of prone episodes (adjusted odds ratio = 1.11, 95% confidence interval: [1.07-1.15]). Device dislodgement was the next most common complication, occurring in 28 of 220 (13%) patients. There were no nerve or retinal injuries reported.</p><p><strong>Conclusions: </strong>Pressure injuries and line dislodgement were the most prevalent complications associated with prone positioning of patients mechanically ventilated for COVID-19. The risk of pressure injuries was associated with male sex and the number of prone positioning episodes.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101117"},"PeriodicalIF":2.6,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on dose-response relationship between awake prone-positioning duration and PaO₂/FiO₂ changes and risk of disease aggravation in patients with severe COVID-19.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1016/j.aucc.2024.09.007","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.007","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101122"},"PeriodicalIF":2.6,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Six-month outcomes after traumatic brain injury in the Augmented versus Routine Approach to Giving Energy multicentre, double-blind, randomised controlled Trial (TARGET).","authors":"Kym Wittholz, Kate Fetterplace, Lee-Anne Chapple, Emma J Ridley, Mark Finnis, Jeffrey Presneill, Marianne Chapman, Sandra Peake, Rinaldo Bellomo, Amalia Karahalios, Adam M Deane","doi":"10.1016/j.aucc.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.001","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients with a traumatic brain injury (TBI) may require prolonged intensive care unit (ICU) admission and hence receive greater exposure to hospital enteral nutrition. It is unknown if augmented energy delivery with enteral nutrition during ICU admission impacts quality of life in survivors or gastrointestinal tolerance during nutrition delivery in the ICU.</p><p><strong>Objectives: </strong>The objective of this study was to compare health-related quality of life, using the EuroQol five-dimensions five-level visual analogue scale at 6 months, in survivors who presented with a TBI and received augmented energy (1.5 kcal/ml) to those who received routine energy (1.0 kcal/ml). Secondary objectives were to explore differences in total energy and protein delivery, gastrointestinal tolerance, and mortality between groups.</p><p><strong>Methods: </strong>Secondary analysis of participants admitted with a TBI in the Augmented versus Routine Approach to Giving Energy Trial (TARGET) randomised controlled trial. Data are represented as n (%) or median (interquartile range).</p><p><strong>Results: </strong>Of the 3957 patients in TARGET, 231 (5.8%) were admitted after a TBI (augmented = 124; routine = 107). Patients within TARGET who were admitted with a TBI were relatively young (42 [27, 61] years) and received TARGET enteral nutrition for an extended period (9 [5, 15] days). At 6 months, EuroQol five-dimensions five-level quality-of-life scores were available for 166 TBI survivors (72% of TBI cohort randomised, augmented = 97, routine = 69). There was no evidence of a difference in quality of life (augmented = 70 [52, 90]; routine = 70 [55, 85]; median difference augmented vs routine = 0 [95% confidence interval: -5, 10]). TBI participants assigned to augmented energy received more energy with a similar protein than the routine group. Gastrointestinal tolerance was similar between groups.</p><p><strong>Conclusion: </strong>While patients admitted after a TBI received enteral nutrition for an extended period, an increased exposure to augmented energy did not affect survivors' quality-of-life scores.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101116"},"PeriodicalIF":2.6,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}