Australian Critical Care最新文献

{"title":"Intensive care unit nurses' experiences of nursing concerns, activities, and documentation on patient deterioration: A focus-group study.","authors":"Mihui Kim, Yesol Kim, Mona Choi","doi":"10.1016/j.aucc.2024.09.011","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.011","url":null,"abstract":"<p><strong>Background: </strong>Although prognosis prediction models using nursing documentation have good predictive performance, the experiences of intensive care unit nurses related to nursing activities and documentation when a patient's condition deteriorates are yet to be explored.</p><p><strong>Objective: </strong>The aim of this study was to explore nurses' experiences of nursing activities and documentation in intensive care units when a patient's condition deteriorates.</p><p><strong>Methods: </strong>This was a descriptive qualitative study using focus-group interviews with intensive care unit nurses in tertiary or university-affiliated hospitals. In total, 19 registered nurses with at least 1 year of clinical experience in the adult intensive care unit were recruited using a purposive sampling method. Five focus-group interviews were conducted, and the data were analysed through a qualitative content analysis.</p><p><strong>Results: </strong>Intensive care unit nurses' experiences with patient deterioration were classified into four main categories-perceived patient deterioration; endeavours to verify nurses' concerns; nursing activities to improve a patient's condition; and optimising documentation practices-which comprised 12 subcategories. Intensive care unit nurses recognise patient deterioration through nursing activities and documentation, and the two processes influence each other. However, nursing activities related to nurses' concerns were mainly handed over verbally rather than documented due to the inflexibility of the available standardised forms and the potential uncertainty of those concerns.</p><p><strong>Conclusions: </strong>The findings reveal how intensive care unit nurses perceive, intervene, and document the condition of a deteriorating patient. Nurses' concerns may be the first sign of a patient's deteriorating condition and are therefore crucial for minimising patient risk. Therefore, efforts to systematically document nurses' concerns may contribute to improving patient outcomes.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101126"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645148","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":"Blood pressure management in acute spinal cord injury: A retrospective study of acute intensive care management of traumatic spinal cord injury in two New South Wales referral centres.","authors":"Tessa Garside, Ralph Stanford, Oliver Flower, Trent Li, Edward Dababneh, Naomi Hammond, Frances Bass, James Middleton, Jonathan Tang, Jonathan Ball, Anthony Delaney","doi":"10.1016/j.aucc.2024.09.016","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.09.016","url":null,"abstract":"<p><strong>Background: </strong>International guidelines recommend maintenance of mean arterial pressure (MAP) > 85 mmHg to defend spinal cord perfusion pressure after acute traumatic spinal cord injury (SCI). Variation in practice has been demonstrated in the emergency department blood pressure management of SCI in New South Wales (NSW). It is unknown whether this variation exists in the phase of intensive care management of acute SCI.</p><p><strong>Objectives: </strong>The objective of this study was to describe and compare current blood pressure management in the intensive care unit (ICU) of patients with acute traumatic SCI in two SCI referral centres in NSW.</p><p><strong>Methods: </strong>Patients with acute traumatic SCI admitted to two SCI referral centres, Unit A and Unit B during 2018-2019 in NSW, were included. Data were summarised using descriptive statistics.</p><p><strong>Results: </strong>Ninety-eight patients were included, with 91 patients having been prescribed a blood pressure target, 81 (83%) having required vasopressors, and 18 (18%) of these having been documented to have complications associated with vasopressor use. The average prescribed MAP target was 78 (interquartile range [IQR]: 10) mmHg in Unit A and 76 (IQR: 12) mmHg in Unit B. Median durations of prescribed target were 120 (IQR: 72) hours and 120 (IQR: 120) hours in Unit A and Unit B, respectively. The average MAP over the first 7 d was 88 (standard deviation: 9.5) mmHg in Unit A and 85 (standard deviation: 7.5) mmHg in Unit B. Sixty-three patients (64%) had a documented systolic blood pressure <90 mmHg in the first 24 h. Median ICU length of stay (LOS) was 9.7 (IQR: 11) d in Unit A and 6 (IQR: 6.6) d in Unit B. Median hospital LOS was 27 (IQR: 56.2) d in Unit B and 34.7 (IQR: 32.3) d in Unit B. ICU LOS was longer in patients who had a MAP target than in those who did not.</p><p><strong>Conclusions: </strong>Current blood pressure management in acute SCI in NSW involves ICU admission and blood pressure support with vasopressors; however, prescribed blood pressure targets are not in line with international guidelines.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101131"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645146","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":"Does intracranial pressure vary based on external ventricular drainage? A real-world clinical observation study.","authors":"Dohee Kwon, Lindsay Riskey, Abdulkadir Kamal, Brittany R Doyle, Brennen Louthen, Jade L Marshall, Samir D Ruxmohan, Amber Salter, DaiWai M Olson","doi":"10.1016/j.aucc.2024.101138","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.101138","url":null,"abstract":"<p><strong>Background: </strong>External ventricular drains (EVDs) are placed in patients with increased intracranial pressure (ICP) to serve as a cerebrospinal fluid (CSF) pressure flow diverter and ICP monitor. EVD management practice among institutions and practitioners varies greatly, with little evidence supporting ideal ICP recording and CSF drainage practice.</p><p><strong>Objective: </strong>This study's aim is to determine variations in ICP across 21 min before and after CSF drainage.</p><p><strong>Methods: </strong>Thirty adult patients with EVDs were consented for a real-world observational study. As per the institution guidelines, each patient's drain was levelled to the tragus and zeroed. The EVD was then clamped for 10 min, opened to drain for 1 min, and clamped again for another 10 min. ICPs were then recorded immediately, at 30 s, 1 min, 5 min, and 10 min after drain clamp. Each patient was eligible for up to 10 separate observation events, limited to one observation per shift.</p><p><strong>Results: </strong>We observed 226 independent drain-clamping events among 30 participants. The most common indication for EVD placement was to monitor and treat a mass-occupying lesion (n = 28). The patients had a mean age of 54.8 (15.9) years, including 12 (41%) females and 17 (59%) males. Fifty-one percent of CSF was characterised as clear, followed by serosanguinous, serous, and sanguineous characterisations. One minute of CSF drainage decreased ICP from 10.30 to 9.20, an average of 1.1 mmHg lower (p < 0.05).</p><p><strong>Conclusion: </strong>The ICP measurement practice is not standardised among clinicians. ICP variations ranged from negative numbers to well above the normal range, whereas no clinical changes in patient exam were seen. Drainage of CSF decreases ICPs momentarily, and the effects of drainage do not last long. Further studies are needed to evaluate the safest approach to EVD management and ICP recording practice.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101138"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645147","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":"Prophylactic dressings for preventing sacral pressure injuries in adult intensive care unit patients: A randomised feasibility trial.","authors":"Sharon Latimer, Wendy Chaboyer, Rachel M Walker, Lukman Thalib, Jodie L Deakin, Brigid M Gillespie","doi":"10.1016/j.aucc.2024.101133","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.101133","url":null,"abstract":"<p><strong>Background: </strong>Prophylactic dressings are used to prevent sacral pressure injuries (PIs) in intensive care unit (ICU) patients. Bedside clinicians are responsible for selecting these dressings despite the lack of comparative evidence.</p><p><strong>Objectives: </strong>The objective of this study was to assess the feasibility of undertaking a larger multisite comparative effectiveness trial of two prophylactic sacral dressings in adult ICU patients.</p><p><strong>Methods: </strong>Using a two-arm pilot randomised feasibility trial design, we randomly allocated adult ICU patients to the Mepilex® Border Sacrum dressing or Allevyn™ Life Sacrum dressing plus usual PI prevention care. Our primary study outcomes were study eligibility, recruitment, retention, intervention fidelity, and missing data criteria. Participants were followed up for up to 14 days or a study endpoint: new sacral PI, ICU discharge, death, prone positioning, urine/faecal incontinence, or withdrawal. Daily clinical data were collected including a deidentified sacral photograph, sacral visual skin assessment, dressing failure rates (rolled edges, adhesion loss), and dressing-related harm (e.g., blisters). The blinded outcome assessor used these data to determine the presence of a new sacral PI.</p><p><strong>Results: </strong>From January to September 2023, 1069 ICU patients were screened; 77 (7.2%) were eligible, and 68 (88.3%) were recruited. Half of our feasibility criteria were met. One participant (1.5%) developed a sacral PI. Throughout the study, half (n = 54; 49.5%) of the dressing changes were due to dressing failure (rolled edges: n = 43; 79.5%, adhesion failure: n = 11; 20.5%).</p><p><strong>Conclusions: </strong>Several prophylactic sacral dressings are available; however, comparative effective evidence between brands relative to performance, benefits, and harms is lacking. Following minor study criteria modifications, we found that a larger multisite comparative trial is feasible. Sacral prophylactic dressing failure and dressing-related harms are care quality and patient safety issues requiring further investigation regarding performance, harm, and costs.</p><p><strong>Trial registration: </strong>Australian and New Zealand Clinical Trial Registration number: ACTRN12622000793718 and World Health Organization Universal Trial number: U1111-1278-6055.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101133"},"PeriodicalIF":2.6,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645149","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 usefulness of a 28-item Therapeutic Intervention Scoring System (TISS-28) in critically ill obstetric patients to detect multiorgan dysfunction: A prospective cohort study.","authors":"Jose Rojas-Suarez, Jeniffer González-Hernández, Diana Borre-Naranjo, Alejandra Vergara-Schotborgh, Laura Saavedra-Valencia, Carmelo Dueñas-Castell, Jose Santacruz-Arias, Wendy Pollock","doi":"10.1016/j.aucc.2024.101137","DOIUrl":"https://doi.org/10.1016/j.aucc.2024.101137","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the effectiveness of the 28-item Therapeutic Intervention Scoring System (TISS-28) in detecting multiorgan dysfunction (MOD) among critically ill obstetric patients and compared its predictive potential to other severity models, such as Sequential Organ Failure Assessment (SOFA) and Mortality Probability Model II (MPM II).</p><p><strong>Methods: </strong>A prospective multicentre cohort study was conducted including obstetric patients, pregnant and up to 42 days postpartum, admitted to the intensive care units of two referral hospitals in Colombia. A total of 93 patients were recruited between March 2016 and February 2017 and from September 2019 to November 2019. Scores from the MPM II, SOFA, and TISS-28 were calculated within the first 24 h post-intensive care unit admission. The primary outcome was to evaluate the effectiveness of TISS-28 in predicting MOD, as defined by the World Health Organization near-miss criteria. We compared the TISS-28 with SOFA and MPM II scores in identifying MOD using the positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve.</p><p><strong>Results: </strong>Data from 93 patients were analysed, of whom 22 developed MOD. Hypertensive disorders were the predominant diagnosis (n = 62; 66.7%). Patients with sepsis exhibited the highest TISS-28 score, indicating more intensive therapeutic interventions. The areas under the receiver operating characteristic curve for TISS-28, SOFA, and MPM II were 0.83 (95% confidence interval: 0.73-0.92), 0.66 (0.51-0.80), and 0.59 (0.43-0.74), respectively (p = 0.001). The cut-off value of a TISS-28 score ≥21 was associated with an increased likelihood of MOD (sensitivity: 83.2%, specificity: 71.2%), a positive predictive value of 47.3%, and a negative predictive value) of 93.2%.</p><p><strong>Conclusions: </strong>TISS-28 demonstrated robust performance in identifying MOD among obstetric patients compared to other severity indexes. The TISS-28 score complements physiology-derived severity scores by reflecting the level of care required, making it a valuable tool in risk stratification and resource allocation for critically ill obstetric patients.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101137"},"PeriodicalIF":2.6,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640319","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":"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}