Publisher: RMIT Publishing   (Total: 387 journals)

 A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  

        1 2 | Last   [Sort by number of followers]   [Restore default list]

Showing 1 - 200 of 387 Journals sorted alphabetically
40 [degrees] South     Full-text available via subscription   (Followers: 4)
Aboriginal and Islander Health Worker J.     Full-text available via subscription   (Followers: 16)
Aboriginal Child at School     Full-text available via subscription   (Followers: 7)
About Performance     Full-text available via subscription   (Followers: 13)
Access     Full-text available via subscription   (Followers: 27)
ACCESS: Critical Perspectives on Communication, Cultural & Policy Studies     Full-text available via subscription   (Followers: 13)
Accounting, Accountability & Performance     Full-text available via subscription   (Followers: 18)
ACORN : The J. of Perioperative Nursing in Australia     Full-text available via subscription   (Followers: 19, SJR: 0.198, CiteScore: 0)
Adelaide Law Review     Full-text available via subscription   (Followers: 23, SJR: 0.122, CiteScore: 0)
Advocate: Newsletter of the National Tertiary Education Union     Full-text available via subscription   (Followers: 1)
Agenda: A J. of Policy Analysis and Reform     Full-text available via subscription   (Followers: 1)
Agora     Full-text available via subscription   (Followers: 6)
Agricultural Commodities     Full-text available via subscription   (SJR: 0.123, CiteScore: 0)
Agricultural Science     Full-text available via subscription   (Followers: 2)
AIMA Bulletin     Full-text available via subscription   (Followers: 4)
AJP : The Australian J. of Pharmacy     Full-text available via subscription   (Followers: 14, SJR: 0.142, CiteScore: 0)
Analysis     Full-text available via subscription   (Followers: 3)
Ancient History : Resources for Teachers     Full-text available via subscription   (Followers: 10)
Anglican Historical Society J.     Full-text available via subscription   (Followers: 4)
Annals of the Royal Australasian College of Dental Surgeons     Full-text available via subscription   (Followers: 5)
ANZSLA Commentator, The     Full-text available via subscription   (Followers: 4)
Appita J.: J. of the Technical Association of the Australian and New Zealand Pulp and Paper Industry     Full-text available via subscription   (Followers: 16, SJR: 0.168, CiteScore: 0)
AQ - Australian Quarterly     Full-text available via subscription  
Arena J.     Full-text available via subscription   (Followers: 1)
Around the Globe     Full-text available via subscription   (Followers: 1)
Art + Law     Full-text available via subscription   (Followers: 12)
Art Monthly Australia     Full-text available via subscription   (Followers: 10)
Artefact : the journal of the Archaeological and Anthropological Society of Victoria     Full-text available via subscription   (Followers: 3)
Artlink     Full-text available via subscription   (Followers: 5)
Asia Pacific J. of Clinical Nutrition     Full-text available via subscription   (Followers: 12, SJR: 0.697, CiteScore: 2)
Asia Pacific J. of Health Management     Full-text available via subscription   (Followers: 4)
Aurora J.     Full-text available via subscription  
Australasian Biotechnology     Full-text available via subscription   (Followers: 1, SJR: 0.1, CiteScore: 0)
Australasian Catholic Record, The     Full-text available via subscription   (Followers: 6)
Australasian Drama Studies     Full-text available via subscription   (Followers: 1)
Australasian Epidemiologist     Full-text available via subscription  
Australasian Historical Archaeology     Full-text available via subscription   (Followers: 7, SJR: 0.212, CiteScore: 0)
Australasian J. of Early Childhood     Full-text available via subscription   (Followers: 5, SJR: 0.535, CiteScore: 1)
Australasian J. of Gifted Education     Full-text available via subscription   (Followers: 7, SJR: 0.123, CiteScore: 0)
Australasian J. of Human Security     Full-text available via subscription   (Followers: 1, SJR: 0.144, CiteScore: 0)
Australasian J. of Irish Studies, The     Full-text available via subscription   (Followers: 9)
Australasian J. of Regional Studies, The     Full-text available via subscription   (Followers: 1, SJR: 0.118, CiteScore: 0)
Australasian Law Management J.     Full-text available via subscription   (Followers: 7)
Australasian Leisure Management     Full-text available via subscription   (Followers: 3)
Australasian Musculoskeletal Medicine     Full-text available via subscription   (Followers: 3)
Australasian Music Research     Full-text available via subscription   (Followers: 4)
Australasian Parks and Leisure     Full-text available via subscription   (Followers: 2)
Australasian Plant Conservation: J. of the Australian Network for Plant Conservation     Full-text available via subscription   (Followers: 4)
Australasian Policing     Full-text available via subscription   (Followers: 6)
Australasian Public Libraries and Information Services     Full-text available via subscription   (Followers: 34)
Australasian Review of African Studies, The     Full-text available via subscription   (Followers: 2)
Australian Aboriginal Studies     Full-text available via subscription   (Followers: 8, SJR: 0.13, CiteScore: 0)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Ageing Agenda     Full-text available via subscription   (Followers: 7)
Australian and Aotearoa New Zealand Psychodrama Association J.     Full-text available via subscription   (Followers: 1)
Australian and New Zealand Continence J.     Full-text available via subscription   (Followers: 4)
Australian and New Zealand Sports Law J.     Full-text available via subscription   (Followers: 10)
Australian Art Education     Full-text available via subscription   (Followers: 8)
Australian Bookseller & Publisher     Full-text available via subscription   (Followers: 1)
Australian Bulletin of Labour     Full-text available via subscription   (Followers: 2)
Australian Canegrower     Full-text available via subscription   (Followers: 2)
Australian Coeliac     Full-text available via subscription   (Followers: 1)
Australian Cottongrower, The     Full-text available via subscription   (Followers: 1)
Australian Family Physician     Full-text available via subscription   (Followers: 3, SJR: 0.317, CiteScore: 1)
Australian Field Ornithology     Full-text available via subscription   (Followers: 4, SJR: 0.209, CiteScore: 0)
Australian Forest Grower     Full-text available via subscription   (Followers: 4)
Australian Grain     Full-text available via subscription   (Followers: 2)
Australian Holstein J.     Full-text available via subscription   (Followers: 1)
Australian Humanist, The     Full-text available via subscription   (Followers: 4)
Australian Indigenous Law Review     Full-text available via subscription   (Followers: 21)
Australian Intl. Law J.     Full-text available via subscription   (Followers: 22)
Australian J. of Acupuncture and Chinese Medicine     Full-text available via subscription   (Followers: 4, SJR: 0.116, CiteScore: 0)
Australian J. of Adult Learning     Full-text available via subscription   (Followers: 15, SJR: 0.297, CiteScore: 0)
Australian J. of Advanced Nursing     Full-text available via subscription   (Followers: 14, SJR: 0.299, CiteScore: 1)
Australian J. of Asian Law     Full-text available via subscription   (Followers: 4)
Australian J. of Cancer Nursing     Full-text available via subscription   (Followers: 9)
Australian J. of Dyslexia and Learning Difficulties     Full-text available via subscription   (Followers: 8, SJR: 0.1, CiteScore: 0)
Australian J. of Emergency Management     Full-text available via subscription   (Followers: 30, SJR: 0.354, CiteScore: 0)
Australian J. of French Studies     Full-text available via subscription   (Followers: 7, SJR: 0.123, CiteScore: 0)
Australian J. of Herbal Medicine     Full-text available via subscription   (Followers: 5)
Australian J. of Language and Literacy, The     Full-text available via subscription   (Followers: 4, SJR: 0.282, CiteScore: 1)
Australian J. of Legal History     Full-text available via subscription   (Followers: 15)
Australian J. of Medical Science     Full-text available via subscription   (Followers: 2)
Australian J. of Music Education     Full-text available via subscription   (Followers: 4)
Australian J. of Music Therapy     Full-text available via subscription   (Followers: 9, SJR: 0.549, CiteScore: 1)
Australian J. of Parapsychology     Full-text available via subscription   (Followers: 2, SJR: 0.511, CiteScore: 0)
Australian J. on Volunteering     Full-text available via subscription   (Followers: 2)
Australian J.ism Review     Full-text available via subscription   (Followers: 8)
Australian Life Scientist     Full-text available via subscription   (Followers: 2)
Australian Literary Studies     Full-text available via subscription   (Followers: 6)
Australian Mathematics Teacher, The     Full-text available via subscription   (Followers: 7)
Australian Nursing J. : ANJ     Full-text available via subscription   (Followers: 6)
Australian Orthoptic J.     Full-text available via subscription  
Australian Primary Mathematics Classroom     Full-text available via subscription   (Followers: 5)
Australian Screen Education Online     Full-text available via subscription   (Followers: 3)
Australian Senior Mathematics J.     Full-text available via subscription   (Followers: 2)
Australian Sugarcane     Full-text available via subscription  
Australian TAFE Teacher     Full-text available via subscription   (Followers: 4)
Australian Tax Forum     Full-text available via subscription   (Followers: 3)
Australian Universities' Review, The     Full-text available via subscription   (Followers: 4)
Australian Voice     Full-text available via subscription   (Followers: 6)
Bar News: The J. of the NSW Bar Association     Full-text available via subscription   (Followers: 8)
Bioethics Research Notes     Full-text available via subscription   (Followers: 14)
BOCSAR NSW Alcohol Studies Bulletins     Full-text available via subscription   (Followers: 4)
Bookseller + Publisher Magazine     Full-text available via subscription   (Followers: 5)
Breastfeeding Review     Full-text available via subscription   (Followers: 18, SJR: 0.183, CiteScore: 0)
British Review of New Zealand Studies     Full-text available via subscription   (Followers: 4)
Brolga: An Australian J. about Dance     Full-text available via subscription   (Followers: 3)
Cancer Forum     Full-text available via subscription   (SJR: 0.115, CiteScore: 0)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Chain Reaction     Full-text available via subscription  
Childrenz Issues: J. of the Children's Issues Centre     Full-text available via subscription  
Chiropractic J. of Australia     Full-text available via subscription   (SJR: 0.111, CiteScore: 0)
Chisholm Health Ethics Bulletin     Full-text available via subscription   (Followers: 1)
Church Heritage     Full-text available via subscription   (Followers: 5)
Commercial Law Quarterly: The J. of the Commercial Law Association of Australia     Full-text available via subscription   (Followers: 5)
Communicable Diseases Intelligence Quarterly Report     Full-text available via subscription   (Followers: 2, SJR: 0.563, CiteScore: 1)
Communication, Politics & Culture     Open Access   (Followers: 14)
Communities, Children and Families Australia     Full-text available via subscription   (Followers: 3)
Connect     Full-text available via subscription   (Followers: 2)
Contemporary PNG Studies     Full-text available via subscription  
Context: J. of Music Research     Full-text available via subscription   (Followers: 8)
Corporate Governance Law Review, The     Full-text available via subscription   (Followers: 8)
Creative Approaches to Research     Full-text available via subscription   (Followers: 14)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 25, SJR: 1.032, CiteScore: 1)
Cultural Studies Review     Full-text available via subscription   (Followers: 16)
Culture Scope     Full-text available via subscription   (Followers: 4)
Dance Forum     Full-text available via subscription   (Followers: 6)
DANZ Quarterly: New Zealand Dance     Full-text available via subscription   (Followers: 4)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Deakin Law Review     Full-text available via subscription   (Followers: 15)
Developing Practice : The Child, Youth and Family Work J.     Full-text available via subscription   (Followers: 20)
Early Days: J. of the Royal Western Australian Historical Society     Full-text available via subscription  
Early Education     Full-text available via subscription   (Followers: 8)
EarthSong J.: Perspectives in Ecology, Spirituality and Education     Full-text available via subscription   (Followers: 1)
East Asian Archives of Psychiatry     Full-text available via subscription   (Followers: 3, SJR: 0.36, CiteScore: 1)
Educare News: The National Newspaper for All Non-government Schools     Full-text available via subscription  
Educating Young Children: Learning and Teaching in the Early Childhood Years     Full-text available via subscription   (Followers: 20)
Education in Rural Australia     Full-text available via subscription   (Followers: 3)
Education, Research and Perspectives     Full-text available via subscription   (Followers: 14)
Educational Research J.     Full-text available via subscription   (Followers: 18)
Electronic J. of Radical Organisation Theory     Full-text available via subscription   (Followers: 3)
Employment Relations Record     Full-text available via subscription   (Followers: 3)
English in Aotearoa     Full-text available via subscription   (Followers: 2)
English in Australia     Full-text available via subscription   (Followers: 2, SJR: 0.18, CiteScore: 0)
Essays in French Literature and Culture     Full-text available via subscription   (Followers: 9)
Ethos: Official Publication of the Law Society of the Australian Capital Territory     Full-text available via subscription   (Followers: 5)
Eureka Street     Full-text available via subscription   (Followers: 5)
Extempore     Full-text available via subscription  
Family Matters     Full-text available via subscription   (Followers: 10, SJR: 0.228, CiteScore: 1)
Fijian Studies: A J. of Contemporary Fiji     Full-text available via subscription   (Followers: 1)
Focus on Health Professional Education : A Multi-disciplinary J.     Full-text available via subscription   (Followers: 7)
Food New Zealand     Full-text available via subscription   (Followers: 4)
Fourth World J.     Full-text available via subscription   (Followers: 1)
Frontline     Full-text available via subscription   (Followers: 18)
Future Times     Full-text available via subscription   (Followers: 3)
Gambling Research: J. of the National Association for Gambling Studies (Australia)     Full-text available via subscription   (Followers: 5)
Gay and Lesbian Law J.     Full-text available via subscription   (Followers: 2)
Gender Impact Assessment     Full-text available via subscription   (Followers: 3)
Geographical Education     Full-text available via subscription   (Followers: 2)
Geriatric Medicine in General Practice     Full-text available via subscription   (Followers: 8)
Gestalt J. of Australia and New Zealand     Full-text available via subscription   (Followers: 2, SJR: 0.1, CiteScore: 0)
Globe, The     Full-text available via subscription   (Followers: 4)
Government News     Full-text available via subscription   (Followers: 2)
Great Circle: J. of the Australian Association for Maritime History, The     Full-text available via subscription   (Followers: 7)
Grief Matters : The Australian J. of Grief and Bereavement     Full-text available via subscription   (Followers: 11)
He Puna Korero: J. of Maori and Pacific Development     Full-text available via subscription   (Followers: 4)
Headmark     Full-text available via subscription   (Followers: 2)
Health Inform     Full-text available via subscription  
Health Issues     Full-text available via subscription   (Followers: 2)
Health Promotion J. of Australia : Official J. of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 8, SJR: 0.531, CiteScore: 1)
Health Voices     Full-text available via subscription  
Heritage Matters : The Magazine for New Zealanders Restoring, Preserving and Enjoying Our Heritage     Full-text available via subscription   (Followers: 2)
High Court Quarterly Review, The     Full-text available via subscription   (Followers: 3)
HIV Australia     Full-text available via subscription   (Followers: 3)
HLA News     Full-text available via subscription   (Followers: 3, SJR: 0.438, CiteScore: 1)
Hong Kong J. of Emergency Medicine     Full-text available via subscription   (Followers: 5, SJR: 0.19, CiteScore: 0)
Idiom     Full-text available via subscription   (Followers: 1)
Impact     Full-text available via subscription   (Followers: 2)
InCite     Full-text available via subscription   (Followers: 17)
Indigenous Law Bulletin     Full-text available via subscription   (Followers: 20)
InPsych : The Bulletin of the Australian Psychological Society Ltd     Full-text available via subscription   (Followers: 2)
Inside Film: If     Full-text available via subscription   (Followers: 6)
Institute of Public Affairs Review: A Quarterly Review of Politics and Public Affairs, The     Full-text available via subscription   (Followers: 12)
Instyle     Full-text available via subscription   (SJR: 0.116, CiteScore: 0)
Intellectual Disability Australasia     Full-text available via subscription   (Followers: 11)
Interaction     Full-text available via subscription   (Followers: 4)
Intl. Employment Relations Review     Full-text available via subscription   (Followers: 3)
Intl. J. of Disability Management Research     Full-text available via subscription   (Followers: 3)
Intl. J. of e-Business Management     Full-text available via subscription  
Intl. J. of Employment Studies     Full-text available via subscription   (Followers: 8)
Intl. J. of Home Economics     Full-text available via subscription   (Followers: 1)
Intl. J. of Narrative Therapy & Community Work     Full-text available via subscription   (Followers: 8)
Intl. J. of Punishment and Sentencing, The     Full-text available via subscription   (Followers: 9)
Irrigation Australia: The Official J. of Irrigation Australia     Full-text available via subscription   (Followers: 3)
ISAA Review     Full-text available via subscription   (Followers: 1)
J. (Australian Native Plants Society. Canberra Region)     Full-text available via subscription   (Followers: 1)
J. of Applied Law and Policy     Full-text available via subscription   (Followers: 3)
J. of Australian Colonial History     Full-text available via subscription   (Followers: 7)
J. of Australian Naval History, The     Full-text available via subscription   (Followers: 3)

        1 2 | Last   [Sort by number of followers]   [Restore default list]

Similar Journals
Journal Cover
Critical Care and Resuscitation
Journal Prestige (SJR): 1.032
Citation Impact (citeScore): 1
Number of Followers: 25  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 1441-2772
Published by RMIT Publishing Homepage  [387 journals]
  • Volume 21 Issue 4 - Internet health information use by surrogate decision
           makers of patients admitted to the intensive care unit: A multicentre
           survey
    • Abstract: Das, Alexander; Anstey, Matthew; Bass, Frances; Blythe, David; Buhr, Heidi; Campbell, Lewis; Davda, Ashish; Delaney, Anthony; Gattas, David; Green, Cameron; Ferrier, Janet; Hammond, Naomi; Palermo, Annamaria; Pellicano, Susan; Phillips, Margaret; Regli, Adrian; Roberts, Brigit; Ross-King, Michelle; Saroode, Vineet; Simpson, Shannon; Spiller, Shakira; Sullivan, Kirsty; Tiruvoipati, Ravindranath; van Haren, Frank; Waterson, Sharon; Yaw, Lai Kin; Litton, Edward
      Objectives: To investigate the use, understanding, trust and influence of the internet and other sources of health information used by the next of kin (NOK) of patients admitted to the intensive care unit (ICU).

      Design: Multicentre structured survey.

      Setting: The ICUs of 13 public and private Australian hospitals.

      Participants: NOK who self-identified as the primary surrogate decision maker for a patient admitted to the ICU.

      Main outcome measures: The frequency, understanding, trust and influence of online sources of health information, and the quality of health websites visited using the Health on the Net Foundation Code of Conduct (HONcode) for medical and health websites.

      Results: There were 473 survey responses. The median ICU admission days and number of ICU visits by the NOK at the time of completing the survey was 3 (IQR, 2-6 days) and 4 (IQR, 2-7), respectively. The most commonly reported sources of health information used very frequently were the ICU nurse (55.6%), ICU doctor (38.7%), family (23.3%), hospital doctor (21.4%), and the internet (11.3%). Compared with the 243 NOK (51.6%) not using the internet, NOK using the internet were less likely to report complete understanding (odds ratio [OR], 0.57; 95% CI, 0.38-0.88), trust (OR, 0.34; 95% CI, 0.19-0.59), or influence (OR, 0.58; 95% CI, 0.38-0.88) associated with the ICU doctor. Overall, the quality of the 40 different reported websites accessed was moderately high.

      Conclusions: A substantial proportion of ICU NOK report using the internet as a source of health information. Internet use is associated with lower reported understanding, trust and influence of the ICU doctor.

      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 4 - Using language descriptors to recognise delirium: A
           survey of clinicians and medical coders to identify delirium-suggestive
           words
    • Abstract: Holmes, Natasha E; Amjad, Sobia; Young, Marcus; Berlowitz, David J; Bellomo, Rinaldo
      Objective: To develop a library of delirium-suggestive words.

      Design: Cross-sectional survey.

      Setting: Single tertiary referral hospital.

      Participants: Medical, nursing and allied health staff and medical coders.

      Main outcome measures: Frequency of graded response on a 5-point Likert scale to individual delirium-suggestive words.

      Results: Two-hundred and three complete responses were received from 227 survey respondents; the majority were medical and nursing staff (42.4% and 43.8% respectively), followed by allied health practitioners and medical coders (10.3% and 3.4%). Words that were "very likely" to suggest delirium were "confused/ confusion", "delirious", "disoriented/disorientation" and "fluctuating conscious state". Differences in word selection were noted based on occupational background, prior knowledge of delirium, and experience in caring for intensive care unit patients. Distractor words included in the survey were rated as "unlikely" or "very unlikely" by respondents as expected. Textual responses identified several other descriptors of delirium-suggestive words.

      Conclusion: A comprehensive repertoire of deliriumsuggestive words was validated using a multidisciplinary survey and new words suggested by respondents were added. The use of natural language processing algorithms may allow for earlier detection of delirium using our delirium library and be deployed for real-time decision making and clinical care.

      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 4 - Survey of critical care practice in Australian and New
           Zealand burn referral centres
    • Abstract: Holley, Anthony D; Reade, Michael C; Lipman, Jeffrey; Delaney, Anthony; Udy, Andrew; Lee, Richard; Litton, Edward; Cheung, Winston; Turner, Andrew; Garside, Tessa; Macken, Lewis; Reddi, Benjamin; Kol, Mark; Kazemi, Alex; Shah, Asim; Townsend, Shane; Cohen, Jeremy
      Each year in Australia, about 1% of the population sustains a thermal injury. The majority of these burns are minor; however, patients with severe burns - defined as area of burn greater than 20% of total body surface area or those necessitating intensive care admission - experience considerable morbidity and mortality.

      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 4 - Therapeutic hypothermia and mortality in the intensive
           care unit: systematic review and meta-analysis
    • Abstract: Alqalyoobi, Shehabaldin; Boctor, Noelle; Sarkeshik, Amir A; Hoerger, Joshua; Klimberg, Nicholas; Bartolome, Brittany G; Stewart, Susan L; Albertson, Timothy E
      Objective: Therapeutic hypothermia (TH) is defined as the designed reduction of the human body's core temperature to 32 degreesC-35 degreesC for a period of 24-48 hours. TH has been studied extensively in many diseases related to critical care illness. This metaanalysis assesses the effect of TH on mortality across different indications in medical, neurological and cardiothoracic care.

      Data sources: The online databases Embase, Ovid MEDLINE, TRIP and CINAHL were searched for eligible studies published between 1940 and October 2018.

      Study selection: Randomised clinical trials of induced TH in adults for any indication.

      Data extraction: Information about baseline characteristics of patients, mortality outcomes, cooling strategy and target temperature achieved in hypothermia and normothermia groups was collected.

      Data synthesis: Eighty studies, with a total of 13 418 patients, were included in this meta-analysis: 22 studies for traumatic brain injury, six studies for stroke, five studies for out-of-hospital cardiac arrest (OHCA), 34 studies for intraoperative cardiopulmonary bypass, and 13 studies for other diseases. A total of 6901 patients (51.4%) were randomly allocated to the TH group and 6517 patients (48.6%) were randomised to the normothermia control group. The unadjusted analysis showed no significant difference in mortality across different critical care illnesses. However, after adjusting for population, gender, age and temperature, only the OHCA group showed a small statistically significant difference favouring TH, but this had a questionable clinical significance.

      Conclusions: This meta-analysis suggests that after decades of extensive research, TH has yet to show a beneficial effect on mortality across different critical care diseases.

      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 4 - The Plasma-Lyte 148 versus Saline (PLUS) study
           protocol amendment
    • Abstract: Hammond, Naomi E; Bellomo, Rinaldo; Gallagher, Martin; Gattas, David; Glass, Parisa; Mackle, Diane; Micallef, Sharon; Myburgh, John; Saxena, Manoj; Taylor, Colman; Young, Paul; Finfer, Simon
      The Plasma-Lyte 148 versus Saline (PLUS) study is a multicentre, blinded, randomised controlled trial that is currently recruiting patients in 52 ICUs in Australia and New Zealand. Just over 3300 of 8800 patients have been randomly allocated to receive either Plasma-Lyte 148 or 0.9% sodium chloride (saline) for all resuscitation episodes and for all compatible crystalloid therapy while in the intensive care unit (ICU) for up to 90 days after randomisation.

      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 4 - The burden of antibiotic allergies in adults in an
           Australian intensive care unit: The basis study
    • Abstract: Moran, Rebekah L; Devchand, Misha; Churilov, Leonid; Warrillow, Stephen; Trubiano, Jason A
      Objective: To determine the prevalence and impact of patient-reported antibiotic allergies in the intensive care unit (ICU), which are currently poorly defined. Antibiotic allergy labels (AALs) are associated with inappropriate antibiotic prescribing and with inferior patient, microbiological and hospital outcomes.

      Design: Prospective, single-centre case-control study.

      Setting: Mixed ICU, Austin Hospital, Melbourne.

      Participants: All adults (>= 18 years old) admitted to the ICU who received at least two doses of systemic antibiotics between 12 February and 20 April 2018.

      Main outcome measures: Demographic data, infection and allergy history, antibiotic prescriptions and ICU interventions and outcomes.

      Results: Of the 247 patients (79.9%) who received systemic antibiotics, 43 patients (17.4%) had an AAL and 204 (82.6%) did not. A higher proportion of patients with AAL were female (P = 0.032) and received vancomycin (37.2% AAL v 18.6% no antibiotic allergies [NAAL]; P = 0.014), and a lower proportion of patients received narrow spectrum beta-lactams (39.5% AAL v 58.8% NAAL; P = 0.028). On multivariable logistic regression, the AAL cohort had twice higher odds of receiving vancomycin (odds ratio [OR], 2.04; 95% CI, 1.07-3.86; P = 0.029) and half the odds of receiving a narrow spectrum beta-lactam (OR, 0.52; 95% CI, 0.29-0.94; P = 0.03). AAL distribution on the electronic medical record included 17% type A (predictable), 13% type B-I (immediate), 2% type B-IV (delayed), 35% type B (unspecified), and 32% unknown. An interview clarifying allergy phenotype found that 59.5% of AALs matched their documented description.

      Conclusion: Patients with AALs had twice the odds of receiving intravenous vancomycin and half the odds of receiving narrow spectrum beta-lactams, which highlights the continued need for antimicrobial stewardship initiatives.

      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 4 - Rapid haemodilution accelerates hypertonicity
           resolution in diabetic ketoacidosis: Data from 25 intensive care
           admissions
    • Abstract: Morgan, Thomas J; Scott, Peter J; Anstey, Christopher M
      Background: Clinically apparent cerebral oedema during diabetic ketoacidosis (DKA) is rare and more common in children and young adults. Subclinical oedema with mild brain dysfunction is more frequent, with unknown long term effects. Rapid tonicity changes may be a factor although not well studied. Guidelines recommend capping hypertonicity resolution at
      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 4 - Small volume vacuum phlebotomy tubes: A controlled
           before-and-after study of a patient blood management initiative in an
           Australian adult intensive care unit
    • Abstract: Briggs, Edward N; Hawkins, David J; Hodges, Aidan M; Monk, Angela M
      Background: Patients admitted to intensive care units (ICUs) undergo multiple blood tests. Small volume vacuum phlebotomy tubes (SVTs) provide an important blood conservation measure. SVTs reduce summative blood loss and may reduce odds of transfusion. We aimed to determine whether low volume blood sampling using SVTs for routine diagnostic purposes translates to decreased fall in haemoglobin concentration, and examine downstream effects on anaemia and need for transfusion during ICU admission.

      Study design and methods: A single-centre, controlled before-and-after study, evaluating a unit-wide changeover from conventional volume vacuum phlebotomy tubes (CVTs) to SVTs on April 2015. All ICU patients admitted for > 48 hours during the 12 months before and after the intervention were included in multivariate and univariate analysis. Groups were stratified into short admissions (2-7 days) and long admissions (> 7 days).

      Results: A total of 318 patients were analysed. For short admissions, SVTs decreased fall in haemoglobin concentration (unstandardized coefficient, -6.7; P = 0.001) and episodes of severe anaemia (odds ratio, 0.37, P = 0.02). There were no changes to haemoglobin concentration in long admissions. No effects on need for transfusion were observed (short admissions, P = 0.05; long admissions, P = 0.11). SVTs reduced daily sampling volumes by 50% with no increase in laboratory error (short admissions, P = 0.61; long admissions, P = 0.98). A moderate correlation existed between blood draws and fall in haemoglobin concentration (short admissions, r = 0.5; long admissions, r = 0.32).

      Conclusion: SVTs reduce sampling volume without increasing laboratory error. Follow-on effects include reduced fall in haemoglobin concentration and severe anaemia. These correlations are absent in long admissions.

      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 4 - A pilot randomised controlled trial evaluating the
           pharmacodynamic effects of furosemide versus acetazolamide in critically
           ill patients
    • Abstract: Brown, Alastair JW; Cutuli, Salvatore L; Eastwood, Glenn M; Bitker, Laurent; Marsh, Philip; Bellomo, Rinaldo
      Objective: To compare the physiological and biochemical effects of a single intravenous dose of furosemide or acetazolamide in critically ill patients.

      Design: Single centre, pilot randomised controlled trial.

      Setting: Large tertiary adult intensive care unit (ICU).

      Participants: Twenty-six adult ICU patients deemed to require diuretic therapy.

      Intervention: Single dose of intravenous 40 mg furosemide or 500 mg acetazolamide.

      Main outcome measures: Data were collected on urine output, cumulative fluid balance, and serum and urine biochemistry for 6 hours before and 6 hours after diuretic administration.

      Results: Study patients had a median age of 55 years (IQR, 50-66) and median APACHE III score of 44 (IQR, 37-52). Furosemide caused a much greater increase inurine output and much greater median mass chloride excretion (121.7 mmol [IQR, 81.1-144.6] v 23.3 mmol [IQR, 20.4-57.3]; P < 0.01) than acetazolamide. Furosemide also resulted in a progressively more negative fluid balance while acetazolamide resulted in greater alkalinisation of the urine (change in median urinary pH, +2 [IQR, 1.75-2.12] v 0 [IQR, 0-0.5]; P = 0.02). In keeping with this effect, furosemide alkalinised and acetazolamide acidified plasma (change in median serum pH, +0.03 [IQR, 0.01-0.04] v -0.01 [IQR, -0.04 to 0]; P = 0.01; change in median serum HCO3 −, +1.5 mmol/L [IQR, 0.75-2] v -2 mmol/L [IQR, -3 to 0]; P < 0.01).

      Conclusions: Furosemide is a more potent diuretic and chloriuretic agent than acetazolamide in critically ill patients, and achieves a threefold greater negative fluid balance. Compared with acetazolamide, furosemide acidifies urine and alkalinises plasma. Our findings imply that combination therapy might be a more physiological approach to diuresis in critically ill patients.

      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 4 - Low tidal volume ventilation during anaesthesia for
           major surgery: Protocol and statistical analysis plan
    • Abstract: Karalapillai, Dharshi; Weinberg, Laurence; Peyton, Phil; Ellard, Louise; Hu, Raymond; Pearce, Brett; Tan, Chong; Story, David; O'Donnell, Mark; Hamilton, Patrick; Oughton, Chad; Galtieri, Jonathan; Wilson, Anthony; Neto, Ary Serpa; Eastwood, Glenn; Bellomo, Rinaldo; Jones, Daryl A
      Background: Mechanical ventilation is mandatory in patients undergoing general anaesthesia for major surgery. Tidal volumes higher than 10 mL/kg of predicted body weight have been advocated for intraoperative ventilation, but recent evidence suggests that low tidal volumes may benefit surgical patients. To date, the impact of low tidal volume compared with conventional tidal volume during surgery has only been assessed in clinical trials that also combine different levels of positive end-expiratory pressure (PEEP) in each arm. We aimed to assess the impact of low tidal volume compared with conventional tidal volume during general anaesthesia for surgery on the incidence of postoperative respiratory complications in adult patients receiving moderate levels of PEEP.

      Study design and methods: Single-centre, two-arm, randomised clinical trial. In total, 1240 adult patients older than 40 years scheduled for at least 2 hours of surgery under general anaesthesia and routinely monitored with an arterial line were included. Patients were ventilated intraoperatively with a moderate level of PEEP (5 cmH2O) and randomly assigned to tidal volume of 6 mL/kg predicted body weight (low tidal volume) or 10 mL/kg predicted body weight (conventional tidal volume in Australia).

      Main outcome measure: The primary outcome is the occurrence of postoperative respiratory complications, recorded as a composite endpoint of adverse respiratory events during the first 7 postoperative days.

      Results and conclusions: This is the first well powered study comparing the effect of low tidal volume ventilation versus high tidal volume ventilation during surgery on the incidence of postoperative respiratory complications in adult patients receiving moderate levels of PEEP.

      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 4 - Addressing high practice variability in reported
           management of burns
    • Abstract: Reade, Michael C
      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 4 - Pharmacokinetic data support 6-hourly dosing of
           intravenous vitamin C to critically ill patients with septic shock
    • Abstract: Hudson, Elizabeth P; Collie, Jake TB; Fujii, Tomoko; Luethi, Nora; Udy, Andrew A; Doherty, Sarah; Eastwood, Glenn; Yanase, Fumitaka; Naorungroj, Thummaporn; Bitker, Laurent; Abdelhamid, Yasmine Ali; Greaves, Ronda F; Deane, Adam M; Bellomo, Rinaldo
      Objectives: To study vitamin C pharmacokinetics in septic shock.

      Design: Prospective pharmacokinetic study.

      Setting: Two intensive care units.

      Participants: Twenty-one patients with septic shock enrolled in a randomised trial of high dose vitamin C therapy in septic shock.

      Intervention: Patients received 1.5 g intravenous vitamin C every 6 hours. Plasma samples were obtained before and at 1, 4 and 6 hours after drug administration, and vitamin C concentrations were measured by high performance liquid chromatography.

      Main outcome measures: Clearance, volume of distribution, and half-life were calculated using noncompartmental analysis. Data are presented as median (interquartile range [IQR]).

      Results: Of the 11 participants who had plasma collected before any intravenous vitamin C administration, two (18%) were deficient (concentrations < 11 mmol/L) and three (27%) had hypovitaminosis C (concentrations between 11 and 23 mmol/L), with a median concentration 28 mmol/L (IQR, 11-44 mmol/L). Volume of distribution was 23.3 L (IQR, 21.9-27.8 L), clearance 5.2 L/h (IQR, 3.3-5.4 L/h), and half-life 4.3 h (IQR, 2.6-7.5 h). For the participants who had received at least one dose of intravenous vitamin C before sampling, T0 concentration was 258 mmol/L (IQR, 162- 301 mmol/L). Pharmacokinetic parameters for subsequent doses were a median volume of distribution 39.9 L (IQR, 31.4-44.4 L), clearance 3.6 L/h (IQR, 2.6-6.5 L/h), and halflife 6.9 h (IQR, 5.7-8.5 h).

      Conclusion: Intravenous vitamin C (1.5 g every 6 hours) corrects vitamin C deficiency and hypovitaminosis C and provides an appropriate dosing schedule to achieve and maintain normal or elevated vitamin C levels in septic shock.

      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 4 - In this issue of CCR
    • Abstract: Bellomo, Rinaldo
      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 4 - O2, do we know what to do'
    • Abstract: Young, Paul J; Bagshaw, Sean M; Bailey, Michael; Bellomo, Rinaldo; Mackle, Diane; Pilcher, David; Landoni, Giovanni; Nichol, Alistair; Martin, Daniel
      PubDate: Tue, 31 Dec 2019 04:25:09 GMT
       
  • Volume 21 Issue 3 - Comparing apples and oranges: The vasoactive effects
           of hydrocortisone and studies investigating high dose vitamin C
           combination therapy in septic shock
    • Abstract: Fujii, Tomoko; Udy, Andrew A; Venkatesh, Balasubramanian
      Vitamin C is an essential water-soluble vitamin with antioxidant and anti-inflammatory properties, in addition to being a cofactor in the synthesis of catecholamines in the human body. As vitamin C enhances the endogenous synthesis of noradrenaline and vasopressin, and is depleted in patients with septic shock, it is certainly not implausible that vitamin C administration in this setting may improve haemodynamic instability and promote more rapid shock reversal. Indeed, an early phase randomised controlled trial in 24 patients with severe sepsis found a statistically significant reduction in sepsis-related Sequential Organ Failure Assessment (SOFA) scores in patients receiving vitamin C (50 mg/kg or 200 mg/kg per day) compared with placebo. Many clinical trials have also assessed the efficacy of corticosteroids in the management of septic shock. In this fashion, glucocorticoids inhibit the arachidonic acid cascade, NF-KB transcription, and nitric oxide production, all of which are thought to contribute to the low vascular resistance state characteristic of sepsis. Moreover, the ADRENAL (Adjunctive Glucocorticoid Therapy in Patients with Septic Shock) trial demonstrated that low dose hydrocortisone (200 mg/day for a maximum of 7 days or until death or discharge from the ICU) resulted in a significant decrease in time to resolution of septic shock (median, 3 days; interquartile range [IQR], 2-5 days) compared with placebo (median, 4 days; IQR, 2-9 days; 'P' < 0.001),8 a finding that has also been confirmed in a recent systematic review with meta-analysis. In this systematic review, seven studies (4302 patients) assessed time to resolution of shock, with the mean difference between the corticosteroid (< 500 mg/day) and control groups being -1.52 days (95% CI, -1.71 to -1.32; 'P' < 0.0001). Extending this finding to consider the risk of random errors, trial sequential analysis suggests a mandatory information size of 662 participants, which has clearly been far exceeded, and results in adjusted 95% confidence intervals (CIs) that remain highly significant (adjusted 95% CI, -1.82 to -0.97). Therefore, these findings consistently demonstrate that corticosteroid therapy shortens the time to resolution of septic shock.

      PubDate: Mon, 9 Sep 2019 23:01:30 GMT
       
  • Volume 21 Issue 3 - In this issue of CCR
    • Abstract: Bellomo, Rinaldo
      PubDate: Mon, 9 Sep 2019 23:01:30 GMT
       
  • Volume 21 Issue 3 - Capacity to train and the intensive care workforce
    • Abstract: Raper, Raymond
      PubDate: Mon, 9 Sep 2019 23:01:30 GMT
       
  • Volume 21 Issue 3 - Targeted fibrinogen concentrate use in severe
           traumatic haemorrhage
    • Abstract: Seebold, Jacqueline A; Campbell, Don; Wake, Elizabeth; Walters, Kerin; Ho, Debbie; Chan, Erick; Bulmer, Andrew C; Wullschleger, Martin; Winearls, James
      Objective: Fibrinogen is one of the first coagulation factors to be depleted during traumatic haemorrhage, and evidence suggests hypofibrinogenaemia leads to poor outcomes. A number of fibrinogen replacement products are currently available, with no clear consensus on the ideal product to use in severe traumatic haemorrhage. We hypothesised that it will be possible to rapidly administer fibrinogen concentrate (FC) guided by rotational thromboelastometry (ROTEM) FIBTEM A5 in patients presenting with trauma haemorrhage.

      Methods: We examined 36 consecutive patients with trauma admitted to a level 1 trauma centre in Australia who received FC as part of their initial resuscitation. ROTEM analysis was conducted at various time points from emergency department (ED) admission to 48 hours after admission. The primary outcome was time to administration of FC after identification of hypofibrinogenaemia using ROTEM FIBTEM A5. Data were collected on quantity and timing of product transfusion, demographics, Injury Severity Score and laboratory values of coagulation. Spearman rank order correlation was used to determine the correlation between FIBTEM A5 and Clauss fibrinogen (FibC).

      Results: Thirty-six patients received FC as their initial form of fibrinogen replacement during the study. Patients were hypofibrinogenaemic by both FIBTEM A5 (6 mm) and FibC (1.7 g/L) on presentation to the ED. It took a median of 22 minutes (IQR, 17-30 minutes) from time of a FIBTEM A5 analysis to FC administration. Both parameters increased significantly ('P' < 0.05) by 24 hours after admission.

      Conclusion: This study suggests that administration of FC represents a rapid and feasible method to replace fibrinogen in severe traumatic haemorrhage. However, the optimal method for replacing fibrinogen in traumatic haemorrhage is controversial and large multicentre randomised controlled trials are needed to provide further evidence. This study provided baseline data to inform the design of further clinical trials investigating fibrinogen replacement in traumatic haemorrhage.

      PubDate: Mon, 9 Sep 2019 23:01:30 GMT
       
  • Volume 21 Issue 3 - Statistical analysis plan for the Standard versus
           Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury
           (STARRT-AKI) trial
    • Abstract: Bagshaw, Sean; Wald, Ron
      Background: The Standard versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial is a multinational randomised controlled trial that will enrol a minimum of 2866 patients comparing two strategies for initiating renal replacement therapy in critically ill patients with acute kidney injury.

      Objective: To describe a pre-specified statistical analysis plan (SAP) for the STARRT-AKI trial before completion of patient recruitment and data collection.

      Methods: The SAP was designed by the principal investigators and statisticians and approved by the international STARRT-AKI Steering Committee. The primary and secondary outcomes are defined, the approach to safety monitoring and data collection are summarised, and a detailed description of the planned statistical analyses, including pre-specified subgroup and secondary analyses, is described.

      Results: We have developed the SAP for the STARRT-AKI trial, including a mock CONSORT diagram, figures and tables. The primary outcome is 90-day all-cause mortality. The primary analysis will be reported as a relative risk (95% CI), absolute risk difference (95% CI), and tested with the 'X'2 test. Secondary analyses of the primary outcome will include adjustment for baseline covariates and site, and evaluation for heterogeneity in treatment effect. Pre-specified subgroups will include patient sex, baseline kidney function, illness acuity, surgical status, presence of sepsis, and geographic location.

      Conclusion: To align with best practice standards for rigour, internal validity and transparency, we have developed a SAP for the STARRT-AKI trial before trial completion. The analysis will adhere to the SAP to avoid bias arising from knowledge of trial results.

      PubDate: Mon, 9 Sep 2019 23:01:30 GMT
       
  • Volume 21 Issue 3 - Renal replacement therapy in the ICU: When should we
           STARRT'
    • Abstract: Bellomo, Rinaldo
      PubDate: Mon, 9 Sep 2019 23:01:30 GMT
       
  • Volume 21 Issue 3 - Characteristics, management and outcomes of patients
           with acute liver failure admitted to Australasian intensive care units
    • Abstract: Warrillow, Stephen; Tibballs, Heath; Bailey, Michael; McArthur, Colin; Lawson-Smith, Pia; Prasad, Bheemasenachar; Anstey, Matthew; Venkatesh, Balasubramanian; Dashwood, Gemma; Walsham, James; Holt, Andrew; Wiersema, Ubbo; Gattas, David; Zoeller, Matthew; Alvarez, Mercedes Garcia; Bellomo, Rinaldo
      Objective: Acute liver failure (ALF) leads to severe illness and usually requires admission to the intensive care unit (ICU). Despite its importance, little is known about patients with ALF in Australia and New Zealand.

      Design: Binational observational study to evaluate the aetiology, baseline characteristics, patterns of illness, management, and outcomes for patients with ALF admitted to Australian and New Zealand ICUs.

      Setting: All six Australian and New Zealand ICUs in liver transplant centres submitted de-identified data for ten or more consecutive patients with ALF. Data were obtained from the clinical record and included baseline characteristics, aetiology, mode of presentation, illness severity, markers of liver failure, critical care interventions, utilisation of transplantation, and hospital outcome.

      Results: We studied 62 patients with ALF. Paracetamol overdose (POD) was the underlying cause of ALF in 53% of patients (33/62), with staggered ingestion in 42% of patients (14/33). Among patients with POD, 70% (23/33) were young women, most had psychiatric diagnoses, and most presented relatively early with overt liver failure. This group were transplanted in only 6% of cases (2/33) and had an overall mortality of 24% (8/33). The remaining patients with ALF had less common conditions, such as hepatitis B and non-paracetamol drug-induced ALF. These patients presented later and exhibited less extreme evidence of acute hepatic necrosis. Transplantation was performed in 38% of patients (11/29) in this subgroup. The mortality of nontransplanted non-POD patients was 56% (10/18). Illness severity at ICU admission, initial requirement for organ support therapies and length of hospital stay were similar between patients with POD and non-POD ALF.

      Conclusion: POD is the major cause of ALF in Australian and New Zealand liver transplant centres and is a unique and separate form of ALF. It has a much lower associated mortality and treatment with liver transplantation than non-POD ALF. Non-POD patients have a poor prognosis in the absence of transplantation.

      PubDate: Mon, 9 Sep 2019 23:01:30 GMT
       
  • Volume 21 Issue 3 - The epidemiology of in-hospital cardiac arrests in
           Australia: A prospective multicentre observational study
    • Abstract: Jones, Daryl
      Background: Australian in-hospital cardiac arrest (IHCA) literature is limited, and mostly published before rapid response teams (RRTs). Contemporary data may inform strategies to improve IHCA outcomes.

      Study design: Prospective observational study of ward adult IHCAs in seven Australian hospitals.

      Participants and outcomes: IHCA was defined as unresponsiveness, no respiratory effort, and commencement of external cardiac compressions. Data included IHCA frequency, patient demographics, resuscitation management, intensive care unit (ICU) management, and hospital discharge status.

      Results: There were 15 953 RRT calls, 185 896 multiday admissions and 159 IHCAs in 152 patients (median age, 71.5 years; interquartile range [IQR], 61.6-81.3 years). The median IHCA frequency was 0.62 IHCAs per 1000 multiday admissions (IQR, 0.50-1.19). Most patients (93.4%) were admitted from home, and 68.4% (104/152) were medical admissions. Eighty-two IHCAs (51.6%) occurred within 4 days of admission, and 66.0% (105/159) of initial rhythms were non-shockable. The median resuscitation duration was 6.5 minutes (IQR, 2.0-18.0 minutes) and adrenaline was the most common intervention (95/159; 59.8%). Death on the ward occurred in 30.2% of IHCAs (48/159), and 49.7% (79/159) were admitted to the ICU, where vasoactive medications (75.9%), ventilation (82.3%), and renal replacement therapy (29.1%) use was extensive. Overall, 92 patients (60.5%) died and 40 (26.3%) were discharged home.

      Conclusion: Among seven Australian hospitals, IHCAs were infrequent, mostly occurred in older medical patients early in the hospital admission. Most were non-shockable, ICU therapy was extensive and nearly two-thirds of patients died in hospital. Further strategies are needed to prevent and improve ICHA outcomes.

      PubDate: Mon, 9 Sep 2019 23:01:30 GMT
       
  • Volume 21 Issue 3 - Cumulative radiation in critically ill patients: A
           retrospective audit of ionising radiation exposure in an intensive care
           unit
    • Abstract: McEvoy, James H; Bihari, Shailesh; Hooker, Antony M; Dixon, Dani-Louise
      Objective: Ionising radiation is a valuable tool in modern medicine including for patients in an intensive care unit (ICU). However, clinicians are faced with a trade-off between benefit of information received from procedure versus risks associated with radiation. As a first step to understanding the risk and benefits of radiation exposure to ICU patients, we aimed to assess the cumulative levels of ionising radiation patients receive during their ICU stay.

      Design: Retrospective audit.

      Setting: A single tertiary care ICU in South Australia.

      Participants: This audit included 526 patients admitted to the ICU at Flinders Medical Centre, Adelaide, SA, for longer than 120 hours (long stay) over a 12-month period from April 2015 to April 2016.

      Main outcome measures: Cumulative radiation exposure to ICU patients.

      Results: The 526 patients audited underwent 4331 procedures totalling 5688.45 mSv of ionising radiation. The most frequent procedure was chest x-ray (82%), which contributed 1.2% to cumulative effective dose (CED). Although only 3.6% of the total procedures, abdominal and pelvic computed tomography (CT) contributed the most to CED (68%). Over 50% of patients received less than 1 mSv CED during their stay in the ICU. However, 6% received > 50 mSv and 1.3% received > 100 mSv CED. Trauma patients received significantly higher CED compared with other admission diagnoses, and CED increased with length of stay.

      Conclusion: Most ICU patients received low CED during their stay, with the majority receiving less than the recommended limit for members of the public (1 mSv). These results may educate clinicians regarding radiation exposures in ICU settings, highlighting the relatively low exposures and thus low risk to the patients.

      PubDate: Mon, 9 Sep 2019 23:01:30 GMT
       
  • Volume 21 Issue 3 - Aboriginal and Torres Strait Islander patients
           requiring critical care: Characteristics, resource use, and outcomes
    • Abstract: Secombe, Paul; Brown, Alex; McAnulty, Greg; Pilcher, David
      Objective: To provide a contemporary description of the demographics, characteristics and outcomes of critically ill Indigenous patients in Australia.

      Design, setting and participants: Retrospective database review using the Australian and New Zealand Intensive Care Society Adult Patient Database for intensive care unit (ICU) admissions in 2017-18. Characteristics of critically ill Indigenous patients were compared with non-Indigenous patients.

      Main outcome measures: Primary outcome was hospital mortality. Secondary outcomes examined demographics and resource use.

      Results: Per capita, Indigenous Australians were over-represented in the intensive care. They were younger (51 v 66 years), more likely to be admitted from outer regional, rural and remote settings (59% v 15%), more likely to require emergency admission (81% v 59%), and had higher rates of mechanical ventilation (35% v 32%; 'P' < 0.01 for all). Indigenous patients were over-represented in the diagnostic categories of sepsis (15% v 9%), trauma (7% v 5%), and respiratory illness (17% v 15%), and had higher rates of ICU re-admission (7% v 5%; 'P' < 0.01 for all). There was no difference in either unadjusted (7.9% for each; 'P' = 0.96) or adjusted (odds ratio, 1.1; 95% CI, 1.0-1.2) in-hospital mortality.

      Conclusion: Indigenous patients, especially young Indigenous patients, were disproportionately represented in Australian ICUs, particularly for sepsis. The high level of acute illness and high proportion of emergency admissions could be interpreted as representing delayed presentation, which, with a higher re-admission rate, suggest access barriers to health care may exist. Nevertheless, there was no mortality gap between Indigenous and non-Indigenous Australians during a hospital admission for critical illness.

      PubDate: Mon, 9 Sep 2019 23:01:30 GMT
       
  • Volume 21 Issue 3 - Duration of intravenous vitamin C therapy is a
           critical consideration
    • PubDate: Mon, 9 Sep 2019 23:01:30 GMT
       
  • Volume 21 Issue 2 - Sepsis uncouples serum C-peptide and insulin levels in
           critically ill patients with type 2 diabetes mellitus
    • Abstract: Bitker, Laurent; Cutuli, Salvatore L; Cioccari, Luca; Osawa, Eduardo A; Toh, Lisa; Luethi, Nora; Young, Helen; Peck, Leah; Eastwood, Glenn M; Martensson, Johan; Bellomo, Rinaldo
      "Objective: To assess the effects of sepsis and exogenous insulin on C-peptide levels and C-peptide to insulin ratios in intensive care unit (ICU) patients with type 2 diabetes mellitus (T2DM).

      Design, setting and participants: In this prospective, observational, single-centre study, we enrolled 31 ICU-admitted adults with T2DM. We measured serum C-peptide and insulin levels during the first 3 days of ICU stay and recorded characteristics of exogenous insulin therapy. Patients were compared on the basis of the presence of sepsis, and their exposure to exogenous insulin therapy. C-peptide levels were also measured in eight healthy subjects.

      Main outcome measures: Serum insulin and C-peptide levels during the first 3 days in ICU.

      Results: Median C-peptide levels were higher in the ICU population compared with healthy subjects (10.9 [IQR, 8.2-14.1] v 4.8 [IQR, 4.6-5.1] nmol/L, P < 0.01). Sepsis was present in 25 ICU patients (81%). Among ICU patients unexposed to exogenous insulin, the 11 patients with sepsis had higher median C-peptide levels compared with the six non-septic patients (2.5 [IQR, 1.8-3.7] v 1.7 [IQR, 0.8-2.2] nmol/L, P = 0.04), and a threefold higher C-peptide to insulin ratio (45 [IQR, 37-62] v 13 [IQR, 11-17], P = 0.03). However, septic patients exposed to exogenous insulin had lower median C-peptide levels (1.2 [IQR, 0.7-2.3] nmol/L, P = 0.01) and C-peptide to insulin ratios (5 [IQR, 2-10], P < 0.01) compared with insulinfree septic patients. The C-peptide to insulin ratio was significantly associated with white cell count and severity of illness in insulin-free septic patients.

      Conclusion: C-peptide levels were elevated in critically ill patients with T2DM. In this population, sepsis increased C-peptide levels and uncoupled serum C-peptide and insulin levels. Exogenous insulin decreased both C-peptide levels and C-peptide to insulin ratios."

      PubDate: Tue, 30 Jul 2019 18:39:00 GMT
       
  • Volume 21 Issue 2 - Is sepsis treatment heating up'
    • Abstract: Young, Paul J
      PubDate: Tue, 30 Jul 2019 18:39:00 GMT
       
  • Volume 21 Issue 2 - Fentanyl versus morphine for analgo-sedation in
           mechanically ventilated adult icu patients
    • Abstract: Casamento, Andrew; Bellomo, Rinaldo
      Pain and discomfort are common in mechanically ventilated intensive care unit (ICU) patients. Modern ICU practice focuses on managing the "ICU triad" of agitation or unpleasant awareness, delirium and pain with sedative agents (propofol, midazolam and dexmedetomidine), antipsychotic agents (haloperidol and quetiapine), and analgesic agents.

      PubDate: Tue, 30 Jul 2019 18:39:00 GMT
       
  • Volume 21 Issue 2 - In this issue of CCR
    • Abstract: Bellomo, Rinaldo
      PubDate: Tue, 30 Jul 2019 18:39:00 GMT
       
  • Volume 21 Issue 2 - Vitamin c, hydrocortisone and thiamine in patients
           with septic shock (vitamins) trial: Study protocol and statistical
           analysis plan
    • Abstract: Fujii, Tomoko; Udy, Andrew A; Deane, Adam M; Luethi, Nora; Bailey, Michael; Eastwood, Glenn M; Frei, Daniel; French, Craig; Orford, Neil; Shehabi, Yahya; Young, Paul J; Bellomo, Rinaldo
      "Background: Septic shock is associated with poor outcomes. Vitamin C (ascorbic acid) is a cellular antioxidant and has anti-inflammatory properties. Whether the combination therapy of vitamin C, thiamine and hydrocortisone reduces vasopressor dependency in septic shock is unclear.

      Objectives: To describe the protocol and statistical analysis plan of a multicentre, open-label, prospective, phase 2 randomised clinical trial evaluating the effects of vitamin C, thiamine and hydrocortisone when compared with hydrocortisone monotherapy on the duration of vasopressor administration in critically ill patients with septic shock.

      Methods: VITAMINS is a multicentre cardiovascular efficacy trial in adult patients with septic shock. Randomisation occurs via a secure website with stratification by site, and allocation concealment is maintained throughout the trial. The primary outcome is the duration of time alive and free of vasopressor administration at Day 7. Secondary outcomes include feasibility endpoints and some patientcentred outcomes. All analyses will be conducted on an intention-to-treat basis.

      Conclusion: The VITAMINS trial will determine whether combination therapy of vitamin C, thiamine and hydrocortisone when compared with hydrocortisone increases vasopressor-free hours in critically ill patients with septic shock. The conduct of this study will provide important information on the feasibility of studying this intervention in a phase 3 trial.

      Trial registration: ClinicalTrials.gov, identification No. NCT03333278."

      PubDate: Tue, 30 Jul 2019 18:39:00 GMT
       
  • Volume 21 Issue 2 - Persistent critical illness: Baseline characteristics,
           intensive care course, and cause of death
    • Abstract: Darvall, Jai N; Boonstra, Tristan; Norman, Jen; Murphy, Donal; Bailey, Michael; Iwashyna, Theodore J; Bagshaw, Sean M; Bellomo, Rinaldo
      "Objectives: Persistent critical illness (PerCI) is associated with high mortality and discharge to institutional care. Little is known about factors involved in its progression, complications and cause of death. We aimed to identify such factors and the time when the original illness was no longer the reason for intensive care unit (ICU) stay.

      Design: Retrospective matched case-control study using an accepted PerCI definition (> 10 days in ICU).

      Setting: Single-centre tertiary metropolitan ICU.

      Participants: All adult patients admitted during a 2-year period were eligible, matched on diagnostic code, gender, age and risk of death.

      Main results: Seventy-two patients staying > 10 days (PerCI cases) were matched to 72 control patients. The original illness was no longer a cause for continued ICU stay after a median of 10 days (interquartile range [IQR], 7-16) versus 2 days (IQR, 0-3); P < 0.001. Patients with PerCI were more likely to develop new sepsis (52.8% v 23.6%; P < 0.001), delirium (37.5% v 9.7%; P < 0.001), ICU-acquired weakness (15.3% v 0%, P = 0.001), and to be discharged to chronic care or rehabilitation (37.5% v 16.7%; P < 0.005). Death resulting from sepsis with multi-organ failure occurred in 16.7% v 8.3% of control patients (P = 0.13), and one-third of patients with PerCI were not mechanically ventilated on Day 10.

      Conclusion: PerCI likely results from complications acquired after ICU admission and mostly unrelated to the original illness; by Day 10, the original illness does not appear to be its cause, and new sepsis appears an important association."

      PubDate: Tue, 30 Jul 2019 18:39:00 GMT
       
  • Volume 21 Issue 2 - Perceived discomfort in patients admitted to intensive
           care (detect discomfort 1) : A prospective observational study
    • Abstract: Jacques, Theresa; Ramnani, Anil; Deshpande, Kush; Kalfon, Pierre
      "Background: Discomfort experienced by patients admitted to intensive care units (ICUs) is an important indicator of the quality of care provided, but few studies have evaluated the incidence and magnitude of discomfort in critically ill patients. The IPREA (Inconforts des Patients de REAnimation) discomfort questionnaire is a tool developed by French intensivists and validated in the French language with good internal consistency (Cronbach's alpha, 0.78).

      Objectives: To translate and validate in English the IPREA discomfort questionnaire, to evaluate discomfort perceived by patients in intensive care, and to identify predictors of discomfort.

      Design, setting and participants: After translating the IPREA questionnaire using published methods that use principles of good practice for translating and culturally adapting patient-reported outcomes measures, all eligible patients (aged > 18 years, Glasgow Coma Scale score of 15, English speaking) admitted to our ICU over the 6-month period from April 2017 to September 2017 were surveyed within 24 hours of ICU discharge. Patient-perceived discomfort was measured using the translated IPREA questionnaire. The patients were asked to score their discomfort for each of 16 items on a scale of 0 (no discomfort) to 100 (maximum discomfort). An overall discomfort score was computed as the mean score of the 16 individual discomfort scores. Multivariate analysis was performed to identify predictors of discomfort. Main outcome measures: Translated questionnaire internal consistency. Individual and overall discomfort scores.

      Results: A total of 168 patients (58% men; mean age, 60.1 +/- 14.8 years; mean APACHE [Acute Physiology and Chronic Health Evaluation] II score, 13.8 +/- 5.6) completed the questionnaire. The translated questionnaire had good internal consistency (Cronbach's alpha, 0.82), and good content and construct validity (average inter-item correlation, 0.23). The mean overall discomfort score was 18.4 +/- 12.5, and discomfort scores did not differ between men and women or between types of ICUs (general ICU, cardiothoracic ICU or high dependency unit). On multivariate analysis, increasing age was an independent predictor of a low discomfort score (beta, -0.27; 95% CI, -0.42 to -0.12; P = 0.001).

      Conclusion: Patients admitted to our ICU reported low overall discomfort. There was an inverse relationship between age and perceived discomfort. The translated questionnaire for measuring discomfort performed well in our setting and could be applied to the Australian population."

      PubDate: Tue, 30 Jul 2019 18:39:00 GMT
       
  • Volume 21 Issue 2 - Prevalence of low-normal body temperatures and use of
           active warming in emergency department patients presenting with severe
           infection
    • Abstract: Gouldthorpe, Oliver T; Pilcher, David V; Bellomo, Rinaldo; Udy, Andrew A
      "Objective: To describe the prevalence of low-normal body temperatures in emergency department (ED) patients presenting with severe infection, and to determine whether active warming is used in this setting.

      Design, setting and participants: We performed a singlecentre retrospective cohort study in ED patients with community-acquired infection who required admission to the intensive care unit (ICU). Temperatures recorded from presentation up until 24 hours in the ICU were extracted from the patients' clinical records. Body temperatures were then classified as low (= 38 degreesC.

      Results: Over the study period, 574 patients were admitted to the ICU with infection. Of them, 151 fulfilled the inclusion criteria, and the in-hospital mortality rate for these patients was 8.6%. On presentation, 22.5% (34 patients) had a low body temperature (35-35.9 degreesC for six patients, and < 35.0 degreesC for three patients). In contrast, 26.5% (40 patients) had a temperature >= 38.0 degreesC. Among those who presented with low temperature, the median time to reach normothermia was 7.9 hours (range, 3.3-14.0 hours). Active warming was only applied to one patient, (whose body temperature was < 35 degreesC).

      Conclusion: Among patients with community-acquired infection requiring ICU admission, about a quarter have a low temperature and active warming was essentially not applied. These findings suggest that active warming of such patients would likely achieve separation from usual care."

      PubDate: Tue, 30 Jul 2019 18:39:00 GMT
       
  • Volume 21 Issue 2 - Assessment of the college of intensive care medicine's
           capacity to train: A survey of trainees and directors
    • Abstract: Venkatesh, Balasubramanian; Ashbolt, Michael; Hart, Philip; Raper, Raymond
      Assessment of the college of intensive care medicine's capacity to train: A survey of trainees and directors

      PubDate: Tue, 30 Jul 2019 18:39:00 GMT
       
  • Volume 21 Issue 2 - Haemodynamic response to fluid boluses in children
           after cardiac surgery: A technical report
    • Abstract: Gelbart, Ben; Bitker, Laurent; Segal, Ahuva; Hutchinson, Adrian; Soh, Norman; Maybury, Tim
      "Objective: To describe the haemodynamic response to fluid boluses (FB) in children after cardiac surgery.

      Design: A prospective observational pilot study.

      Setting: Single-centre, paediatric cardiac intensive care unit.

      Participants: Children after cardiac surgery.

      Interventions: FB of 0.9% saline, 4% albumin or modified ultrafiltrate blood administered in less than 30 minutes.

      Main outcome measures: Heart rate, arterial blood pressure, central venous pressure, oesophageal temperature, and end-tidal carbon dioxide were measured continuously and reported minutely from 5 minutes before and 30 minutes after FB. A mean arterial pressure (MAP)-responsive episode was defined as a 10% increase in MAP from baseline.

      Results: There were 21 FB recorded in 9 patients. Most patients (n = 8) weighed
      PubDate: Tue, 30 Jul 2019 18:39:00 GMT
       
  • Volume 21 Issue 2 - Survey
    • Abstract: Toolis, Michael; Tiruvoipati, Ravindranath; Botha, John; Green, Cameron; Subramaniam, Ashwin
      "Objective: To characterise intubation practices in Australian and New Zealand intensive care units (ICUs) and investigate clinician support for establishing airway management guidelines in Australian and New Zealand ICUs.

      Design: An online survey was designed, piloted and distributed to members of the mailing list of the Australian and New Zealand Intensive Care Society (ANZICS), with medical members invited to participate. Respondents were excluded if their primary practice was in paediatric ICUs.

      Main outcome measures: Data collected included the respondents' demographics and airway management practices and whether respondents supported the formulation of Australian and New Zealand intubation guidelines for critically ill patients in ICU and mandatory airway management training for Fellows of the College of Intensive Care Medicine of Australia and New Zealand (CICM).

      Results: Over a quarter of ANZICS medical members completed the survey (203/756, 27%), of which 166 (22%) were included in the analysis. The majority of respondents were male (80%), consultant intensivists (80%), and from tertiary centres (59%). Seventeen per cent worked concurrently in ICU and anaesthesia, and 52% had not completed formal airway training within the previous 3 years. Propofol was the preferred induction agent (67%) and rocuronium was the preferred neuromuscular blocking agent (58%). Videolaryngoscopy was immediately available in 97% of the ICUs and used first-line by 43% of respondents. Sixty-one per cent of respondents were in favour of the development of Australian and New Zealand ICU airway management guidelines, and 80% agreed that airway management training should be mandatory for CICM Fellows.

      Conclusion: Variation of practices in intubation was noted in the participants. Approximately 61% of respondents supported the development of Australian and New Zealand ICU airway management guidelines, and 80% supported mandatory airway management training."

      PubDate: Tue, 30 Jul 2019 18:39:00 GMT
       
  • Volume 21 Issue 1 - The angoff method in the written exam of the college
           of intensive care medicine of australia and new zealand: Setting a new
           standard
    • Abstract: Karcher, Christian
      In any test, a cut-point or standard needs to be established to discriminate between acceptable and unacceptable examinee performance. In the case of the Fellowship exam of the College of Intensive Care Medicine of Australia and New Zealand (CICM), the written component functions as a filter to exclude candidates who are deemed not yet ready for the clinical component examination.

      PubDate: Tue, 19 Mar 2019 14:02:13 GMT
       
  • Volume 21 Issue 1 - "Set and forget" is not an ideal approach to pressure
           support ventilation: The ongoing saga of high tidal volumes
    • Abstract: Lewis, Jane E
      PubDate: Tue, 19 Mar 2019 14:02:13 GMT
       
  • Volume 21 Issue 1 - In this issue of CCR
    • Abstract: Bellomo, Rinaldo
      PubDate: Tue, 19 Mar 2019 14:02:13 GMT
       
  • Volume 21 Issue 1 - The normal cardiac index in older healthy individuals:
           A scoping review
    • Abstract: Cioccari, Luca; Luethi, Nora; Glassford, Neil J; Bellomo, Rinaldo
      The adequacy of the cardiac index is commonly assessed in the context of surrogate measures of oxygen delivery, such as mixed venous oxygen saturation, blood lactate levels, peripheral perfusion and urine output. Cardiac index is commonly measured as a part of such an assessment, and numeric thresholds have been proposed to differentiate between impaired oxygen delivery and utilisation, and to guide fluid management. In addition, reference values are also used to define clinical states requiring intervention, such as the low cardiac output syndrome.

      PubDate: Tue, 19 Mar 2019 14:02:13 GMT
       
  • Volume 21 Issue 1 - Reported practice of temperature adjustment
           (alpha-stat v pH-stat) for arterial blood gases measurement among
           investigators from two major cardiac arrest trials
    • Abstract: Eastwood, Glenn M; Nielsen, Niklas; Nichol, Alistair D; Skrifvars, Markus B; French, Craig; Bellomo, Rinaldo
      Background: Two major cardiac arrest trials are evaluating different strategies that may potentially mitigate neurological injury after cardiac arrest and are allowing co-enrolment. However, one trial will target hypothermia and the other will target mild hypercapnia, in which the carbon dioxide (CO2) measurement may be influenced by the choice of temperature adjustment during arterial blood gases (ABGs) measurement. The trials have agreed to standardise assessment by the alpha-stat method.

      Objectives: To describe the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) and Targeted Hypothermia versus Targeted Normothermia after Out-of-hospital Cardiac Arrest (TTM2) site investigators' self-reported practice of ABG analysis and, in particular, their view of whether alpha-stat or pH-stat assessment of ABGs is considered optimal.

      Methods: We performed an online anonymous multichoice survey. Of the 136 site investigators emailed, 70 (51%) responded. Of these, 19 (27%) were participating in the TAME trial only, 22 (31%) were in TTM2 only, and 29 (41%) were participating in both.

      Results: The majority of respondents identified alpha-stat (41/68, 60%) compared with pH-stat (27/68, 40%) as their usual approach to ABG analysis when targeting 33 degreesC. In addition, the proportion and pattern of concern over hyperventilation was similarly reported as either "not concerned" or "neutral" when using an alpha-stat (46/69, 66%) or pH-stat (50/68, 73%) ABG analysis approach. Finally, for the purpose of a randomised controlled trial, most respondents either "strongly agreed", "agreed" or "neither agreed nor disagreed" to use the alpha-stat (59/69, 85%) or the pH-stat (61/70, 87%) approach.

      Conclusion: Our survey findings support the acceptability of the decision to apply the alpha-stat approach across participating sites for both trials.

      PubDate: Tue, 19 Mar 2019 14:02:13 GMT
       
  • Volume 21 Issue 1 - "Likely overassistance" during invasive pressure
           support ventilation in patients in the intensive care unit: A multicentre
           prospective observational study
    • Abstract: Al-Bassam, Wisam; Dade, Fabian; Bailey, Michael; Eastwood, Glenn; Osawa, Eduardo; Eyeington, Chris; Anesty, James; Yi, George; Ralph, Jolene; Kakho, Nima; Kurup, Vishnu; Licari, Elisa; King, Emma C; Knott, Cameron; Chimunda, Timothy; Smith, Julie; Subramaniam, Ashwin; Reddy, Mallikarjuna; Green, Cameron; Parkin, Geoffrey; Shehabi, Yahya; Bellomo, Rinaldo
      Objective: To evaluate the prevalence of "likely overassistance" (categorised by respiratory rate (RR)
      PubDate: Tue, 19 Mar 2019 14:02:13 GMT
       
  • Volume 21 Issue 1 - Modifications to predefined rapid response team
           calling criteria: Prevalence, characteristics and associated outcomes
    • Abstract: Ganju, Anamika; Kapitola, Karoline; Chalwin, Richard
      Objective: Standardised rapid response team (RRT) calling criteria may not be applicable to all patients, and thus, modifications of these criteria may be reasonable to prevent unnecessary calls. Little data are available regarding the efficacy or safety of modifying RRT calling criteria; therefore, this study aimed to detail the prevalence and characteristics of modifications to RRT call triggers and explore their relationship with patient outcomes.

      Design and outcome measures: A pilot retrospective cohort study within a convenience sample of patients attended by a hospital RRT between July and December 2014; rates of repeat RRT calling and in-hospital mortality were compared between patients with and without modifications to standard calling criteria. Secondary analyses examined four different types of modifications, narrowing or widening of existing physiological calling criteria, to observations without defined calling criteria, and others. All analyses were performed using multivariable regression.

      Results: During the study period, 673 patients had RRT calls, of whom 620 (91.2%) had data available for analysis. The majority of study patients (393; 63.4%) had modifications documented. Patients with modifications were more likely to have repeat RRT calls (odds ratio [OR], 2.86; 95% CI, 1.69-4.85) and experience in-hospital mortality (OR, 2.16; 95% CI, 1.31-3.57) versus patients without modifications. In the secondary analyses, although all classes of modification had higher rates of repeat calling, none reached statistical significance. Mortality was associated with having modifications that were more conservative than the standard calling criteria (adjusted OR, 2.81; 95% CI, 1.31-6.08).

      Conclusion: Modifications to standard calling criteria were frequently made, but did not seem to prevent further RRT calls and were associated with increased mortality. These findings suggest that modifications should be made with caution.

      PubDate: Tue, 19 Mar 2019 14:02:13 GMT
       
  • Volume 21 Issue 1 - A novel biometric approach to estimating tidal volume
    • Abstract: O'Brien, Darragh E; Kam, Jeffrey KP; Slater, Reuben J; Tobin, Antony E
      Background: Low tidal volume ventilation (LTVV) of 4-8 mL/kg of ideal body weight (IBW) reduces mortality in patients with acute respiratory distress syndrome, and, more recently, it has been recommended as the default therapy for all controlled ventilation. However, adherence to LTVV is poor. Barriers to adherence include not having height measurements taken or IBW calculated during admission. The aim of our project was to develop and validate a simple one step biometric measuring tool to directly estimate tidal volume (VT) in ventilated patients based on their demispan.

      Objectives: To validate our novel biometric approach for the estimation of VT in mechanically ventilated patients by demonstrating its accuracy as a simple reliable alternative to IBW derived from measured height.

      Design and setting: A simple computer program was written based on regression equations for demispan, height and IBW which used simple substitution to produce a vector graphic scale with markings in millilitres of 6 mL/kg IBW VT printed onto a paper tape. We performed an observational validation study on ventilated patients after cardiac surgery comparing the VT derived from demispan measurements using our tape with the VT based on IBW calculated from pre-operative vertical height.

      Main outcome measure: We compared compliance with a target VT
      PubDate: Tue, 19 Mar 2019 14:02:13 GMT
       
  • Volume 21 Issue 1 - Neither vitamin D levels nor supplementation are
           associated with the development of persistent critical illness: A
           retrospective cohort analysis
    • Abstract: Viglianti, Elizabeth M; Zajic, Paul; Iwashyna, Theodore J; Amrein, Karin
      Objective: The purpose of this study was to evaluate if vitamin D deficiency is associated with increased rates of persistent critical illness, and whether repletion of vitamin D among patients with this deficiency leads to decreased persistent critical illness.

      Design: Retrospective cohort analysis.

      Setting: Seven intensive care units (ICUs) at the University Medical Center of Graz, Austria, with participants recruited between July 2008 and April 2010. The VITdAL-ICU trial cohort included five ICUs at the University Medical Center of Graz, Austria, with patients recruited between May 2010 through September 2012.

      Participants: There were 628 patients aged >= 18 years admitted to the ICU and who had their 25-hydroxyvitamin D (25(OH)D) level measured at least once. The VITdAL-ICU cohort included 475 patients aged >= 18 years who were expected to stay in the ICU for greater than 48 hours and found to have a 25(OH)D level of
      PubDate: Tue, 19 Mar 2019 14:02:13 GMT
       
  • Volume 21 Issue 1 - A protocol for a phase 3 multicentre randomised
           controlled trial of continuous versus intermittent beta-lactam antibiotic
           infusion in critically ill patients with sepsis: Bling III
    • Abstract: Lipman, Jeffrey; Brett, Stephen J; de Waele, Jan J; Cotta, Menino O; Davis, Joshua S; Finfer, Simon; Glass, Parisa; Knowles, Serena; McGuinness, Shay; Myburgh, John; Paterson, David L; Peake, Sandra; Rajbhandari, Dorrilyn; Rhodes, Andrew; Roberts, Jason A; Shirwadkar, Charudatt; Starr, Therese; Taylor, Colman; Billot, Laurent; Dulhunty, Joel M
      Background and rationale: beta-Lactam antibiotics display a time-dependent mechanism of action, with evidence suggesting improved outcomes when administering these drugs via continuous infusion compared with standard intermittent infusion. However, there is no phase 3 randomised controlled trial (RCT) evidence to support one method of administration over another in critically ill patients with sepsis.

      Design and setting: The beta-Lactam Infusion Group (BLING) III study is a prospective, multicentre, open, phase 3 RCT to compare continuous infusion with standard intermittent infusion of beta-lactam antibiotics in critically ill patients with sepsis. The study will be conducted in about 70 intensive care units (ICUs) in Australia, New Zealand, the United Kingdom, Belgium and selected other countries, from 2018 to 2021.

      Participants and interventions: BLING III will recruit 7000 critically ill patients with sepsis being treated with one of two beta-lactam antibiotics (piperacillin-tazobactam or meropenem) to receive the beta-lactam antibiotic by either continuous or intermittent infusion.

      Main outcome measures: The primary outcome is allcause mortality within 90 days after randomisation. Secondary outcomes are clinical cure at Day 14 after randomisation, new acquisition, colonisation or infection with a multiresistant organism or Clostridium difficile diarrhoea up to 14 days after randomisation, all-cause ICU mortality and all-cause hospital mortality. Tertiary outcomes are ICU length of stay, hospital length of stay and duration of mechanical ventilation and duration of renal replacement therapy up to 90 days after randomisation.

      Results and conclusions: The BLING III study will compare the effect on 90-day mortality of beta-lactam antibiotics administered via continuous versus intermittent infusion in 7000 critically ill patients with sepsis.

      PubDate: Tue, 19 Mar 2019 14:02:13 GMT
       
  • Volume 21 Issue 1 - Clinical management practices of life-threatening
           asthma: An audit of practices in intensive care
    • Abstract: Secombe, Paul; Stewart, Penny; Singh, Sunil; Campbell, Lewis; Stephens, Dianne; Tran, Khoa; White, Hayden; Sheehy, Robert; Gibson, Justine; Cooke, Robyn; Townsend, Shane; Apte, Yogesh; Winearls, James; Ferry, Olivia R; Pradhan, Rahul; Ziegenfuss, Marc; Fong, Kwun M; Yang, Ian A; McGinnity, Paul; Meyer, Jason; Walsham, James; Boots, Rob; Clement, Pierre; Bandeshe, Hiran; Gracie, Christopher; Jarret, Paul; Collins, Stephenie; Coulston, Caitlin; Ng, Melisa; Howells, Valerie; Chatterjee, Indranil; Visser, Adam; Smith, Judy; Trout, Melita
      Objective: Lack of management guidelines for lifethreatening asthma (LTA) risks practice variation. This study aims to elucidate management practices of LTA in the intensive care unit (ICU).

      Design: A retrospective cohort study.

      Setting: Thirteen participating ICUs in Australia between July 2010 and June 2013.

      Participants: Patients with the principal diagnosis of LTA.

      Main outcome measures: Clinical history, ICU management, patient outcomes, ward education and discharge plans.

      Results: Of the 270 (267 patients) ICU admissions, 69% were female, with a median age of 39 years (interquartile range [IQR], 26-53 years); 119 (44%) were current smokers; 89 patients (33%) previously required ICU admission, of whom 23 (25%) were intubated. The median ICU stay was 2 days (IQR, 2-4 days). Three patients (1%) died. Seventy-nine patients (29%) received non-invasive ventilation, with 11 (14%) needing subsequent invasive ventilation. Sixty-eight patients (25%) were intubated, with the majority of patients receiving volume cycled synchronised intermittent mechanical ventilation (n = 63; 93%). Drugs used included 2-agonist by intravenous infusion (n = 69; 26%), inhaled adrenaline (n = 15; 6%) or an adrenaline intravenous infusion (n = 23; 9%), inhaled anticholinergics (n = 238; 90%), systemic corticosteroids (n = 232; 88%), antibiotics (n = 126; 48%) and antivirals (n = 22; 8%). When suitable, 105 patients (n = 200; 53%) had an asthma management plan and 122 (n = 202; 60%) had asthma education upon hospital discharge. Myopathy was associated with hyperglycaemia requiring treatment (odds ratio [OR], 31.6; 95% CI, 2.1-474). Asthma education was more common under specialist thoracic medicine care (OR, 3.0; 95% CI, 1.61-5.54).

      Conclusion: In LTA, practice variation is common, with opportunities to improve discharge management plans and asthma education.

      PubDate: Tue, 19 Mar 2019 14:02:13 GMT
       
  • Volume 21 Issue 1 - Early electroencephalogram does not reliably
           differentiate outcomes in post-hypoxic myoclonus
    • Abstract: Dalic, Linda J; Fennessy, Gerard; Edmonds, Mark; Carney, Patrick; Opdam, Helen; Archer, John
      Objective: Prognostication in patients with post-hypoxic brain injury remains difficult; yet, clinicians are commonly asked to guide decisions regarding withdrawal of life support. We aimed to assess whether electroencephalogram (EEG) is a useful tool in predicting neurological outcome in patients with post-hypoxic myoclonus (PHM).

      Design and setting: This study was conducted as part of an internal hospital audit assessing therapeutic hypothermia in patients with hypoxic cardiac arrest.

      Participants: We identified 20 patients with PHM and evaluated their initial routine EEG.

      Main outcome measures: Three blinded neurologists independently assessed EEGs and scored them using the standardised critical care EEG terminology from the American Clinical Neurophysiology Society (2012 version) and the EEG patterns identified by the Target Temperature Management (TTM) trial group. Glasgow Outcome Scale (GOS) scores were used to assess neurological outcome at 30 and 90 days. Mortality rates at these time points were also documented.

      Results: We found that the majority of patients (18/20) with PHM had an initial EEG that was "highly malignant" or "malignant", but outcomes at 30 and 90 days were not universally fatal. Six patients were alive at 30 days, and five at 90 days. Of the latter, two patients had moderate disability (GOS score 4) and one improved from a GOS score of 3 to 5, with only low disability. Two patients with "benign" EEGs had unchanged GOS scores of 3 at 30 and 90 days, indicating severe disability.

      Conclusion: This study shows that PHM is associated with a poor but not universally fatal prognosis. Early EEG does not reliably distinguish between good and poor outcomes.

      PubDate: Tue, 19 Mar 2019 14:02:13 GMT
       
  • Volume 20 Issue 4 - What should we target after target'
    • Abstract: Young, Paul J; Bellomo, Rinaldo; Chapman, Marianne J; Deane, Adam M; Peake, Sandra L
      PubDate: Fri, 4 Jan 2019 14:43:57 GMT
       
  • Volume 20 Issue 4 - In this issue of CCR
    • Abstract: Bellomo, Rinaldo
      PubDate: Fri, 4 Jan 2019 14:43:57 GMT
       
  • Volume 20 Issue 4 - Organ donation after circulatory death following
           voluntary assisted dying: Practical and ethical considerations for
           Victoria
    • Abstract: Philpot, Steven J
      On 19 June 2019, the Voluntary Assisted Dying Bill 2017 (Vic) will be enacted. Up to ten per cent of people deemed eligible for voluntary assisted dying will be medically suitable for organ donation. Donation after circulatory death after assisted dying is possible, although there are important challenges to address for donation to be successful in this context. This article explores the practical and ethical considerations that need to be reviewed in order to support organ donation after assisted dying. In particular, it discusses the ways in which organ donation will affect the place, timing and mechanism of death, and the ethics around consent for donation. The article explores potential ways to minimise warm ischaemic time, and finally discusses the potential for donation to influence the decision to consume the voluntary assisted dying substance.

      PubDate: Fri, 4 Jan 2019 14:43:57 GMT
       
  • Volume 20 Issue 4 - Prediction of tracheostomy in critically ill trauma
           patients: A systematic review
    • Abstract: Casamento, Andrew J; Bebee, Bronwyn; Glassford, Neil J; Bellomo, Rinaldo
      Background: Tracheostomy is relatively common in mechanically ventilated patients in the intensive care unit (ICU). The prediction of which patients will receive a tracheostomy is crucial to both clinical decision making and the design of targeted interventional trials of its timing.

      Objectives: We aimed to systematically review the literature to ascertain whether useful predictors of eventual tracheostomy can be identified, with a particular focus on trauma patients.

      Data sources and review methods: We searched three electronic databases to identify all studies of any design evaluating potential predictors of tracheostomy in mechanically ventilated ICU patients. Bias was assessed using the Quality in Prognosis Studies tool.

      Results: Of 140 potentially eligible studies, we identified 12 relevant observational studies recruiting a total of 119 945 mechanically ventilated patients, of whom 14 080 (11.7%) received a tracheostomy. Seven studies were performed in trauma populations and included 24 858 patients, of whom 6140 (24.7%) received a tracheostomy. Factors predictive of receiving a tracheostomy in the trauma population included patient factors (age and comorbidities), diagnostic factors (injury type and injury severity score), and intervention factors (craniotomy or laparotomy). Profound clinical and methodological heterogeneity prevented meaningful meta-analysis. Significantly, more predictors were present on the day of admission in trauma populations than in non-trauma patients with brain injury and in other populations (89.7% v 73.3% v 25.0%).

      Conclusion: There are a number of clinical factors associated with subsequent tracheostomy in mechanically ventilated patients, in particular trauma patients. Given the need to prevent patients from receiving an unnecessary tracheostomy, these findings indicate that better predictive models are needed before the conduct of interventional trials.

      Systematic review registration number: PROSPERO registry no. CRD42018084987.

      PubDate: Fri, 4 Jan 2019 14:43:57 GMT
       
  • Volume 20 Issue 4 - Haemodynamic effects of cold versus warm fluid bolus
           in healthy volunteers: A randomised crossover trial
    • Abstract: Wall, Olof; Ehrenberg, Lars; Joelsson-Alm, Eva; Martensson, Johan; Bellomo, Rinaldo; Svensen, Christer; Cronhjort, Maria
      Objective: To test the hypothesis that changes in cardiac index and mean arterial pressure (MAP) during and after a fluid bolus (FB) are altered by fluid temperature.

      Design: Randomised, controlled, crossover trial.

      Setting: Research laboratory at Swedish teaching hospital.

      Participants: Twenty-one healthy adult volunteers.

      Interventions: Subjects were randomly allocated to 500 mL of Ringer's acetate at room temperature (22 degrees C; cold) or body temperature (38 degrees C; warm).

      Main outcome measures: For 2 hours after starting the FB, we measured cardiac index, MAP, systolic blood pressure, diastolic blood pressure and pulse rate (PR) continuously. We recorded temperature and O2 saturation every 5 minutes during infusion and every 15 minutes thereafter. In a second session, volunteers crossed over.

      Results: During the first 15 minutes, mean cardiac index increased more with warm FB (0.09 L/min/m2 [95% CI, 0.06- 0.11] v 0.03 L/min/m2 [95% CI, 0.01-0.06]; P < 0.001). This effect was mediated by a significant difference in mean PR (+0.80 beats/min [95% CI, 0.47-1.13] v -1.33 beats/ min [95% CI, -1.66 to -1.01]; P < 0.010). In contrast, MAP increased more with cold FB (4.02 mmHg [95% CI, 3.63-4.41] v 0.60 mmHg [95% CI, 0.26-0.95]; P < 0.001). Cardiac index and MAP returned to baseline after a median of 45.3 min (interquartile range [IQR], 10.7-60.7 min) and 27.7 min (IQR, 5.3-105.0 min), respectively, after cold FB, and by 15.8 min (IQR, 3.8-64.3 min) and 22.7 min (IQR, 3.3-105.0 min), respectively, after warm FB. Conclusion: Intravenous FB at body temperature leads to a greater increase in cardiac index compared with room temperature, while the reverse applies to MAP. These findings imply that in healthy volunteers, when a room temperature FB is given, the temperature of the fluid rather than its volume accounts for most of the MAP increase.

      Trial registration: EudraCT no. 2016-002548-18 and Clinicaltrials.gov NCT03209271.

      PubDate: Fri, 4 Jan 2019 14:43:57 GMT
       
  • Volume 20 Issue 4 - Communication with families regarding organ and tissue
           donation after death in intensive care (COMFORT): A multicentre
           before-and-after study
    • Abstract: Potter, Julie E; Perry, Lin; Elliott, Rosalind M; Aneman, Anders; Brieva, Jorge L; Cavazzoni, Elena; Cheng, Andrew TH; O'Leary, Michael J; Seppelt, Ian M; Herkes, Robert G
      Objective: To implement a best-practice intervention offering deceased organ donation, testing whether it increased family consent rates.

      Design: A multicentre before-and-after study of a prospective cohort compared with pre-intervention controls.

      Setting: Nine Australian intensive care units.

      Participants: Families and health care professionals caring for donor-eligible patients without registered donation preferences or aged
      PubDate: Fri, 4 Jan 2019 14:43:57 GMT
       
  • Volume 20 Issue 4 - The carbon footprint of treating patients with septic
           shock in the intensive care unit
    • Abstract: McGain, Forbes; Burnham, Jason P; Lau, Ron; Aye, Lu; Kollef, Marin H; McAlister, Scott
      Objective: To use life cycle assessment to determine the environmental footprint of the care of patients with septic shock in the intensive care unit (ICU).

      Design, setting and participants: Prospective, observational life cycle assessment examining the use of energy for heating, ventilation and air conditioning; lighting; machines; and all consumables and waste associated with treating ten patients with septic shock in the ICU at Barnes- Jewish Hospital, St. Louis, MO, United States (US-ICU) and ten patients at Footscray Hospital, Melbourne, Vic, Australia (Aus-ICU).

      Main outcome measures: Environmental footprint, particularly greenhouse gas emissions.

      Results: Energy use per patient averaged 272 kWh/day for the US-ICU and 143 kWh/day for the Aus-ICU. The average daily amount of single-use materials per patient was 3.4 kg (range, 1.0-6.3 kg) for the US-ICU and 3.4 kg (range, 1.2-8.7 kg) for the Aus-ICU. The average daily particularly greenhouse gas emissions arising from treating patients in the US-ICU was 178 kg carbon dioxide equivalent (CO2-e) emissions (range, 165-228 kg CO2-e), while for the Aus-ICU the carbon footprint was 88 kg CO2-e (range, 77-107 kg CO2-e). Energy accounted for 155 kg CO2-e in the US-ICU (87%) and 67 kg CO2-e in the Aus-ICU (76%). The daily treatment of one patient with septic shock in the US-ICU was equivalent to the total daily carbon footprint of 3.5 Americans' CO2-e emissions, and for the Aus-ICU, it was equivalent to the emissions of 1.5 Australians.

      Conclusion: The carbon footprints of the ICUs were dominated by the energy use for heating, ventilation and air conditioning; consumables were relatively less important, with limited effect of intensity of patient care. There is large opportunity for reducing the ICUs' carbon footprint by improving the energy efficiency of buildings and increasing the use of renewable energy sources.

      PubDate: Fri, 4 Jan 2019 14:43:57 GMT
       
  • Volume 20 Issue 4 - Intensive care implications of epidemic thunderstorm
           asthma
    • Abstract: Darvall, Jai N; Durie, Matthew; Pilcher, David; Wigmore, Geoffrey; French, Craig; Karalapillai, Dharshi; McGain, Forbes; Newbigin, Edward; Byrne, Timothy; Sarode, Vineet; Gelbart, Ben; Casamento, Andrew; Dyett, John; Crosswell, Ashley; Vetro, Joseph; McCaffrey, Joseph; Taori, Gopal; Subramaniam, Ashwin; MacIsaac, Christopher; Cross, Anthony; Ku, David; Bellomo, Rinaldo
      Objective: To investigate the environmental precipitants, treatment and outcome of critically ill patients affected by the largest and most lethal reported epidemic of thunderstorm asthma.

      Design, setting and participants: Retrospective multicentre observational study. Meteorological, airborne particulate and pollen data, and a case series of 35 patients admitted to 15 intensive care units (ICUs) due to the thunderstorm asthma event of 21-22 November 2016, in Victoria, Australia, were analysed and compared with 1062 total ICU-admitted Australian patients with asthma in 2016.

      Main outcome measures: Characteristics and outcomes of total ICU versus patients with thunderstorm asthma, the association between airborne particulate counts and storm arrival, and ICU resource utilisation.

      Results: All 35 patients had an asthma diagnosis; 13 (37%) had a cardiac or respiratory arrest, five (14%) died. Compared with total Australian ICU-admitted patients with asthma in 2016, patients with thunderstorm asthma had a higher mortality (15% v 1.3%, P < 0.001), were more likely to be male (63% v 34%, P < 0.001), to be mechanically ventilated, and had shorter ICU length of stay in survivors (median, 31.8 hours [interquartile range (IQR), 14.8-43.6 hours] v 40.7 hours [IQR, 22.3-75.1 hours]; P = 0.025). Patients with cardiac arrest were more likely to be born in Asian or subcontinental countries (5/10 [50%] v 4/25 [16%]; relative risk, 3.13; 95% CI, 1.05-9.31). A temporal link was demonstrated between airborne particulate counts and arrival of the storm. The event used 15% of the public ICU beds in the region.

      Conclusion: Arrival of a triggering storm is associated with an increase in respirable airborne particles. Affected critically ill patients are young, have a high mortality, a short duration of bronchospasm, and a prior diagnosis of asthma is common.

      PubDate: Fri, 4 Jan 2019 14:43:57 GMT
       
  • Volume 20 Issue 4 - Addressing the inadvertent sodium and chloride burden
           in critically ill patients: A prospective before-and-after study in a
           tertiary mixed intensive care unit population
    • Abstract: Bihari, Shailesh; Prakash, Shivesh; Potts, Simon; Matheson, Elisha; Bersten, Andrew D
      Background: Inadvertent fluid loading - and resultant sodium and chloride - is common in critically ill patients. Sources such as fluid used as vehicles for drug infusions and boluses (fluid creep) and maintenance fluid are a common cause. We hypothesised that total sodium and chloride loading can be safely reduced in critically ill patients both by the use of 5% glucose as a diluent for infusions and boluses, when possible, and by its use as a maintenance fluid.

      Methods: This was a prospective before-and-after study design in a single centre tertiary mixed intensive care unit (ICU). Comprehensive data about patient demographics, sources of fluid, feeds, intravenous drugs, fluid balance and electrolyte levels were collected for 4 weeks before and after the intervention (2016 and 2017). The amount of administered sodium was estimated from these sources.

      Results: There were 146 patients (643 study days) and 133 patients (684 study days) examined in 2016 and 2017 respectively. The change of practice lead to an increase in the use of 5% glucose as the maintenance fluid and as a diluent, which resulted in a decrease in the total daily administered sodium from a median of 197 mmol (interquartile range [IQR], 155-328 mmol) to a median of 109 mmol (IQR, 77-288 mmol) (P = 0.0001). It also resulted in decrease in daily fluid balance, plasma chloride and ICU-acquired hypernatraemia.

      Conclusions: It is safely possible to decrease the total sodium and chloride loading to ICU patients by intervening on fluid creep and on maintenance fluid types. This intervention was accompanied by favourable changes in serum electrolyte and fluid balance.

      PubDate: Fri, 4 Jan 2019 14:43:57 GMT
       
  • Volume 20 Issue 4 - In-hospital cardiac arrests: Events worth
           monitoring'
    • PubDate: Fri, 4 Jan 2019 14:43:57 GMT
       
  • Volume 20 Issue 4 - Risk factors for candidaemia and their cumulative
           effect over time in a cohort of critically ill, non-neutropenic patients
    • Abstract: Aljeboori, Zeyad; Gorelik, Alexandra; Jenkins, Emily; McFarlane, Thomas; Darvall, Jai
      Objectives: There is an increasing incidence of invasive candidal infections in critically ill patients worldwide, which has prompted development of various risk prediction rules, both clinical and microbiological. To date, however, there is a lack of research into how cumulative risk factors over time affect transition to candidaemia. The aim of this study was to investigate the association of risk factor accumulation over time with candidaemia in a cohort of critically ill, nonneutropenic adult patients.

      Design, setting and participants: A single centre, retrospective, matched case-control study in a tertiary referral intensive care unit (ICU). Data were retrieved and analysed from 108 patients (54 cases and 54 controls) admitted between 1 January 2008 and 1 August 2016.

      Main outcome measures: Primary outcome was the association between time-dependent risk factors and candidaemia. Secondary outcomes were ICU and inhospital mortality.

      Results: Baseline demographic and clinical factors were similar across both groups. Time dependent univariate factors associated with candidaemia were days of mechanical ventilation, systemic antibiotic use, renal replacement therapy, central venous access, total parenteral nutrition (TPN), systemic inflammatory response syndrome, Candida site colonisation and number of surgeries. Factors persisting on multivariate analysis were days of TPN use (odds ratio [OR], 1.8; 95% CI, 1.02-3.22; P = 0.041) and total Candida site colonisation days (OR, 2.41; 95% CI, 1.30-4.46; P = 0.005). Mortality and length of stay (LOS) was greater in patients with candidaemia v control patients (ICU mortality, 15 [28%] v 10 [19%]; P = 0.254; hospital mortality, 26 [48%] v 16 [30%]; P = 0.048; ICU LOS median, 13 days [interquartile range (IQR), 5-29 days] v 2 days [IQR, 1-5 days]; P < 0.001; hospital LOS median, 36 days [IQR,19- 63 days] v 13 days [IQR, 6-28 days]; P < 0.001).

      Conclusion: This study demonstrates an association between TPN use, Candida colonisation and cumulative risk over time of developing candidaemia.

      PubDate: Fri, 4 Jan 2019 14:43:57 GMT
       
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
 


Your IP address: 34.204.200.74
 
Home (Search)
API
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-