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: 28)
ACCESS: Critical Perspectives on Communication, Cultural & Policy Studies     Full-text available via subscription   (Followers: 15)
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: 26, 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: 2)
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: 17, SJR: 0.142, CiteScore: 0)
Analysis     Full-text available via subscription   (Followers: 4)
Ancient History : Resources for Teachers     Full-text available via subscription   (Followers: 9)
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  
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: 11)
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: 6)
Asia Pacific J. of Clinical Nutrition     Full-text available via subscription   (Followers: 13, 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: 2)
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: 6, 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: 4)
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: 9, 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: 2)
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: 2)
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: 23)
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: 16, 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: 10)
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: 31, 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: 6)
Australian J. of Language and Literacy, The     Full-text available via subscription   (Followers: 5, SJR: 0.282, CiteScore: 1)
Australian J. of Legal History     Full-text available via subscription   (Followers: 16)
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: 10, 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: 7)
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: 15)
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: 19, 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: 26, 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: 10)
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: 19)
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: 2)
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: 3)
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: 18)
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: 12)
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: 9)
Intl. J. of Home Economics     Full-text available via subscription   (Followers: 2)
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: 10)
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: 8)
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: 26  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 1441-2772
Published by RMIT Publishing Homepage  [387 journals]
  • Volume 22 Issue 2 - Fast reshaping of intensive care unit facilities in a
           large metropolitan hospital in Milan, Italy: Facing the COVID-19 pandemic
           emergency
    • Abstract: Zangrillo, Alberto; Beretta, Luigi; Silvani, Paolo; Colombo, Sergio; Scandroglio, Anna Mara; Dell'Acqua, Antonio; Fominskiy, Evgeny; Landoni, Giovanni; Monti, Giacomo; Azzolini, Maria Luisa; Monaco, Fabrizio; Oriani, Alessandro; Belletti, Alessandro; Sartorelli, Marianna; Pallanch, Ottavia; Saleh, Omar; Sartini, Chiara; Nardelli, Pasquale; Lombardi, Gaetano; Morselli, Federica; Scquizzato, Tommaso; Frontera, Antonio; Ruggeri, Annalisa; Scotti, Raffaella; Assanelli, Andrea; Dagna, Lorenzo; Rovere-Querini, Patrizia; Castagna, Antonella; Scarpellini, Paolo; di Napoli, Davide; Ambrosio, Alberto; Ciceri, Fabio; Tresoldi, Moreno
      At the end of 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak spread from China all around the world, causing thousands of deaths. In Italy, the hardest hit region was Lombardy, with the first reported case on 20 February 2020.

      San Raffaele Scientific Institute - a large tertiary hospital and research centre in Milan, Italy - was immediately involved in the management of the public health emergency. Since the beginning of the outbreak, the elective surgical activity of the hospital was rapidly reduced and large areas of the hospital were simultaneously reorganised to admit and assist patients with coronavirus disease 2019 (COVID-19). In addition, the hospital became the regional referral hub for cardiovascular emergencies in order to keep ensuring a high level of health care to non-COVID-19 patients in northern Italy.

      In a few days, a COVID-19 emergency department was created, improving the general ward capacity to a total number of 279 beds dedicated to patients with COVID-19. Moreover, the number of intensive care unit (ICU) beds was increased from 28 to 72 (54 of them dedicated to patients with COVID-19, and 18 to cardiology and cardiac surgery hub emergencies), both converting pre-existing areas and creating new high technology spaces.

      All the involved health care personnel were rapidly trained to use personal protection equipment and to manage this particular category of patients both in general wards and ICUs.

      Furthermore, besides clinical activities, continuously important research projects were carried out in order to find new strategies and more effective therapies to better face an unprecedented health emergency in Italy.

      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - In this issue of CCR
    • Abstract: Bellomo, Rinaldo
      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - Microvascular COVID-19 lung vessels obstructive
           thromboinflammatory syndrome (MicroCLOTS): An atypical acute respiratory
           distress syndrome working hypothesis
    • Abstract: Ciceri, Fabio; Beretta, Luigi; Scandroglio, Anna Mara; Colombo, Sergio; Landoni, Giovanni; Ruggeri, Annalisa; Peccatori, Jacopo; D'Angelo, Armando; de Cobelli, Francesco; Rovere-Querini, Patrizia; Tresoldi, Moreno; Dagna, Lorenzo; Zangrillo, Alberto
      We suggest the use of MicroCLOTS (microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome) as a new name for severe pulmonary coronavirus disease 2019 (COVID-19). We hypothesise that, in predisposed individuals, alveolar viral damage is followed by an inflammatory reaction and by microvascular pulmonary thrombosis. This progressive endothelial thromboinflammatory syndrome may also involve the microvascular bed of the brain and other vital organs, leading to multiple organ failure and death. Future steps in the understanding of the disease and in the identification of treatments may benefit from this definition and hypothesised sequence of events.

      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - ANZICS guiding principles for complex decision making
           during the COVID-19 pandemic
    • Abstract: Warrillow, Stephen; Austin, Danielle; Cheung, Winston; Close, Eliana; Holley, Anthony; Horgan, Ben; Jansen, Melanie; Joynt, Gavin; Lister, Paula; Moodie, Stewart; Nichol, Alistair; Nicholls, Mark; Peake, Sandra; Skowronski, George; Streat, Stephen; White, Ben; Willmott, Lindy
      The global 2019 coronavirus disease (COVID-19) pandemic has led to major challenges in clinical decision making when the demand for intensive care exceeds local capacity. In order to promote consistent, transparent, objective and ethical decision making, the Australian and New Zealand Intensive Care Society (ANZICS) formed a committee to urgently develop guidelines outlining key principles that should be utilised during the pandemic. This guidance is intended to support the practice of intensive care specialists during the COVID-19 pandemic and to promote the development of local admission policies that should be endorsed by health care organisations and relevant local authorities.

      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - Opportunities and challenges of clustering, crossing
           over, and using registry data in the PEPTIC trial
    • Abstract: Young, Paul J; Bagshaw, Sean M; Forbes, Andrew B; Nichol, Alistair D; Wright, Stephen E; Bellomo, Rinaldo; van Haren, Frank; Litton, Edward; Webb, Steve A
      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - 'Qua pote quisque, in ea conterat arte diem': COVID-19
           and Australian and New Zealand intensive care
    • Abstract: Udy, Andrew
      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - Comparative effectiveness research in critically ill
           patients: Risks associated with mischaracterising usual care
    • Abstract: Applefeld, Willard N; Wang, Jeffrey; Klein, Harvey G; Danner, Robert L; Eichacker, Peter Q; Natanson, Charles
      Comparative effectiveness research can help guide the use of common, routine medical practices. However, to be safe and informative, such trials must include at least one treatment arm that accurately portrays current practices. While comparative effectiveness research is widely perceived as safe and to involve no or only minimal risks, these assumptions may not hold true if unrecognised deviations from usual care exist in one or more study arms. For critically ill subjects in particular, such practice deviations may increase the risk of death or injury and undermine safety monitoring. Furthermore, unrecognised unusual care seems likely to corrupt informed consent documents, with underappreciated risks shrouded under the reassuring "comparative effectiveness" research label. At present, oversight measures are inadequate to ensure that research subjects enrolled in comparative effectiveness trials are actually receiving usual and not unusual care. Oversight by governmental and non-governmental entities with appropriate expertise, empowered to ensure that current clinical practice has been properly represented, could help prevent occurrences in clinical trials of unusual care masquerading as usual care.

      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - Critically ill patients with COVID-19 in Hong Kong: A
           multicentre retrospective observational cohort study
    • Abstract: Ling, Lowell; So, Christina; Shum, Hoi Ping; Chan, Paul KS; Lai, Christopher KC; Kandamby, Darshana H; Ho, Eunise; So, Dominic; Yan, Wing Wa; Lui, Grace; Leung, Wai Shing; Chan, Man Chun; Gomersall, Charles D
      Objective: To report the first eight cases of critically ill patients with coronavirus disease 2019 (COVID-19) in Hong Kong, describing the treatments and supportive care they received and their 28-day outcomes.

      Design: Multicentre retrospective observational cohort study.

      Setting: Three multidisciplinary intensive care units (ICUs) in Hong Kong.

      Participants: All adult critically ill patients with confirmed COVID-19 admitted to ICUs in Hong Kong between 22 January and 11 February 2020.

      Main outcome measure: 28-day mortality.

      Results: Eight out of 49 patients with COVID-19 (16%) were admitted to Hong Kong ICUs during the study period. The median age was 64.5 years (range, 42-70) with a median admission Sequential Organ Failure Assessment (SOFA) score of 6 (IQR, 4-7). Six patients (75%) required mechanical ventilation, six patients (75%) required vasopressors and two (25%) required renal replacement therapy. None of the patients required prone ventilation, nitric oxide or extracorporeal membrane oxygenation. The median times to shock reversal and extubation were 9 and 11 days respectively. At 28 days, one patient (12%) had died and the remaining seven (88%) all survived to ICU discharge. Only one of the survivors (14%) still required oxygen at 28 days.

      Conclusion: Critically ill patients with COVID-19 often require a moderate duration of mechanical ventilation and vasopressor support. Most of these patients recover and survive to ICU discharge with supportive care using lung protective ventilation strategies, avoiding excess fluids, screening and treating bacterial co-infection, and with timely intubation. Lower rather than upper respiratory tract viral burden correlates with clinical severity of illness.

      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - Temporal trend and survival impact of infection source
           among patients with sepsis: A nationwide study
    • Abstract: Chen, Yueh-Sheng; Liao, Tin-Yun; Hsu, Tzu-Chun; Hsu, Wan-Ting; Lee, Meng-Tse G; Lee, Chien-Chang
      Background: To determine the temporal trends of incidence and outcome based on different sources of sepsis using a nationwide administrative database.

      Methods: From 2002 to 2012, the entire Taiwan's health insurance claims data of emergency-treated and hospital-treated sepsis were analysed for incidence and mortality trends. The information about patients with sepsis and sources of sepsis was identified using a set of validated International Classification of Diseases, ninth revision, clinical modification (ICD-9-CM) codes. The 30-day all-cause mortality was verified by linked death certificate database.

      Results: A total of 1 259 578 episodes of sepsis were identified during the 11-year study period. Lower respiratory tract infection is the most common source of sepsis in patients, with the highest mortality rate. The incidence of genitourinary tract infection has the fastest growing rate. The sepsis mortality was declining at different rates for each source of sepsis. Co-infections in patients with sepsis are associated with higher mortality rate.

      Conclusion: The temporal trends of sepsis incidence and mortality varied among different sources of sepsis, with lower respiratory tract being the highest burden among patients with sepsis. Furthermore, sources of sepsis and the presence of co-infection are independent predictors of mortality. Our results support source-specific preventive and treatment strategies for future sepsis management.

      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - Study protocol and statistical analysis plan for the
           Liberal Glucose Control in Critically Ill Patients with Pre-existing Type
           2 Diabetes (LUCID) trial
    • Abstract: Poole, Alexis P; Finnis, Mark E; Anstey, James; Bellomo, Rinaldo; Bihari, Shailesh; Biradar, Vishwanath; Doherty, Sarah; Eastwood, Glenn; Finfer, Simon; French, Craig J; Ghosh, Angaj; Heller, Simon; Horowitz, Michael; Kar, Palash; Kruger, Peter S; Maiden, Matthew J; Martensson, Johan; McArthur, Colin J; McGuinness, Shay P; Secombe, Paul J; Tobin, Antony E; Udy, Andrew A; Young, Paul J; Deane, Adam M
      Background: Contemporary glucose management of intensive care unit (ICU) patients with type 2 diabetes is based on trial data derived predominantly from patients without type 2 diabetes. This is despite the recognition that patients with type 2 diabetes may be relatively more tolerant of hyperglycaemia and more susceptible to hypoglycaemia. It is uncertain whether glucose targets should be more liberal in patients with type 2 diabetes.

      Objective: To detail the protocol, analysis and reporting plans for a randomised clinical trial - the Liberal Glucose Control in Critically Ill Patients with Pre-existing Type 2 Diabetes (LUCID) trial - which will evaluate the risks and benefits of targeting a higher blood glucose range in patients with type 2 diabetes.

      Design, setting, participants and intervention: A multicentre, parallel group, open label phase 2B randomised controlled clinical trial of 450 critically ill patients with type 2 diabetes. Patients will be randomised 1:1 to liberal blood glucose (target 10.0-14.0 mmol/L) or usual care (target 6.0-10.0 mmol/L).

      Main outcome measures: The primary endpoint is incident hypoglycaemia (< 4.0 mmol/L) during the study intervention. Secondary endpoints include biochemical and feasibility outcomes.

      Results and conclusion: The study protocol and statistical analysis plan described will delineate conduct and analysis of the trial, such that analytical and reporting bias are minimised.

      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - Risk prediction for severe acute kidney injury by
           integration of urine output, glomerular filtration, and urinary cell cycle
           arrest biomarkers
    • Abstract: Bitker, Laurent; Cutuli, Salvatore L; Toh, Lisa; Bittar, Intissar; Eastwood, Glenn M; Bellomo, Rinaldo
      Background: Frequent assessment of urine output (UO), serum creatinine (sCr) and urinary cell cycle arrest biomarkers (CCAB) may improve acute kidney injury (AKI) prediction.

      Objective: To study the performance of UO, short term sCr changes and urinary CCAB to predict severe AKI.

      Methods: We measured 6 hours of UO, 6-hourly sCr changes, and urinary CCABs in all critically ill patients with cardiovascular or respiratory failure or early signs of renal stress between February and October 2018. We studied the association of such measurements, and their combination, with the development of AKI Stage 2 or 3 of the Kidney

      Disease: Improving Global Outcomes (KDIGO) definition at 12 hours. We evaluated predictive performance with logistic regression, area under the receiver operating characteristic (AUROC) curve, and net reclassification indices. We computed an optimal cut-off value for each biomarker.

      Results: We assessed 622 patients and, as per the exclusion criteria, we enrolled 105 critically ill patients. After 12 hours of enrolment, AKI occurred in 32 patients (30%). UO, sCr change over 6 hours and CCABs were significantly associated with severe AKI at 12 hours, with all variables achieving an AUROC > 0.7 after adjustment. Combination of any of the two or three variables achieved an AUROC > 0.7 for subsequent severe AKI at 12 hours. The optimal predictive high specificity cut-off values were = 1.5 (ng/mL)2/1000 for CCABs.

      Conclusion: In this prospective study, an integrative approach using UO, short term sCr change and/or urinary CCABs showed a satisfactory performance for the prediction of severe AKI development at 12 hours.

      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - Faecal diversion system usage in an adult intensive
           care unit
    • Abstract: Wilson, Nicholas; Bellomo, Rinaldo; Hay, Tyler; Fazio, Timothy; Entwistle, Jasmine; Presneill, Jeffrey J; Abdelhamid, Yasmine Ali; Deane, Adam M
      Objective: To determine the frequency, indications and complications associated with the use of faecal diversion systems (rectal tubes) in critically ill patients.

      Design: A single centre observational study over 15 months.

      Setting: Intensive care unit (ICU).

      Participants: Patients admitted during this period.

      Main outcome measures: Frequency of rectal tubes utilisation in ICU, as well as associated adverse events, with major events defined as lower gastrointestinal bleeding associated with defined blood transfusion of two or more units of red cells or endoscopy or surgical intervention.

      Results: Of 3418 admission episodes, there were 111 episodes of rectal tubes inserted in 99 patients. Rectal tubes remained indwelling for a median of 5 days (range, 1-23) for a total of 641 patient-days. The most frequent indication for insertion was excessive bowel motions. A major adverse event was observed in three patients (3%; 0.5 events per 100 device days). Two patients underwent laparotomy and one patient sigmoidoscopy. These patients received between two and 23 units of packed red blood cells. Patients who had a rectal tube inserted had a substantially greater duration of ICU admission (mean, 14 days [SD, 14] v 2.8 days [SD, 3.7]) and hospital mortality (15% 'v' 7.7%; risk ratio, 2.0; 95% CI, 1.2-3.4) as well as an overall higher Australian and New Zealand Risk of Death (ANZROD) score (mean, 27 [SD, 22] 'v' 12.6 [SD, 20]).

      Conclusion: Rectal tubes appear to be frequently inserted and can lead to major adverse events in critically ill patients.

      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - Continuous renal replacement therapy and its impact on
           hyperammonaemia in acute liver failure
    • Abstract: Warrillow, Stephen; Fisher, Caleb; Tibballs, Heath; Bailey, Michael; McArthur, Colin; Lawson-Smith, Pia; Prasad, Bheemasenachar; Anstey, Matthew; Venkatesh, Bala; Dashwood, Gemma; Walsham, James; Holt, Andrew; Wiersema, Ubbo; Gattas, David; Zoeller, Matthew; Alvarez, Mercedes Garcia; Bellomo, Rinaldo
      Objective: Hyperammonaemia contributes to complications in acute liver failure (ALF) and may be treated with continuous renal replacement therapy (CRRT), but current practice is poorly understood.

      Design: We retrospectively analysed data for baseline characteristics, ammonia concentration, CRRT use, and outcomes in a cohort of Australian and New Zealand patients with ALF.

      Setting: All liver transplant ICUs across Australia and New Zealand.

      Participants: Sixty-two patients with ALF.

      Main outcome measures: Impact of CRRT on hyperammonaemia and patient outcomes.

      Results: We studied 62 patients with ALF. The median initial (first 24 h) peak ammonia was 132 mmol/L (interquartile range [IQR], 91-172), median creatinine was 165 mmol/L (IQR, 92-263) and median urea was 6.9 mmol/L (IQR, 3.1-12.0). Most patients (43/62, 69%) received CRRT within a median of 6 hours (IQR, 2-12) of ICU admission. At CRRT commencement, three-quarters of such patients did not have Stage 3 acute kidney injury (AKI): ten patients (23%) had no KDIGO creatinine criteria for AKI, 12 (28%) only had Stage 1, and ten patients (23%) had Stage 2 AKI. Compared with non-CRRT patients, those treated with CRRT had higher ammonia concentrations (median, 141 mmol/L [IQR, 102-198] v 91 mmol/L [IQR, 54-115]; P = 0.02), but a nadir Day 1 pH of only 7.25 (standard deviation, 0.16). Prevention of extreme hyperammonaemia (> 140 mmol/L) after Day 1 was achieved in 36 of CRRT-treated patients (84%) and was associated with transplant-free survival (55% v 13%; P = 0.05).

      Conclusion: In Australian and New Zealand patients with ALF, CRRT is typically started early, before Stage 3 AKI or severe acidaemia, and in the presence hyperammonaemia. In these more severely ill patients, CRRT use was associated with prevention of extreme hyperammonaemia, which in turn, was associated with increased transplant-free survival.

      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - A survey of extracorporeal membrane oxygenation
           practice in 23 Australian adult intensive care units
    • Abstract: Linke, Natalie J; Fulcher, Bentley J; Engeler, Daniel M; Anderson, Shannah; Bailey, Michael J; Bernard, Stephen; Board, Jasmin V; Brodie, Daniel; Buhr, Heidi; Burrell, Aidan JC; Cooper, David J; Fan, Eddy; Fraser, John F; Gattas, David J; Higgins, Alisa M; Hopper, Ingrid K; Huckson, Sue; Litton, Edward; McGuinness, Shay P; Nair, Priya; Orford, Neil; Parke, Rachael L; Pellegrino, Vincent A; Pilcher, David V; Sheldrake, Jayne; Reddi, Benjamin AJ; Stub, Dion; Trapani, Tony V; Udy, Andrew A; Hodgson, Carol L
      In Australia, extracorporeal membrane oxygenation (ECMO) is one of the most expensive diagnosis-related groups, costing $305 463 per complex admission to the intensive care unit (ICU). Mortality in this group of patients is high, about 43% for respiratory failure and 68% for cardiac failure. ECMO is associated with significant risk to the patient and requires specialist training and expertise. Variation in clinical practice for patients supported with ECMO may compromise patient care and outcomes.

      PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - Errata
    • PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - Catheterisation of the brachial artery in children:
           Should we be so concerned'
    • PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 2 - Intensive care services during a pandemic: Who should
           be driving the messaging'
    • PubDate: Thu, 25 Jun 2020 23:56:19 GMT
       
  • Volume 22 Issue 1 - In this issue of 'CCR'
    • Abstract: Bellomo, Rinaldo
      PubDate: Thu, 12 Mar 2020 20:32:54 GMT
       
  • Volume 22 Issue 1 - The implications of the PEPTIC trial for clinical
           practice
    • Abstract: Young, Paul J; Bagshaw, Sean M; Bellomo, Rinaldo; Nichol, Alistair D; Wright, Stephen E
      PubDate: Thu, 12 Mar 2020 20:32:54 GMT
       
  • Volume 22 Issue 1 - Risk factors and outcomes of postoperative emergency
           response team activation: A matched case - control study
    • Abstract: Hardman, Matthew I; Kruthiventi, SChandralekha; Schmugge, Michelle R; Cavalcante, Alexandre N; Jensen, Jeffrey B; Schroeder, Darrell R; Sprung, Juraj; Weingarten, Toby N
      Objective: To determine patient and perioperative characteristics associated with unexpected postoperative clinical deterioration as determined for the need of a postoperative emergency response team (ERT) activation.

      Design: Retrospective case-control study.

      Setting: Tertiary academic hospital.

      Participants: Patients who underwent general anaesthesia discharged to regular wards between 1 January 2013 and 31 December 2015 and required ERT activation within 48 postoperative hours. Controls were matched based on age, sex and procedure.

      Main outcome measures: Baseline patient and perioperative characteristics were abstracted to develop a multiple logistic regression model to assess for potential associations for increased risk for postoperative ERT.

      Results: Among 105 345 patients, 797 had ERT calls, with a rate of 7.6 (95% CI, 7.1-8.1) calls per 1000 anaesthetics (0.76%). Multiple logistic regression analysis showed the following risk factors for postoperative ERT: cardiovascular disease (odds ratio [OR], 1.61; 95% CI, 1.18-2.18), neurological disease (OR, 1.57; 95% CI, 1.11-2.22), preoperative gabapentin (OR, 1.60; 95% CI, 1.17-2.20), longer surgical duration (OR, 1.06; 95% CI, 1.02-1.11, per 30 min), emergency procedure (OR, 1.54; 95% CI, 1.09-2.18), and intraoperative use of colloids (OR, 1.50; 95% CI, 1.17-1.92). Compared with control participants, ERT patients had a longer hospital stay, a higher rate of admissions to critical care (55.5%), increased postoperative complications, and a higher 30-day mortality rate (OR, 3.36; 95% CI, 1.73-6.54).

      Conclusion: We identified several patient and procedural characteristics associated with increased likelihood of postoperative ERT activation. ERT intervention is a marker for increased rates of postoperative complications and death.

      PubDate: Thu, 12 Mar 2020 20:32:54 GMT
       
  • Volume 22 Issue 1 - Haemodynamic effect of a 20% albumin fluid bolus in
           postcardiac surgery patients
    • Abstract: Cutuli, Salvatore L; Bitker, Laurent; Osawa, Eduardo A; O'Brien, Zachary; Canet, Emmanuel; Yanase, Fumitaka; Ancona, Paolo; Wilson, Anthony; Lucchetta, Luca; Kubicki, Mark; Cronhjort, Maria; Cioccari, Luca; Peck, Lea; Young, Helen; Eastwood, Glenn M; Martensson, Johan; Glassford, Neil J; Bellomo, Rinaldo
      Objective: To study the cardiovascular effect over 30 minutes following the end of fluid bolus therapy (FBT) with 20% albumin in patients after cardiac surgery.

      Design: Prospective observational study.

      Setting: Intensive care unit of a tertiary university-affiliated hospital.

      Participants: Twenty post-cardiac surgery mechanically ventilated patients with a clinical decision to administer FBT.

      Intervention: FBT with a 100 mL bolus of 20% albumin.

      Main outcome measures: Cardiac index (CI) response was defined by a >= 15% increase, while mean arterial pressure (MAP) response was defined by a >= 10% increase.

      Results: The most common indication for FBT was hypotension (40%). Median duration of infusion was 7 minutes (interquartile range [IQR], 3-9 min). At the end of FBT, five patients (25%) showed a CI response, which increased to almost half in the following 30 minutes and dissipated in one patient. MAP response occurred in 11 patients (55%) and dissipated in five patients (45%) by a median of 6 minutes (IQR, 6-10 min). CI and MAP responses coexisted in four patients (20%). An intrabolus MAP response occurred in 17 patients (85%) but dissipated in 11 patients (65%) within a median of 7 minutes (IQR, 2-11 min). On regression analysis, faster fluid bolus administration predicted MAP increase at the end of the bolus.

      Conclusion: In post-cardiac surgery patients, CI response to 20% albumin FBT was not congruous with MAP response over 30 minutes. Although hypotension was the main indication for FBT and a MAP response occurred in most of patients, such response was maximal during the bolus, dissipated in a few minutes, and was dissociated from the CI response.

      PubDate: Thu, 12 Mar 2020 20:32:54 GMT
       
  • Volume 22 Issue 1 - Prospective observational study of mechanical
           cardiopulmonary resuscitation, extracorporeal membrane oxygenation and
           early reperfusion for refractory cardiac arrest in Sydney: The 2CHEER
           study
    • Abstract: Dennis, Mark; Buscher, Hergen; Gattas, David; Burns, Brian; Habig, Karel; Bannon, Paul; Patel, Sanjay; Buhr, Heidi; Reynolds, Claire; Scott, Sean; Nair, Priya; Hayman, Jon; Granger, Emily; Lovett, Ryan; Forrest, Paul; Coles, Jennifer; Lowe, David A
      Background: Patients with prolonged cardiac arrest that is not responsive to conventional cardiopulmonary resuscitation have poor outcomes. The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest has shown promising results in carefully selected cases. We sought to validate the results from an earlier extracorporeal cardiopulmonary resuscitation (ECPR) study (the CHEER trial.

      Methods: Prospective, consecutive patients with refractory in-hospital (IHCA) or out-of-hospital cardiac arrest (OHCA) who met predefined inclusion criteria received protocolised care, including mechanical cardiopulmonary resuscitation, initiation of ECMO, and early coronary angiography (if an acute coronary syndrome was suspected).

      Results: Twenty-five patients were enrolled in the study (11 OHCA, 14 IHCA); the median age was 57 years (interquartile range [IQR], 39-65 years), and 17 patients (68%) were male. ECMO was established in all patients, with a median time from arrest to ECMO support of 57 minutes (IQR, 38-73 min). Percutaneous coronary intervention was performed on 18 patients (72%). The median duration of ECMO support was 52 hours (IQR, 24-108 h). Survival to hospital discharge with favourable neurological recovery occurred in 11/25 patients (44%, of which 72% had IHCA and 27% had OHCA). When adjusting for lactate, arrest to ECMO flow time was predictive of survival (odds ratio, 0.904; P = 0.035).

      Conclusion: ECMO for refractory cardiac arrest shows promising survival rates if protocolised care is applied in conjunction with predefined selection criteria.

      PubDate: Thu, 12 Mar 2020 20:32:54 GMT
       
  • Volume 22 Issue 1 - Autonomic function, postprandial hypotension and falls
           in older adults at one year after critical illness
    • Abstract: Abdelhamid, Yasmine Ali; Weinel, Luke M; Hatzinikolas, Seva; Summers, Matthew; Nguyen, Thu Anh Ngoc; Kar, Palash; Phillips, Liza K; Horowitz, Michael; Deane, Adam M; Jones, Karen L
      Objective: Postprandial hypotension occurs frequently in older survivors of critical illness at 3 months after discharge. We aimed to determine whether postprandial hypotension and its predictors - gastric dysmotility and cardiovascular autonomic dysfunction - persist or resolve as older survivors of critical illness recover, and whether postprandial hypotension after intensive care unit (ICU) discharge is associated with adverse outcomes at 12 months.

      Design: Prospective observational study.

      Setting: Tertiary medical-surgical ICU.

      Participants: Older adults (aged >= 65 years) who had been studied 3 months after ICU discharge and who returned for a follow-up study at 12 months after discharge.

      Main outcome measures: On both occasions after fasting overnight, participants consumed a 300 mL drink containing 75 g glucose, radiolabelled with 20 MBq 99mTcphytate. Blood pressure, heart rate, blood glucose concentration and gastric emptying rate were measured concurrently before and after ingestion of the drink. Falls, quality of life, hospitalisation and mortality rates were also quantified.

      Results: Out of 35 older adults studied at 3 months, 22 returned for the follow-up study at 12 months. Postprandial hypotension was evident in 29% of participants (95% CI, 14-44%) at 3 months and 10% of participants (95% CI, 1-30%) at 12 months. Postprandial hypotension at 3 months was associated with a more than threefold increase in the risk of falls in the year after ICU discharge (relative risk, 3.7 [95% CI, 1.6-8.8]; P = 0.003). At 12 months, gastric emptying was normal (mean time taken for 50% of gastric contents to empty, 101.6 [SD, 33.3] min) and cardiovascular autonomic dysfunction prevalence was low (9% [95% CI, 1-29%]).

      Conclusions: In older adults who were evaluated 3 and 12 months after ICU discharge, postprandial hypotension at 3 months was associated with an increased risk of subsequent falls, but the prevalence of postprandial hypotension decreased with time.

      PubDate: Thu, 12 Mar 2020 20:32:54 GMT
       
  • Volume 22 Issue 1 - Prevalence, characteristics, drainage and outcome of
           radiologically diagnosed pleural effusions in critically ill patients
    • Abstract: Bates, Davina; Yang, Natalie; Bailey, Michael; Bellomo, Rinaldo
      Objective: Pleural effusions in the intensive care unit (ICU) are clinically important. However, there is limited information regarding effusions in such patients. We aimed to estimate the prevalence, patient characteristics, mortality, effusion duration, radiological resolution, drainage, and reaccumulation rates of pleural effusions in ICU patients.

      Methods: This retrospective cohort study assessed all patients admitted to a tertiary hospital ICU from 1 January to 31 December 2015 with a chest x-ray report of pleural effusion. All chest x-ray reports were reviewed and data were combined with an established clinical ICU database. Statistical analysis of the combined dataset was performed.

      Results: Among 2094 patients admitted to the ICU, 566 (27%) had pleural effusions diagnosed by chest x-ray. The effusion median duration was 3 days (IQR, 1-5 days). Radiologically documented clearance of the effusion occurred in 243 patients (43%) and drainage was performed in 52 patients (9%). Among patients with effusion clearance, 80 (33%) reaccumulated the effusion. Drainage was more common in patients who experienced reaccumulation (19% v 7%; P = 0.004). Overall, 89 patients (16%) died, with 20% mortality among those with reaccumulation versus 9% among patients without reaccumulation (P = 0.037).

      Conclusion: Pleural effusions are common in ICU patients and drainage is infrequent. One-third of effusions reaccumulate, even after drainage, and one in six patients with an effusion die in hospital. This information helps clinicians estimate resolution rates, advantages and disadvantages of effusion drainage, and overall prognosis.

      PubDate: Thu, 12 Mar 2020 20:32:54 GMT
       
  • Volume 22 Issue 1 - Epidemiology and outcomes of obese critically ill
           patients in Australia and New Zealand
    • Abstract: Secombe, Paul; Woodman, Richard; Chan, Sean; Pilcher, David; van Haren, Frank
      Objective: The apparent survival benefit of being overweight or obese in critically ill patients (the obesity paradox) remains controversial. Our aim is to report on the epidemiology and outcomes of obesity within a large heterogenous critically ill adult population.

      Design: Retrospective observational cohort study.

      Setting: Intensive care units (ICUs) in Australia and New Zealand.

      Participants: Critically ill patients who had both height and weight recorded between 2010 and 2018.

      Outcome measures: Hospital mortality in each of five body mass index (BMI) strata. Subgroups analysed included diagnostic category, gender, age, ventilation status and length of stay.

      Results: Data were available for 381 855 patients, 68% of whom were overweight or obese. Increasing level of obesity was associated with lower unadjusted hospital mortality: underweight (11.9%), normal weight (7.7%), overweight (6.4%), class I obesity (5.4%), and class II obesity (5.3%). After adjustment, mortality was lowest for patients with class I obesity (adjusted odds ratio, 0.78; 95% CI, 0.74- 0.82). Adverse outcomes with class II obesity were only seen in patients with cardiovascular and cardiac surgery ICU admission diagnoses, where mortality risk rose with progressively higher BMIs.

      Conclusion: We describe the epidemiology of obesity within a critically ill Australian and New Zealand population and confirm that some level of obesity is associated with lower mortality, both overall and across a range of diagnostic categories and important subgroups. Further research should focus on potential confounders such as nutritional status and the appropriateness of BMI in isolation as an anthropometric measure in critically ill patients.

      PubDate: Thu, 12 Mar 2020 20:32:54 GMT
       
  • Volume 22 Issue 1 - Nitric oxide: A new role in intensive care
    • Abstract: Lee, Alexandra; Butt, Warwick
      Inhaled nitric oxide has been used for 30 years to improve oxygenation and decrease pulmonary vascular resistance. In the past 15 years, there has been increased understanding of the role of endogenous nitric oxide on cell surface receptors, mitochondria, and intracellular processes involving calcium and superoxide radicals. This has led to several animal and human experiments revealing a potential role for administered nitric oxide or nitric oxide donors in patients with systemic inflammatory response syndrome or ischaemia-reperfusion injury, and in patients for whom exposure of blood to artificial surfaces has occurred.

      PubDate: Thu, 12 Mar 2020 20:32:54 GMT
       
  • Volume 22 Issue 1 - Statistical analysis plan for the maximizing the
           efficacy of sedation and reducing neurological dysfunction and mortality
           in septic patients with acute respiratory failure trial
    • Abstract: Chandrasekhar, Rameela; Hughes, Christopher G; Pun, Brenda T; Orun, Onur M; Ely, EWesley; Pandharipande, Pratik P
      Background: The best sedative medication to reduce delirium, mortality and long term brain dysfunction in mechanically ventilated septic patients is unclear. This multicentre, double-blind, randomised trial investigates the short term and long term effects of dexmedetomidine versus propofol for sedation in mechanically ventilated severely septic patients.

      Objectives: To describe the statistical analysis plan for this randomised clinical trial comprehensively and place it in the public domain before unblinding.

      Methods: To ensure that analyses are not selectively reported, we developed a comprehensive statistical analysis plan before unblinding. This trial has an enrolment target of 420 severely septic and mechanically ventilated adult patients, randomly assigned to dexmedetomidine or propofol in a 1:1 ratio. Enrolment was completed in January 2019, and the study was estimated to be completed in September 2019. The primary endpoint is days alive without delirium or coma during first 14 study days. Secondary outcomes include 28-day ventilator-free days, 90-day all-cause mortality and cognitive function at 180 days. Time frames all begin on the day of randomisation. All analyses will be conducted on an intention-to-treat basis.

      Conclusion: This study will compare the effects of two sedatives in mechanically ventilated severely septic patients. In keeping with the guidance on statistical principles for clinical trials, we have developed a comprehensive statistical analysis plan by which we will adhere, as this will avoid bias and support transparency and reproducibility.

      PubDate: Thu, 12 Mar 2020 20:32:54 GMT
       
  • Volume 22 Issue 1 - Sodium bicarbonate in 5% dextrose: Can clinicians tell
           the difference'
    • Abstract: Jude, Briony; Naorungroj, Thummaporn; Neto, Ary Serpa; Fujii, Tomoko; Udy, Andrew; Bellomo, Rinaldo
      Background: Due to the lack of double-blind randomised controlled trials, the true effect of intravenous sodium bicarbonate therapy in ICU patients with metabolic acidosis remains unclear.

      Methods: We diluted 100 mL 8.4% sodium bicarbonate in 150 mL 5% dextrose (D5W) within a 250 mL polyolefin bag after removing 100 mL. We asked ICU clinicians to inspect a 250 mL bag containing sodium bicarbonate or a 250 mL bag where 100 mL of D5W had been removed and then returned. The bags were attached to intravenous giving sets. We asked participants to identify the contents of the bags.

      Results: Among 60 participants (39 nursing staff [65%], 20 medical staff [33.3%] and one pharmacist), 36 (60%) answered correctly. The Cohen κ for agreement between test bag content and participants' answers was 0.20 (95% CI, -0.05 to 0.45; P = 0.12), implying the answers were correct by chance. In the group of 28 participants who indicated they used a clue to help them decide their answer, 15 (53.6%) answered correctly, whereas in the remainder (n = 32), 21 (65.6%) answered correctly (P = 0.49).

      Conclusion: When 100 mL of 8.4% sodium bicarbonate were diluted in 150 mL of D5W within a 250 mL polyolefin bag, clinicians were unable to correctly identify the contents of the bags. Our findings imply that sodium bicarbonate therapy can be successfully blinded.

      PubDate: Thu, 12 Mar 2020 20:32:54 GMT
       
  • Volume 22 Issue 1 - Letter to the editor
    • PubDate: Thu, 12 Mar 2020 20:32:54 GMT
       
  • Volume 22 Issue 1 - Stability of bicarbonate in normal saline: A technical
           report
    • Abstract: Naorungroj, Thummaporn; Neto, Ary Serpa; Fujii, Tomoko; Jude, Briony; Udy, Andrew; Bellomo, Rinaldo
      Background: The benefit of intravenous sodium bicarbonate administration in patients with severe metabolic acidosis remains controversial, partly due to lack of double-blind trials. From a practical viewpoint, such blinding requires testing of the stability of sodium bicarbonate in polyolefin bags.

      Methods: We examined seven samples of 100 mL 8.4% sodium bicarbonate diluted in 150 mL normal saline within a 250 mL polyolefin bag at time 0, 24 and 48 hours after preparation. We measured pH, Pco2, and bicarbonate concentration.

      Results: Over a period of 48 hours, both pH and Pco2 decreased significantly (hourly rate of change, -0.001 [P = 0.043) and -0.098 [P < 0.001] respectively). However, the concentration of bicarbonate did not decrease, with an hourly rate of change of only -0.009 (P = 0.42).

      Conclusion: When 100 mL of 8.4% sodium bicarbonate are diluted in 150 mL of normal saline within a 250 mL polyolefin bag, changes in pH and Pco2 over a 48-hour period are small and bicarbonate concentration remains stable.

      PubDate: Thu, 12 Mar 2020 20:32:54 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: 75.101.173.236
 
Home (Search)
API
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-