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| 4. |
- Castegren, Markus, et al.
(author)
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Initial levels of organ failure, microbial findings and mortality in intensive care-treated primary, secondary and tertiary sepsis
- 2015
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In: Critical Care and Resuscitation. - 1441-2772. ; 17:3, s. 174-181
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Journal article (peer-reviewed)abstract
- Objective: Analysis of whether patients with primary, secondary and tertiary sepsis, defined by the presence or absence of recent systemic inflammation-inducing events before the onset of sepsis, differ in clinical presentation, microbiological test results, treatment received and outcome. Design, setting and participants: A retrospective observational study in a single, general intensive care unit, of all patients treated for severe sepsis or septic shock from 2006 to 2011. Patients with haematological malignancies, with immunosuppressive diseases or being treated with immunosuppressive drugs were excluded. Interventions: None. Main outcome measures: Sequential Organ Failure Assessment score, incidence of organ failure, microbiological results of blood cultures and mortality. Results: We included 213 patients, who were classified as having primary (n = 121), secondary (n = 65) or tertiary sepsis (n = 27). The groups differed significantly in SOFA score, the incidence of kidney failure and coagulation failure at onset of sepsis in the ICU, as well as in blood culture findings. No differences in 7-day or 28-day mortality were seen, but the time of death occurred earlier among non-survivors in the primary sepsis group. Conclusions: Inflammatory insults before the onset of sepsis affect the clinical picture, blood microbial findings, and in non-survivors, the time of death. These results could, if validated in a prospective study, form a basis for a novel and simple strategy for stratifying patients in clinical studies for immunomodulation therapies in sepsis.
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- Frost, Steven A, et al.
(author)
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Unplanned admission to the intensive care unit in the very elderly and risk of in-hospital mortality.
- 2010
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In: Critical care and resuscitation. - 1441-2772. ; 12:3, s. 171-6
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Journal article (peer-reviewed)abstract
- BACKGROUND: Unplanned admission to the intensive care unit has been shown to significantly increase the risk of inhospital mortality. Medical advances and increased expectations have resulted in a greater number of very elderly patients (80 years and over) being admitted to the ICU. The risk of in-hospital death associated with unplanned admission to the ICU in very elderly patients has not been clearly defined. OBJECTIVE: To estimate the risk of in-hospital mortality associated with unplanned admission to the ICU in patients aged 80 years and over. DESIGN, SETTING AND PARTICIPANTS: Retrospective review of an adult intensive care database. The setting was Liverpool Hospital, a large teaching hospital in Sydney, Australia, with a 28-bed ICU that has about 2000 admissions per year. We analysed data on very elderly patients (n = 1680), aged 80 years or more, admitted to the ICU between 1 January 1997 and 31 December 2007. MAIN OUTCOME MEASURES: Baseline risk factors for inhospital mortality. RESULTS: Mortality among patients with unplanned ICU admissions was 47%, compared with 25% in patients with planned admissions (adjusted rate ratio [RR], 1.92 [95% CI, 1.59-2.32]). An estimated 50% of the overall risk of inhospital death among very elderly patients was attributable to a combination of unplanned admission to the ICU, the presence of at least one comorbid condition, acute renal failure and respiratory failure requiring intubation. CONCLUSION: Unplanned admission to the ICU increases the risk of in-hospital mortality in very elderly patients. At least 50% of the risk of in-hospital death in this age group is attributable to a combination of unplanned ICU admission, comorbidity (≥1 comorbid condition), acute renal failure and respiratory failure.
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- Jonsson, Niklas, et al.
(author)
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Calprotectin as an early biomarker of bacterial infections in critically ill patients : an exploratory cohort assessment
- 2017
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In: Criminology & Public Policy. - 1538-6473 .- 1745-9133. ; 19:3, s. 205-213
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Journal article (peer-reviewed)abstract
- BACKGROUND: Calprotectin is the most abundant protein in the cytosolic fraction of neutrophils, and neutrophil degranulation is a major response to bacterial infections.OBJECTIVES: To assess the value of plasma calprotectin as an early marker of bacterial infections in critically ill patients and compare it with the corresponding values for procalcitonin (PCT), C-reactive protein (CRP) and white blood cell count (WBC).METHODS: We measured daily plasma calprotectin levels in 110 intensive care unit patients using a newly developed turbidimetric assay run on clinical chemistry analysers. The likelihood of infection was determined according to the International Sepsis Forum criteria.RESULTS: Overall, 58 patients (52.7%) developed a suspected or confirmed bacterial infection. Plasma calprotectin predicted such infections within 24 hours with an area under the receiver operating characteristics curve (ROC area) of 0.78 (95% CI, 0.68-0.89). The ROC area for calprotectin was significantly greater than the corresponding ROC areas for WBC (P < 0.001) and PCT (P = 0.02) but only marginally better than the ROC area for CRP (0.71; 95% CI, 0.68-0.89).CONCLUSION: Plasma calprotectin appears to be a useful early marker of bacterial infections in critically ill patients, with better predictive characteristics than WBC and PCT.
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| 13. |
- Lipcsey, Miklos, et al.
(author)
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Epidemiology of secondary fluid bolus therapy for infection-associated hypotension
- 2016
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In: Critical Care and Resuscitation. - 1441-2772. ; 18:3, s. 165-173
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Journal article (peer-reviewed)abstract
- Objective: Fluid bolus therapy (FBT) is a common therapy for hypotensive sepsis, but no studies have compared primary FBT (in the first 6 hours after presentation to the emergency department [ED]) with secondary FBT (6-24 hours after presentation to the ED). We aimed to describe the patterns of use, physiological sequelae and outcomes of patients with hypotensive sepsis who were treated with primary FBT or combined primary and secondary FBT (secondary FBT). Design, setting and patients: A retrospective observational study of patients with hypotensive sepsis presenting to the ED of a tertiary hospital from 1 January to 31 December 2010. Results: We studied 100 consecutive eligible patients (primary FBT, n = 52; secondary FBT, n = 48). Secondary FBT occurred in the ward (n = 31) or in the intensive care unit (n = 17). More patients receiving secondary FBT had sepsis with undefined focus or septic shock (P = 0.005, P = 0.0001, respectively), and fewer patients receiving secondary FBT had pneumonia (P = 0.0004). At 24 hours, the use of secondary FBT was similar for patients admitted to the ward and the ICU, and represented about 40% of all secondary fluids given. The volume of any bolus was greater during primary resuscitation, and the size of physiological changes associated with FBT diminished with time. The mortality rate at 28 days was 27%, and was similar for ward and ICU admissions. Conclusions: Secondary FBT is given to about half of patients presenting with hypotensive sepsis, takes place in wards more often than in the ICU and delivers a significant proportion of overall fluids, but is associated with limited changes in measured physiological variables.
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| 14. |
- Lipcsey, Miklos, et al.
(author)
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Near-infrared spectroscopy of the thenar eminence : comparison of dynamic testing protocols
- 2012
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In: Critical Care and Resuscitation. - 1441-2772. ; 14:2, s. 142-147
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Journal article (peer-reviewed)abstract
- Background: Near-infrared spectroscopy of the thenar eminence (NIRSth) is a non-invasive bedside method for assessing tissue oxygenation. The vascular occlusion test (VOT) with a pressure cuff can be used to provide a dynamic assessment of the tissue oxygenation response to ischaemia. VOT has been applied to assess the microcirculation by NIRSth in critically ill patients. The optimal mode of performing such VOT, however, remains controversial. Design, participants and setting: Prospective observational study among a cohort of 11 healthy volunteers in a tertiary intensive care department. Intervention: Measurement of NIRS-derived parameters using 1-, 2- and 3-minute VOTs or VOT to 40% tissue oxygen saturation (StO(2)). Main outcome measure: Changes in StO(2) and tissue haemoglobin index (THI) over time, and relative change from baseline for StO(2) and THI. Results: Mean baseline StO(2) was 80% (SD, 5%) and mean THI was 13.7 (SD, 1.9). The lowest StO(2) at the end of the VOT was 39% (SD, 13%) and 39% (SD, 2%) in the 3-minute and the 40% StO(2) VOTs, respectively. The duration of the 40% StO(2) VOT ranged from 1:35 to 8:21 minutes (median, 3:29 min). There was a difference between the StO(2) curves for the 3-minute and 40% StO(2) VOT (P = 0.005) but not the THI curves. Reported pain score was a median of 3.5 (IQR, 2.5-5.5) and 4 (IQR 2-4) for the 3-minute and 40% StO(2) VOTs, respectively. Conclusions: The 3-minute VOT and the 40% StO(2) appear equivalent. However, the 3-minute VOT carries a degree of decreased patient discomfort and shorter overall duration of execution.
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| 15. |
- Lipcsey, Miklos, et al.
(author)
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Primary fluid bolus therapy for infection-associated hypotension in the emergency department
- 2015
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In: Critical Care and Resuscitation. - 1441-2772. ; 17:1, s. 6-11
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Journal article (peer-reviewed)abstract
- Objectives: The physiological changes associated with fluid bolus therapy (FBI) for patients with infection-associated hypotension in the emergency department (ED) are poorly understood. We describe the physiological outcomes of FBT in the first 6 hours (primary FBT) for patients presenting to the ED with infection-associated hypotension. Methods: We studied 101 consecutive ED patients with infection and a systolic blood pressure (SBP) <100 mmHg who underwent FBI in the first 6 hours. Results: We screened 1123 patients with infection and identified 101 eligible patients. The median primary FBI volume given was 1570 mL (interquartile range, 1000 2490 mL). The average mean arterial pressure (MAP) did not change from admission to 6 hours in the whole cohort, or in patients who were hypotensive on arrival at the ED. However, the average MAP increased from its lowest value during the first 6 hours (66 mmHg [SD, 10 mmHg]) to its value at 6 hours (73 mmHg [SD, 12 mmHg]; P < 0.001). The mean heart rate, body temperature, respiratory rate and plasma creatinine level decreased (P < 0.05). In patients who were severely hypotensive (SBP <90 mmHg) on arrival at the ED, the MAP increased from 54 mmHg (SD, 8 mmHg) to 70 mmHg (SD, 14 mmHg) (P < 0.001). At 6 hours, however, SBP was still <100 mmHg in 44 patients and <90 mmHg in 17 patients. When noradrenaline was used, in 10 patients, hypotension was corrected in all 10 and the MAP increased from 58 mmHg (SD, 9 mmHg) to 75 mmHg (SD, 13 mmHg). Conclusion: Among ED patients admitted to an Australian teaching hospital with infection, hypotension was uncommon. FBT for hypotension was limited in volumes given and failed to achieve a sustained SBP of > 100 mmHg in 40% of cases. In contrast, noradrenaline therapy corrected hypotension in all patients who received it.
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- Mårtensson, Johan, et al.
(author)
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COVID-19 critical illness in Sweden : characteristics and outcomes at a national population level
- 2020
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In: Critical Care and Resuscitation. - Strawberry Hills, NSW, Australia : AUSTRALASIAN MED PUBL CO LTD. - 1441-2772. ; 22:4, s. 312-320
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Journal article (peer-reviewed)abstract
- Objective: During the coronavirus disease 2019 (COVID-19) pandemic, baseline demographics and comorbidities of patients with COVID-19 have been presented, but there are limited data on outcomes of severely ill patients. We aimed to examine the association between patient characteristics and 30-day mortality among patients with COVID-19 treated in the intensive care unit (ICU).Design: Population-based cohort study.Setting: ICUs in Sweden.Participants: All consecutive patients with COVID-19 admitted to Swedish ICUs from 6 March to 5 April 2020.Main outcome measures: The primary outcome was 30-day mortality after ICU admission. Patient demographics, comorbidities and clinical characteristics were also retrieved.Results: A total of 604 patients were included. The median age was 61 years (interquartile range [IQR], 52-70 years) and 458 patients (76%) were males. The most common comorbidities were hypertension (35.9%) and diabetes (25.7%), whereas 36.4% of patients had no comorbidities. Median Simplified Acute Physiology Score (SAPS) 3 was 53 (IQR, 46-60). Of 573 patients with available respiratory support data, 487 (85.0%) received invasive mechanical ventilation. Among 518 patients with available data, 117 (22.6%) received renal replacement therapy. Median length of stay was 13 days (IQR, 6-20 days). Mortality at 30 days was 32.6%. In the multivariable Cox regression model, age (hazard ratio [HR] 1.06; 95% CI, 1.04-1.07 per year), the presence of one or more comorbidities (HR, 1.80; 95% CI, 1.20-2.68), chronic obstructive pulmonary disease or asthma (HR, 1.68; 95% CI, 1.12-2.50), hypertension (HR, 1.41; 95% CI, 1.01-1.99), and acute illness severity (SAPS 3 excluding age and comorbidity) (HR, 1.06; 95% CI, 1.04-1.09) were associated with 30-day mortality.Conclusions: This population-based cohort study presents 30-day mortality of 604 ICU patients with COVID-19. The higher mortality was explained by older age, the presence chronic illness, and acute illness severity.
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| 20. |
- Nichol, Alistair, et al.
(author)
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Protocol summary and statistical analysis plan for the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) trial
- 2021
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In: Critical Care and Resuscitation. - 1441-2772. ; 23:4, s. 374-385
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Journal article (peer-reviewed)abstract
- Background: Targeted therapeutic mild hypercapnia may attenuate brain injury in comatose adults resuscitated from out-of-hospital cardiac arrest. Objective: To describe the study protocol and statistical analysis plan for the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) trial. Design, setting, participants and interventions: TAME is a phase 3, multicentre, parallel-group, participant-and outcome assessor-blinded randomised controlled trial that will be conducted in intensive care units in Australia, Canada, Ireland, Saudi Arabia, New Zealand, Scandinavia, Singapore, Central and Western Europe, and the United Kingdom. A total of 1700 comatose adults resuscitated from out-of-hospital cardiac arrest will be randomly assigned to 24 hours of targeted therapeutic mild hypercapnia (arterial carbon dioxide tension 50–55 mmHg) or targeted normocapnia (arterial carbon dioxide tension 35–45 mmHg) in a 1:1 ratio. TAME recruitment began in March 2018 and is expected to be complete in September 2021. Main outcome measures: The primary outcome measure is the proportion of participants with a favourable functional outcome at 6 months. Functional outcomes will be assessed using the Glasgow Outcome Scale-Extended (GOSE); this scale ranges from 1 to 8, with a higher value indicating a better outcome. We will define participants with a GOSE of 5 to 8 as having a favourable functional outcome. Secondary outcomes include 6-month mortality, cognitive function and quality of life. All analyses will be conducted on an intention-to-treat basis. Results and conclusions: TAME will compare the effect of targeted therapeutic mild hypercapnia versus targeted normocapnia on functional outcomes in adults resuscitated from out-of-hospital cardiac arrest who are admitted to an intensive care unit. Trial registration: Australian and New Zealand Clinical Trials Registry (ACTRN12617000036314p) and ClinicalTrials.gov (NCT03114033).
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| 25. |
- Schneider, Antoine G., et al.
(author)
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Relationship between illness severity scores in acute kidney injury
- 2012
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In: Critical Care and Resuscitation. - 1441-2772. ; 14:1, s. 53-55
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Journal article (peer-reviewed)abstract
- Background: In the field of critical care nephrology, recent publications have used different illness severity scoring systems, making outcome comparisons difficult.Objective: To establish a methodology to translate one illness severity scoring system into another for critically ill patients with acute kidney injury (AKI). Design: Statistical analysis of prospectively obtained data.Methods: Using data from the Australian and New Zealand Intensive Care Society Adult Patient Database, we obtained Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III and Simplified Acute Physiology Score (SAPS II) scores for all patients admitted with AKI. We applied correlation and linear regression analyses as well as cross-validation with holdout samples.Results: Between 2001 and 2010, the three illness severity scores were obtained in 636 431 admissions. Of these, 37 203 fulfilled the APACHE score criteria for AKI. The coefficient of determination (R-2) between APACHE II and APACHE III scores was 0.66. The overall model was APACHE III = 3.13 x APACHE II + 7.99 (P<0.001). Similarly, the R-2 between APACHE III and the SAPS II scores was 0.78. The overall model was APACHE III = 1.49 x SAPS II + 15.5 (P<0.001). The R-2 between APACHE II and SAPS II scores was 0.62. The overall model was APACHE II = 0.35 x SAPS II + 9.3 (P<0.001).Conclusions: Simple, robust translational formulae can be developed to allow clinicians to compare illness severity of patients with AKI when illness severity is expressed with different scoring systems.
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| 29. |
- Woinarski, Nicholas C. Z., et al.
(author)
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Near-infrared spectroscopy of the thenar eminence to estimate forearm blood flow
- 2013
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In: Critical Care and Resuscitation. - 1441-2772. ; 15:4, s. 323-326
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Journal article (peer-reviewed)abstract
- Background: Near-infrared spectroscopy of the thenar eminence (NIRSth) can be used at the bedside to assess tissue oxygenation (Sto(2)), the reperfusion response to ischaemia and the tissue haemoglobin index (THI). Its ability to estimate forearm blood flow (FBF) has not previously been assessed. Objectives: We aimed to test whether short-lived venous occlusion-induced changes in NIRSth-derived THI (Delta THI/minute) correlate with strain gauge plethysmography (SGP) measurements. Methods: We measured FBF in nine volunteers with SGP by venous occlusion, while estimating Delta THI. Measurements were obtained in two forearm positions (elevated and horizontal) at baseline and during induced hyperaemia. Results: We performed 246 paired measurements at rest and after occlusion-induced hyperaemia. At rest, mean SGP-estimated FBF was 3.5-3.6 mL/dL/minute at baseline, compared with 12.9-13.6 mL/dL/minute during hyperaemia. At rest, Delta THI was 6.1-8.2/minute, compared with 29.7-32.5/minute during hyperaemia. Delta THI was a significant predictor of SGP FBF (P<0.01), with stronger correlation during hyperaemia (P<0.01). An equation was developed to convert Delta THI/minute into FBF at mL/dL/minute (FBF=0.362 x Delta THI/minute + 0.864). Conclusions: NIRSth can be used to estimate FBF. Given its portability and its ability to also measure Sto(2) and vascular reactivity, NIRSth can assist in providing a comprehensive bedside assessment of the forearm circulation in critically ill patients.
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| 30. |
- Wong, LY, et al.
(author)
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Long-term outcomes after severe drug overdose
- 2016
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In: Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine. - 1441-2772. ; 18:4, s. 247-254
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Journal article (peer-reviewed)
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