Adult Intensive Care Unit

Brisbane, Australia

Adult Intensive Care Unit

Brisbane, Australia
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Breitkreutz R.,Saarland University | Breitkreutz R.,Goethe University Frankfurt | Price S.,Adult Intensive Care Unit | Steiger H.V.,Kerckhoff Heart Center | And 7 more authors.
Resuscitation | Year: 2010

Purpose of the study: Focused ultrasound is increasingly used in the emergency setting, with an ALS-compliant focused echocardiography algorithm proposed as an adjunct in peri-resuscitation care (FEEL). The purpose of this study was to evaluate the feasibility of FEEL in pre-hospital resuscitation, the incidence of potentially treatable conditions detected, and the influence on patient management. Patients, materials and methods: A prospective observational study in a pre-hospital emergency setting in patients actively undergoing cardio-pulmonary resuscitation or in a shock state. The FEEL protocol was applied by trained emergency doctors, following which a standardised report sheet was completed, including echo findings and any echo-directed change in management. These reports were then analysed independently. Results: A total of 230 patients were included, with 204 undergoing a FEEL examination during ongoing cardiac arrest (100) and in a shock state (104). Images of diagnostic quality were obtained in 96%. In 35% of those with an ECG diagnosis of asystole, and 58% of those with PEA, coordinated cardiac motion was detected, and associated with increased survival. Echocardiographic findings altered management in 78% of cases. Conclusions: Application of ALS-compliant echocardiography in pre-hospital care is feasible, and alters diagnosis and management in a significant number of patients. Further research into its effect on patient outcomes is warranted. © 2010 Elsevier Ireland Ltd.

Delaney A.P.,Royal North Shore Hospital | Delaney A.P.,University of Sydney | Peake S.L.,Monash University | Peake S.L.,The Queen Elizabeth Hospital | And 14 more authors.
Critical Care and Resuscitation | Year: 2013

Background: The Australasian Resuscitation in Sepsis Evaluation (ARISE) study is an international, multicentre, randomised, controlled trial designed to evaluate the effectiveness of early goal-directed therapy compared with standard care for patients presenting to the emergency department with severe sepsis. Objective: In keeping with current practice, and considering aspects of trial design and reporting specific to non-pharmacological interventions, our plan outlines the principles and methods for analysing and reporting the trial results. The document is prepared before completion of recruitment into the ARISE study, without knowledge of the results of the interim analysis conducted by the data safety and monitoring committee and before completion of the two related international studies. Methods: Our statistical analysis plan was designed by the ARISE chief investigators, and reviewed and approved by the ARISE steering committee. We reviewed the data collected by the research team as specified in the study protocol and detailed in the study case report form. We describe information related to baseline characteristics, characteristics of delivery of the trial interventions, details of resuscitation, other related therapies and other relevant data with appropriate comparisons between groups. We define the primary, secondary and tertiary outcomes for the study, with description of the planned statistical analyses. Results: We have developed a statistical analysis plan with a trial profile, mock-up tables and figures. We describe a plan for presenting baseline characteristics, microbiological and antibiotic therapy, details of the interventions, processes of care and concomitant therapies and adverse events. We describe the primary, secondary and tertiary outcomes with identification of subgroups to be analysed. Conclusion: We have developed a statistical analysis plan for the ARISE study, available in the public domain, before the completion of recruitment into the study. This will minimise analytical bias and conforms to current best practice in conducting clinical trials.

Schmidt M.,Klinika Anesteziologie A Resuscitace | Schmidt M.,Charles University | Pokorna E.,Transplantcentrum IKEM | Fric M.,Klinika Anesteziologie A Resuscitace | And 2 more authors.
Anesteziologie a Intenzivni Medicina | Year: 2012

Objective: To identify potential organ donors after cardiac death (DCD) in the intensive care unit. Design: Retrospective, observational, single-center study. Setting: Department of Anaesthesiology and Intensive Care Medicine, University Hospital. Materials and methods: Out of 1513 patients admitted between 2010 and 2011, we retrospectively tested the ability of the subgroup of nonsurvivors to become DCD organ donors. Results: 23 patients were diagnosed as brain dead and became organ donors (DBD). Another 21 patients met the criteria for donors after cardiac death. Conclusion: Implementation of the DCD programme would significantly increase the number of organ donors (by up to 50% in our institution).

Price S.,Adult Intensive Care Unit | Ilper H.,Goethe University Frankfurt | Uddin S.,Barts and the London NHS Trust | Steiger H.V.,Kerckhoff Heart Center | And 9 more authors.
Resuscitation | Year: 2010

Aims: Echocardiography performed in an ALS-compliant manner provides a tool whereby some of the potentially reversible causes of cardiac arrest can be diagnosed in real time by minimally trained practitioners. One of the major concerns this raises is how to deliver effective training to the required standard. The objective of this study was to determine the effectiveness of number of different educational methods used teach echocardiography to novices. This involved assessment of cognitive, psychomotor skills and affective aspects in five key areas. Methods: The study population was a convenience sample from participants attending standardised structured one-day training courses in peri-resuscitation echocardiography (n= 204). Subjects were assessed for five learning outcomes including knowledge and image interpretation, practical performance of echocardiography including time taken to obtain a diagnostic view, integration into the ALS algorithm and overall compliance with established resuscitation guidelines. Results: There was a significant improvement in knowledge and interpretation of echocardiographic images before and after completion of the one-day course (pre 62%, post 78%, pandlt;0.01). Skills acquisition resulted in 100% of participants being able to obtain a subcostal view of diagnostic quality by the end of the course, and 86% with a mean time to acquisition of andlt;10 s. On completion of the training programme, incorporation of echocardiography into current resuscitation practice did not compromise ALS-compliance. Conclusion: Novice echocardiographers can obtain knowledge and skills relevant to ALS-compliant peri-resuscitation echocardiography using a range of educational techniques. In addition to the standard one-day training courses available, continued mentored practice and didactic adherence to ALS algorithms is required. andcopy; 2010 Elsevier Ireland Ltd.

Bittner M.-I.,Albert Ludwigs University of Freiburg | Donnelly M.,Tallaght Hospital | van Zanten A.R.H.,Gelderse Vallei Hospital | Andersen J.S.,Copenhagen University | And 9 more authors.
Annals of Intensive Care | Year: 2013

Reimbursement schemes in intensive care are more complex than in other areas of healthcare, due to special procedures and high care needs. Knowledge regarding the principles of functioning in other countries can lead to increased understanding and awareness of potential for improvement. This can be achieved through mutual exchange of solutions found in other countries. In this review, experts from eight European countries explain their respective intensive care unit reimbursement schemes. Important conclusions include the apparent differences in the countries' reimbursement schemes-despite all of them originating from a DRG system-, the high degree of complexity found, and the difficulties faced in several countries when collecting the data for this collaborative work. This review has been designed to assist the intensivist clinician and researcher in understanding neighbouring countries' approaches and in putting research into the context of a European perspective. In addition, steering committees and decision makers might find this a valuable source to compare different reimbursement schemes. © 2013 Bittner et al.

Dimeski G.,Princess Alexandra Hospital | Morgan T.J.,Adult Intensive Care Unit | Presneill J.J.,Adult Intensive Care Unit | Venkatesh B.,Princess Alexandra and Wesley Hospitals
Journal of Critical Care | Year: 2012

Purpose: We estimated the proportion of indirect ion selective electrode (ISE) plasma sodium analyses in intensive care unit (ICU) and hospital wide, exhibiting important disagreement with direct ISE results in relation to abnormal plasma protein concentrations. Materials and Methods: Direct and indirect ISE plasma sodium measurements were performed on 346 clinical specimens selected to reflect low, normal, or high total protein concentrations. Important intermethod disagreement was defined as |4| mmol/L or higher. Results were extrapolated to a 3-month laboratory series of 48033 indirect ISE assays, including 2877 samples from intensive care. Results: Intermethod sodium disagreement at |4| mmol/L or higher was predicted for 25% of ICU samples. Almost all (97%) occurred in hypoproteinemic samples where indirect tended to exceed direct ISE estimates. Hospital wide, such disagreement was projected to occur in 8% of samples, of which the majority (70%) were also hypoproteinemic. Conclusions: Important disagreement between indirect and direct ISE sodium measurements may exist in up to 1 in 4 ICU specimens and 1 in 12 hospital-wide samples. The main problem is indirect ISE overestimation associated with hypoproteinemia, potentially leading to misclassifications of pseudohypernatremia and pseudonormonatremia. We recommend that hospital laboratories consider standardization using direct ISE sodium measurement. © 2012 Elsevier Inc.

Dean C.,Imperial College London | Dean C.,Mammalian Genetics Unit | Bingle C.,University of Sheffield | Hind M.,Adult Intensive Care Unit
Clinical Science | Year: 2013

The IMPC (International Mouse Phenotyping Consortium) was launched recently, and its aim is to develop and phenotype mouse knockouts of 4000 genes over the next 5 years and, ultimately, of all 20000 or so genes in the mouse genome. As part of the IMPC, the MRC (Medical Research Council) also launched a call for MRC mouse networks, where groups of U.K.-based researchers could form a consortium based around a particular area of research. Members of the respiratory research community formed the RDDRC (Respiratory Development and Disease Research Consortium) to consolidate and develop respiratory phenotyping methods suitable for high-throughput screening. This paper, arising from a Biochemical Society workshop held in London in 2012, highlights the purposes of the RDDRC and the needs of the respiratory research community. ©2013 Biochemical Society.

Shorr A.F.,Washington Hospital Center | Janes J.M.,Eli Lilly and Company | Artigas A.,Autonomous University of Barcelona | Tenhunen J.,University of Tampere | And 9 more authors.
Critical Care | Year: 2010

Introduction: Serial alterations in protein C levels appear to correlate with disease severity in patients with severe sepsis, and it may be possible to tailor severe sepsis therapy with the use of this biomarker. The purpose of this study was to evaluate the dose and duration of drotrecogin alfa (activated) treatment using serial measurements of protein C compared to standard therapy in patients with severe sepsis.Methods: This was a phase 2 multicenter, randomized, double-blind, controlled study. Adult patients with two or more sepsis-induced organ dysfunctions were enrolled. Protein C deficient patients were randomized to standard therapy (24 μg/kg/hr infusion for 96 hours) or alternative therapy (higher dose and/or variable duration; 24/30/36 μg/kg/hr for 48 to 168 hours). The primary outcome was a change in protein C level in the alternative therapy group, between study Day 1 and Day 7, compared to standard therapy.Results: Of 557 patients enrolled, 433 patients received randomized therapy; 206 alternative, and 227 standard. Baseline characteristics of the groups were largely similar. The difference in absolute change in protein C from Day 1 to Day 7 between the two therapy groups was 7% (P = 0.011). Higher doses and longer infusions were associated with a more pronounced increase in protein C level, with no serious bleeding events. The same doses and longer infusions were associated with a larger increase in protein C level; higher rates of serious bleeding when groups received the same treatment; but no clear increased risk of bleeding during the longer infusion. This group also experienced a higher mortality rate; however, there was no clear link to infusion duration.Conclusions: The study met its primary objective of increased protein C levels in patients receiving alternative therapy demonstrating that variable doses and/or duration of drotrecogin alfa (activated) can improve protein C levels, and also provides valuable information for incorporation into potential future studies. Trial registration: identifier: NCT00386425. © 2010 Shorr et al.; licensee BioMed Central Ltd.

PubMed | Adult Intensive Care Unit
Type: | Journal: BMJ case reports | Year: 2011

During a high speed road traffic accident, a 26-year-old man suffered multiple fractures of his thoracic vertebrae and bilateral pneumothoraces. The day after admission and commencement of nasogastric feeding, milky fluid was noted in his right chest drain. Feeding was stopped and a contrast oesophogram and oesophagoscopy were performed, which were normal. The chylothorax quickly resolved and both drains were removed on day 6. Initial treatment of chylothorax aims to decompress the pleural space and minimise chyle production by stopping enteral feeding. Most authors recommend conservative management for 2 weeks or more unless certain parameters are met: average daily chyle loss of >1.5 litres for a 5 day period, or imminent nutritional complications. In this case, surgical management of the chylothorax and spinal fractures was planned. However, conservative management was successful, highlighting the fact that early aggressive surgical intervention for chyle leaks in blunt trauma is not necessary.

Zampieri F.G.,University of Sao Paulo | Zampieri F.G.,Hospital Alemao Oswaldo Cruz | Nassar A.P.,University of Sao Paulo | Nassar A.P.,Adult Intensive Care Unit | And 7 more authors.
Critical Care | Year: 2015

Introduction: Nebulized antibiotics are a promising new treatment option for ventilator-associated pneumonia. However, more evidence of the benefit of this therapy is required. Methods: The Medline, Scopus, EMBASE, Biological Abstracts, CAB Abstracts, Food Science and Technology Abstracts, CENTRAL, Scielo and Lilacs databases were searched to identify randomized controlled trials or matched observational studies that compared nebulized antibiotics with or without intravenous antibiotics to intravenous antibiotics alone for ventilator-associated pneumonia treatment. Two reviewers independently collected data and assessed outcomes and risk of bias. The primary outcome was clinical cure. Secondary outcomes were microbiological cure, ICU and hospital mortality, duration of mechanical ventilation, ICU length of stay and adverse events. A mixed-effect model meta-analysis was performed. Trial sequential analysis was used for the main outcome of interest. Results: Twelve studies were analyzed, including six randomized controlled trials. For the main outcome analysis, 812 patients were included. Nebulized antibiotics were associated with higher rates of clinical cure (risk ratio (RR) = 1.23; 95% confidence interval (CI), 1.05 to 1.43; I2 = 34%; D2 = 45%). Nebulized antibiotics were not associated with microbiological cure (RR = 1.24; 95% CI, 0.95 to 1.62; I2 = 62.5), mortality (RR = 0.90; CI 95%, 0.76 to 1.08; I2 = 0%), duration of mechanical ventilation (standardized mean difference = -0.10 days; 95% CI, -1.22 to 1.00; I2 = 96.5%), ICU length of stay (standardized mean difference = 0.14 days; 95% CI, -0.46 to 0.73; I2 = 89.2%) or renal toxicity (RR = 1.05; 95% CI, 0.70 to 1.57; I2 = 15.6%). Regarding the primary outcome, the number of patients included was below the information size required for a definitive conclusion by trial sequential analysis; therefore, our results regarding this parameter are inconclusive. Conclusions: Nebulized antibiotics seem to be associated with higher rates of clinical cure in the treatment of ventilator-associated pneumonia. However, the apparent benefit in the clinical cure rate observed by traditional meta-analysis does not persist after trial sequential analysis. Additional high-quality studies on this subject are highly warranted. Trial registration number: CRD42014009116. Registered 29 March 2014. © Zampieri et al.; licensee BioMed Central.

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