Now showing 1 - 10 of 41
  • Publication
    Journal Article
    Study protocol and statistical analysis plan for the Liberal Glucose Control in Critically Ill Patients with Pre-existing Type 2 Diabetes (LUCID) trial.
    (2020-06)
    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
    ;
    Mårtensson, Johan
    ;
    McArthur, Colin J
    ;
    McGuinness, Shay P
    ;
    ;
    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. TRIAL REGISTRATION: This trial has been registered on the Australian New Zealand Clinical Trials Registry (ACTRN No. 12616001135404) and has been endorsed by the Australian and New Zealand Intensive Care Society Clinical Trials Group.
  • Publication
    Journal Article
    The effect of alcohol policy on intensive care unit admission patterns in Central Australia: A before-after cross-sectional study.
    (2021-01-28)
    Wright, Carly
    ;
    McAnulty, Greg R
    ;
    Alcohol misuse is a disproportionately large contributor to morbidity and mortality in the Northern Territory. A number of alcohol harm minimisation policies have been implemented in recent years. The effect of these on intensive care unit (ICU) admissions has not been fully explored. A retrospective before-after cross-sectional study was conducted at the Alice Springs Hospital ICU between 1 October 2017 and 30 September 2019. The primary outcome was the proportion of admissions in which alcohol misuse was a contributing factor in the 12 months before (pre-reforms phase) versus the 12 months following (post-reforms phase) implementation of alcohol legislation reforms. Secondary outcomes were measures of critical care resource use (length of stay, need for and duration of mechanical ventilation). After exclusions, 1323 ICU admissions were analysed. There was a reduction in the proportion of admissions associated with alcohol misuse between the pre-reforms and post-reforms phases (18.8% versus 11.7%, P < 0.01). This was true for both acute (10.6% versus 3.6%, P < 0.01) and chronic misuse (13.3% versus 9.6%, P = 0.03). Rates of mechanical ventilation were unchanged during the post-reforms phase (18.3% versus 14.7%). Admissions with a primary diagnosis of trauma were lower (10.5% versus 4.7%, P < 0.01). This study demonstrated a reduction in ICU admissions associated with alcohol misuse following the implementation of new alcohol harm minimisation policies. This apparent reduction in alcohol-related harm is suggestive of the effectiveness of the Northern Territory's integrated alcohol harm reduction framework.
      1099
  • Publication
    Journal Article
    Aboriginal and Torres Strait Islander patients requiring critical care: characteristics, resource use, and outcomes.
    (2019-09) ;
    Brown, Alex
    ;
    McAnulty, Greg
    ;
    Pilcher, David
    To provide a contemporary description of the demographics, characteristics and outcomes of critically ill Indigenous patients in Australia. Retrospective database review using the Australian and New Zealand Intensive Care Society Adult Patient Database for intensive care unit (ICU) admissions in 2017-18. Characteristics of critically ill Indigenous patients were compared with non-Indigenous patients. Primary outcome was hospital mortality. Secondary outcomes examined demographics and resource use. Per capita, Indigenous Australians were overrepresented in the intensive care. They were younger (51 v 66 years), more likely to be admitted from outer regional, rural and remote settings (59% v 15%), more likely to require emergency admission (81% v 59%), and had higher rates of mechanical ventilation (35% v 32%; P < 0.01 for all). Indigenous patients were over-represented in the diagnostic categories of sepsis (15% v 9%), trauma (7% v 5%), and respiratory illness (17% v 15%), and had higher rates of ICU re-admission (7% v 5%; P < 0.01 for all). There was no difference in either unadjusted (7.9% for each; P = 0.96) or adjusted (odds ratio, 1.1; 95% CI, 1.0-1.2) in-hospital mortality. Indigenous patients, especially young Indigenous patients, were disproportionately represented in Australian ICUs, particularly for sepsis. The high level of acute illness and high proportion of emergency admissions could be interpreted as representing delayed presentation, which, with a higher re-admission rate, suggest access barriers to health care may exist. Nevertheless, there was no mortality gap between Indigenous and non-Indigenous Australians during a hospital admission for critical illness.
      2549
  • Publication
    Journal Article
    The impact of alcohol-related admissions on resource use in critically ill patients from 2009 to 2015: An observational study
    (2018-01-01) ;
    Stewart PC
    Excessive alcohol use is associated with increased health care utilisation and increased mortality. This observational study sought to identify the proportion of patients admitted with a critical illness in which alcohol misuse contributed, and to examine the resource use for this group. We performed an observational retrospective database review of all admissions to the Alice Springs Hospital intensive care unit (ICU) between 1 January 2009 and 31 December 2015. The Alice Springs Hospital ICU is a ten-bed unit located in Central Australia, with approximately 600 admissions annually. The per capita consumption of alcohol in Central Australia is approximately 1.5 times the national average. The primary aim was to determine the proportion of admissions to intensive care in which alcohol misuse was identified as a contributing cause. Secondary aims examined resource utilisation including ICU and hospital length of stay, need for and duration of mechanical ventilation, and ICU re-admission. There were 3,768 admissions involving 2,670 individual patients. Of these admissions 947 (25%) were associated with alcohol misuse. Admissions associated with alcohol were significantly more likely to require mechanical ventilation (30% versus 20%, P
      422
  • Publication
    Journal Article
    Does the use of BariBoard™ improve adequacy of chest compressions in morbid obesity? A pilot study using a simulation model.
    (2021-12-17)
    Goulding K
    ;
    Marchetti R
    ;
    Perera R
    ;
    ;
    Bailey M
    ;
    BACKGROUND: Obesity is a growing health problem worldwide. Morbid obesity has been associated with significant barriers to effective thoracic cage compression during cardiopulmonary resuscitation. OBJECTIVE: The BariBoard™ purports to improve adequacy of chest compressions in morbidly obese patients. This study uses a simulation model to evaluate this. METHODS: This was a prospective blinded randomised-controlled crossover pilot trial using a simulation model of obesity. Participants, recruited from hospital departments and prehospital services, performed 2 minutes of continuous compressions on mannequins modified to emulate a morbidly obese patient. Participants were randomised by coin toss to a sequence of either control/intervention or intervention/control, with the BariBoard™ in the intervention arm. Accelerometers measured chest wall movement during compressions. The primary endpoint was a composite measure of compression adequacy (rate, depth, and recoil). Secondary endpoints comprised the individual components of the composite outcome, as both dichotomous outcomes (adequate vs. inadequate) and continuous variables. All endpoints were adjusted for potential confounders. RESULTS: Of 205 participants recruited, 201 were analysed. There was a significant difference in the primary outcome between the control and intervention arms (13.4% vs. 4.5%, respectively, p = 0.001) and between the control and intervention arms for the secondary endpoints of adequate compression depth (31.3% vs. 15.9%, p < 0.001) and recoil (63.7% vs. 41.3%, p < 0.001). After adjustment for confounders and interactions, there was no difference in overall efficacy (odds ratio: 0.62, 95% confidence interval: 0.20-1.90, p = 0.40). CONCLUSION: This pilot study describes the successful assessment of a device using a simulation model of obesity. Within these constraints and after adjustment for confounders, use of the BariBoard ™ did not improve efficacy of chest compressions.
      2287
  • Publication
    Journal Article
    Hazardous and harmful alcohol use in the Northern Territory, Australia: the impact of alcohol policy on critical care admissions using an extended sampling period.
    (2021-04-23) ; ;
    Brown, Alex
    ;
    Bailey, Michael
    ;
    Pilcher, David
    AIMS: To describe the effect of alcohol policy on the incidence of intensive care unit (ICU) admissions associated with hazardous and harmful alcohol use in the Northern Territory (NT) of Australia DESIGN, SETTING AND PARTICIPANTS: Before and after analysis of admissions to NT ICUs between April 2018 and September 2019, extending on both a descriptive study describing hazardous and harmful alcohol use and single-centre analyses of harm minimization policies. After exclusions, 2281 (83%) admissions were analysed, 20.3% of which were associated with hazardous and harmful alcohol use. MEASUREMENTS: Primary outcome was the incidence of admissions associated with hazardous and harmful alcohol use in the 5 months preceding (baseline period) the introduction of new alcohol policies [full-time stationing of Police Auxiliary Liquor Inspectors (PALIs) and minimum unit price (MUP)] compared with 12 months (post-intervention) following. Secondary outcomes included measures of resource use [length of stay (LoS), need for mechanical ventilation] and mortality, stratified by site. FINDINGS: Overall, there was a 4.5% [95% confidence interval (CI) = 0.8-8.2%] absolute risk reduction between the time-periods (95% CI = 23.4 versus 18.9% for baseline and post-intervention, respectively, P = 0.01), predominantly due to a reduction in admissions associated with acute misuse (2.3%, 95% CI = -0.2 to 4.9% risk reduction, P = 0.06). There were regional differences, with a more marked relative risk reduction observed in Central Australia compared with the city of Darwin (27.0 versus 16.7% relative risk reduction, respectively). CONCLUSIONS: Introduction of new alcohol harm minimization policies in the Northern Territory of Australia appears to have reduced the number of intensive care unit admissions associated with hazardous and harmful alcohol use. Strength of effect varies by geographical region and chronicity of hazardous and harmful alcohol use.
      1320
  • Publication
    Journal Article
    Surge capacity of intensive care units in case of acute increase in demand caused by COVID-19 in Australia.
    (2020-04-19)
    Litton E
    ;
    Bucci T
    ;
    Chavan S
    ;
    Ho YY
    ;
    Holley A
    ;
    Howard G
    ;
    Huckson S
    ;
    Kwong P
    ;
    Millar J
    ;
    Nguyen N
    ;
    ;
    Ziegenfuss M
    ;
    Pilcher D
    To assess the capacity of intensive care units (ICUs) in Australia to respond to the expected increase in demand associated with COVID-19. Analysis of Australian and New Zealand Intensive Care Society (ANZICS) registry data, supplemented by an ICU surge capability survey and veterinary facilities survey (both March 2020). All Australian ICUs and veterinary facilities. Baseline numbers of ICU beds, ventilators, dialysis machines, extracorporeal membrane oxygenation machines, intravenous infusion pumps, and staff (senior medical staff, registered nurses); incremental capability to increase capacity (surge) by increasing ICU bed numbers; ventilator-to-bed ratios; number of ventilators in veterinary facilities. The 191 ICUs in Australia provide 2378 intensive care beds during baseline activity (9.3 ICU beds per 100 000 population). Of the 175 ICUs that responded to the surge survey (with 2228 intensive care beds), a maximal surge would add an additional 4258 intensive care beds (191% increase) and 2631 invasive ventilators (120% increase). This surge would require additional staffing of as many as 4092 senior doctors (245% increase over baseline) and 42 720 registered ICU nurses (269% increase over baseline). An additional 188 ventilators are available in veterinary facilities, including 179 human model ventilators. The directors of Australian ICUs report that intensive care bed capacity could be near tripled in response to the expected increase in demand caused by COVID-19. But maximal surge in bed numbers could be hampered by a shortfall in invasive ventilators and would also require a large increase in clinician and nursing staff numbers.
      1603
  • Publication
    Journal Article
    Clinical outcomes of Indigenous Australians and New Zealand Māori with metabolic acidosis and acidaemia.
    (2023-10-18)
    Neto, Ary Serpa
    ;
    Fujii, Tomoko
    ;
    Moore, James
    ;
    Young, Paul J
    ;
    Peake, Sandra
    ;
    Bailey, Michael
    ;
    Hodgson, Carol
    ;
    Higgins, Alisa M
    ;
    See, Emily J
    ;
    ;
    Russ, Vanessa
    ;
    ;
    Young, Meredith
    ;
    Maeda, Mikihiro
    ;
    Pilcher, David
    ;
    Cooper, Jamie
    ;
    Udy, Andrew
    Objective: To assess the incidence and impact of metabolic acidosis in Indigenous and non-Indigenous patients Design: Retrospective study. Setting: Adult intensive care units (ICUs) from Australia and New Zealand. Participants: Patients aged 16 years or older admitted to an Australian or New Zealand ICU in one of 195 contributing ICUs between January 2019 and December 2020 who had metabolic acidosis, defined as pH < 7.30, base excess (BE) < -4 mEq/L and PaCO(2) ≤ 45 mmHg. Main outcome measures: The primary outcome was the prevalence of metabolic acidosis. Secondary outcomes included ICU length of stay, hospital length of stay, receipt of renal replacement therapy (RRT), major adverse kidney events at 30 days (MAKE30), and hospital mortality. Results: Overall, 248 563 patients underwent analysis, with 11 537 (4.6%) in the Indigenous group and 237 026 (95.4%) in the non-Indigenous group. The prevalence of metabolic acidosis was higher in Indigenous patients (9.3% v 6.1%; P < 0.001). Indigenous patients with metabolic acidosis received RRT more often (28.2% v 22.0%; P < 0.001), but hospital mortality was similar between the groups (25.8% in Indigenous v 25.8% in non-Indigenous; P = 0.971). Conclusions: Critically ill Indigenous ICU patients are more likely to have a metabolic acidosis in the first 24 hours of their ICU admission, and more often received RRT during their ICU admission compared with non-Indigenous patients. However, hospital mortality was similar between the groups.
      516
  • Publication
    Journal Article
    Clinical management practices of life-threatening asthma: An audit of practices in intensive care
    (2019-03-01) ;
    Stewart, Penny
    ;
    Singh, Sunil
    ;
    ; ;
    Tran, Khoa
    ;
    White, Hayden
    ;
    Sheehy, Robert
    ;
    Gibson, Justine
    ;
    Cooke, Robyn
    ;
    Townsend, Shane
    ;
    Apte, Yogesh
    ;
    Winearls, James
    ;
    Ferry, Olivia R
    ;
    Pradhan, Rahul
    ;
    Ziegenfuss, Marc
    ;
    Fong, Kwun M
    ;
    Yang, Ian A
    ;
    McGinnity, Paul
    ;
    Meyer, Jason
    ;
    Walsham, James
    ;
    Boots, Rob
    ;
    Clement, Pierre
    ;
    Bandeshe, Hiran
    ;
    Gracie, Christopher
    ;
    Jarret, Paul
    ;
    Collins, Stephenie
    ;
    Coulston, Caitlin
    ;
    Ng, Melisa
    ;
    Howells, Valerie
    ;
    Chatterjee, Indranil
    ;
    Visser, Adam
    ;
    Smith, Judy
    ;
    Trout, Melita
    Objective: Lack of management guidelines for lifethreatening asthma (LTA) risks practice variation. This study aims to elucidate management practices of LTA in the intensive care unit (ICU). Design: A retrospective cohort study. Setting: Thirteen participating ICUs in Australia between July 2010 and June 2013. Participants: Patients with the principal diagnosis of LTA. Main outcome measures: Clinical history, ICU management, patient outcomes, ward education and discharge plans. Results: Of the 270 (267 patients) ICU admissions, 69% were female, with a median age of 39 years (interquartile range [IQR], 26-53 years); 119 (44%) were current smokers; 89 patients (33%) previously required ICU admission, of whom 23 (25%) were intubated. The median ICU stay was 2 days (IQR, 2-4 days). Three patients (1%) died. Seventy-nine patients (29%) received non-invasive ventilation, with 11 (14%) needing subsequent invasive ventilation. Sixty-eight patients (25%) were intubated, with the majority of patients receiving volume cycled synchronised intermittent mechanical ventilation (n = 63; 93%). Drugs used included 2-agonist by intravenous infusion (n = 69; 26%), inhaled adrenaline (n = 15; 6%) or an adrenaline intravenous infusion (n = 23; 9%), inhaled anticholinergics (n = 238; 90%), systemic corticosteroids (n = 232; 88%), antibiotics (n = 126; 48%) and antivirals (n = 22; 8%). When suitable, 105 patients (n = 200; 53%) had an asthma management plan and 122 (n = 202; 60%) had asthma education upon hospital discharge. Myopathy was associated with hyperglycaemia requiring treatment (odds ratio [OR], 31.6; 95% CI, 2.1-474). Asthma education was more common under specialist thoracic medicine care (OR, 3.0; 95% CI, 1.61-5.54). Conclusion: In LTA, practice variation is common, with opportunities to improve discharge management plans and asthma education.
      398