Now showing 1 - 10 of 15
  • Publication
    Journal Article
    Nutrition delivery across hospitalisation in critically ill patients with COVID-19: An observational study of the Australian experience.
    (2024-05-01)
    Chapple, Lee-Anne S
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    Ridley, Emma J
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    Ainscough, Kate
    ;
    Ballantyne, Lauren
    ;
    Burrell, Aidan
    ;
    ;
    Dux, Claire
    ;
    Ferrie, Suzie
    ;
    Fetterplace, Kate
    ;
    Fox, Virginia
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    Jamei, Matin
    ;
    King, Victoria
    ;
    Serpa Neto, Ary
    ;
    Nichol, Alistair
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    Osland, Emma
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    Paul, Eldho
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    Summers, Matthew J
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    Marshall, Andrea P
    ;
    Udy, Andrew
    Data on nutrition delivery over the whole hospital admission in critically ill patients with COVID-19 are scarce, particularly in the Australian setting.The objective of this study was to describe nutrition delivery in critically ill patients admitted to Australian intensive care units (ICUs) with coronavirus disease 2019 (COVID-19), with a focus on post-ICU nutrition practices.A multicentre observational study conducted at nine sites included adult patients with a positive COVID-19 diagnosis admitted to the ICU for >24 h and discharged to an acute ward over a 12-month recruitment period from 1 March 2020. Data were extracted on baseline characteristics and clinical outcomes. Nutrition practice data from the ICU and weekly in the post-ICU ward (up to week four) included route of feeding, presence of nutrition-impacting symptoms, and nutrition support received.A total of 103 patients were included (71% male, age: 58 ± 14 years, body mass index: 30±7 kg/m), of whom 41.7% (n = 43) received mechanical ventilation within 14 days of ICU admission. While oral nutrition was received by more patients at any time point in the ICU (n = 93, 91.2% of patients) than enteral nutrition (EN) (n = 43, 42.2%) or parenteral nutrition (PN) (n = 2, 2.0%), EN was delivered for a greater duration of time (69.6% feeding days) than oral and PN (29.7% and 0.7%, respectively). More patients received oral intake than the other modes in the post-ICU ward (n = 95, 95.0%), and 40.0% (n = 38/95) of patients were receiving oral nutrition supplements. In the week after ICU discharge, 51.0% of patients (n = 51) had at least one nutrition-impacting symptom, most commonly a reduced appetite (n = 25; 24.5%) or dysphagia (n = 16; 15.7%).Critically ill patients during the COVID-19 pandemic in Australia were more likely to receive oral nutrition than artificial nutrition support at any time point both in the ICU and in the post-ICU ward, whereas EN was provided for a greater duration when it was prescribed. Nutrition-impacting symptoms were common.
  • Publication
    Journal Article
    The performance of trauma team activation criteria at an Australian regional hospital.
    (2018-10-05)
    Cameron, Mitchell
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    McDermott, Kathleen M
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    It is common practice for hospitals to use a trauma team activation criteria (TTAC) to identify patients at risk of major trauma and to activate a multidisciplinary team to receive such patients on arrival to the ED. The aims of this study are to describe the frequency of individual criteria and the ability of one currently used system to predict major trauma, and to estimate the effect of simplified criteria on the prediction. A retrospective observational study of the entire cohort of adult patients who a) received trauma team activation or b) were included in the trauma registry of Royal Darwin Hospital in 2015. From the original clinical record all components of the TTAC, and corresponding outcomes, were extracted for each case. The predictive effect of each criterion, adjusted for the presence of others, was assessed by logistic regression. The poorest predictors were sequentially "dropped" to develop a number of models of which the predictive value of the resulting hypothetical TTAC was calculated. Major trauma (MT) was defined as a death in ED, immediate operative intervention or direct admission to ICU. Overtriage was defined as activation of the trauma team without major trauma. Undertriage was defined as major trauma without trauma team activation. 794 trauma presentations were reviewed, 428 of those presentations met TTAC. Major trauma was present in 135 (32%) of those with TTAC hence overtriage was 68%. Criteria based on mechanism of injury (MOI) were responsible for over half of the overtriage and were collectively present without other activation criteria in only 10 MTs (6%). Removal of the criteria with the worst predictive value decreased overtriage to 50% before a rise in undertriage to beyond 24%. A number of criteria including those based on MOI decrease the accuracy of TTAC and lead to high rates of overtriage. Airway, respiratory and neurological compromise were the best predictors of MT. Any criteria simplification should be introduced in the context of a further audit of TTAC performance, as the estimates of the separate criteria in the current TTAC are not robustto bias or to undetected correlation.
      1022
  • Publication
    Journal Article
    People in intensive care with COVID-19: demographic and clinical features during the first, second, and third pandemic waves in Australia.
    (2022-06-09)
    Begum, Husna
    ;
    Neto, Ary S
    ;
    Alliegro, Patricia
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    Broadley, Tessa
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    Trapani, Tony
    ;
    ;
    Cheng, Allen C
    ;
    Cheung, Winston
    ;
    Cooper, D James
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    Erickson, Simon J
    ;
    French, Craig J
    ;
    Litton, Edward
    ;
    McAllister, Richard
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    Nichol, Alistair
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    Palermo, Annamaria
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    Plummer, Mark P
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    Rotherham, Hannah
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    Ramanan, Mahesh
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    Reddi, Benjamin
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    Reynolds, Claire
    ;
    Webb, Steven Ar
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    Udy, Andrew A
    ;
    Burrell, Aidan
    OBJECTIVE: To compare the demographic and clinical features, management, and outcomes for patients admitted with COVID-19 to intensive care units (ICUs) during the first, second, and third waves of the pandemic in Australia. DESIGN, SETTING, AND PARTICIPANTS: People aged 16 years or more admitted with polymerase chain reaction-confirmed COVID-19 to the 78 Australian ICUs participating in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia project during the first (27 February - 30 June 2020), second (1 July 2020 - 25 June 2021), and third COVID-19 waves (26 June - 1 November 2021). MAIN OUTCOME MEASURES: Primary outcome: in-hospital mortality. SECONDARY OUTCOMES: ICU mortality; ICU and hospital lengths of stay; supportive and disease-specific therapies. RESULTS: 2493 people (1535 men, 62%) were admitted to 59 ICUs: 214 during the first (9%), 296 during the second (12%), and 1983 during the third wave (80%). The median age was 64 (IQR, 54-72) years during the first wave, 58 (IQR, 49-68) years during the second, and 54 (IQR, 41-65) years during the third. The proportion without co-existing illnesses was largest during the third wave (41%; first wave, 32%; second wave, 29%). The proportion of ICU beds occupied by patients with COVID-19 was 2.8% (95% CI, 2.7-2.9%) during the first, 4.6% (95% CI, 4.3-5.1%) during the second, and 19.1% (95% CI, 17.9-20.2%) during the third wave. Non-invasive (42% v 15%) and prone ventilation strategies (63% v 15%) were used more frequently during the third wave than during the first two waves. Thirty patients (14%) died in hospital during the first wave, 35 (12%) during the second, and 281 (17%) during the third. After adjusting for age, illness severity, and other covariates, the risk of in-hospital mortality was similar for the first and second waves, but 9.60 (95% CI, 3.52-16.7) percentage points higher during the third than the first wave. CONCLUSION: The demographic characteristics of patients in intensive care with COVID-19 and the treatments they received during the third pandemic wave differed from those of the first two waves. Adjusted in-hospital mortality was highest during the third wave.
      3451
  • Publication
    Journal Article
    Outcomes for patients with COVID-19 admitted to Australian intensive care units during the first four months of the pandemic.
    (2020-12-15)
    Burrell, Aidan Jc
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    Pellegrini, Breanna
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    Salimi, Farhad
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    Begum, Husna
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    Broadley, Tessa
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    Cheng, Allen C
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    Cheung, Winston
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    Cooper, D James
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    Earnest, Arul
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    Erickson, Simon J
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    French, Craig J
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    Kaldor, John M
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    Litton, Edward
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    Murthy, Srinivas
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    McAllister, Richard E
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    Nichol, Alistair D
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    Palermo, Annamaria
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    Plummer, Mark P
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    Ramanan, Mahesh
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    Reddi, Benjamin Aj
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    Reynolds, Claire
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    Trapani, Tony
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    Webb, Steve A
    ;
    Udy, Andrew A
    OBJECTIVES: To describe the characteristics and outcomes of patients with COVID-19 admitted to intensive care units (ICUs) during the initial months of the pandemic in Australia. DESIGN, SETTING: Prospective, observational cohort study in 77 ICUs across Australia. PARTICIPANTS: Patients admitted to participating ICUs with laboratory-confirmed COVID-19 during 27 February - 30 June 2020. MAIN OUTCOME MEASURES: ICU mortality and resource use (ICU length of stay, peak bed occupancy). RESULTS: The median age of the 204 patients with COVID-19 admitted to intensive care was 63.5 years (IQR, 53-72 years); 140 were men (69%). The most frequent comorbid conditions were obesity (40% of patients), diabetes (28%), hypertension treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (24%), and chronic cardiac disease (20%); 73 patients (36%) reported no comorbidity. The most frequent source of infection was overseas travel (114 patients, 56%). Median peak ICU bed occupancy was 14% (IQR, 9-16%). Invasive ventilation was provided for 119 patients (58%). Median length of ICU stay was greater for invasively ventilated patients than for non-ventilated patients (16 days; IQR, 9-28 days v 3 days; IQR, 2-5 days), as was ICU mortality (26 deaths, 22%; 95% CI, 15-31% v four deaths, 5%; 95% CI, 1-12%). Higher Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores on ICU day 1 (adjusted hazard ratio [aHR], 1.15; 95% CI, 1.09-1.21) and chronic cardiac disease (aHR, 3.38; 95% CI, 1.46-7.83) were each associated with higher ICU mortality. CONCLUSION: Until the end of June 2020, mortality among patients with COVID-19 who required invasive ventilation in Australian ICUs was lower and their ICU stay longer than reported overseas. Our findings highlight the importance of ensuring adequate local ICU capacity, particularly as the pandemic has not yet ended.
      1162
  • 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
    What is the optimal speed of correction of the hyperosmolar hyperglycemic state in diabetic ketoacidosis? An observational cohort study of USA intensive care patients.
    (2022-06-07) ;
    Blank, Ruth M
    ;
    OBJECTIVE: International guidelines for the treatment of diabetic ketoacidosis (DKA) advise against rapid changes in osmolarity and glucose, but the optimal rates of correction are unknown. We aimed to evaluate rates of change in tonicity and glucose in intensive care patients with DKA and their relationship with mortality and altered mental status. METHODS: Observational cohort study using two publicly available databases of USA intensive care patients (Medical Information Mart for Intensive Care-IV and eICU), evaluating adults with DKA and associated hyperosmolarity (baseline Osm≥300mosm/L). The primary outcome was hospital mortality. A secondary neurological outcome used a composite of diagnosed cerebral oedema or Glasgow coma scale ≤12. Multivariable regression models were used to control for confounding factors. RESULTS: On adjusted analysis, those who underwent the most rapid correction of up to approximately 3mmol/L/hr in tonicity had reduced mortality (n=2307, odds ratio (OR) 0.21, overall p<0.001) and adverse neurological outcomes (OR 0.44, p<0.001). Faster correction of glucose levels up to 5mmol/L/hr (90mg/dL/hr) was associated with improvements in mortality (n=2361, OR 0.24, p=0.020) and adverse neurological events (OR 0.52, p=0.046). The number of patients corrected significantly faster than these rates was low. A maximal hourly rate of correction between 2-5mmol/L for tonicity was associated with the lowest mortality rate on adjusted analysis. CONCLUSION: Based on large volume observational data, relatively rapid correction of tonicity and glucose was associated with lower mortality and more favourable neurological outcomes. Avoiding a maximum hourly rate of correction of tonicity >5mmol/L may be advisable.
      3375
  • Publication
    Journal Article
    Clinical outcomes of Indigenous Australians and New Zealand Māori with metabolic acidosis and acidaemia.
    (2023-10-18)
    Neto, Ary Serpa
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    Fujii, Tomoko
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    Moore, James
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    Young, Paul J
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    Peake, Sandra
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    Bailey, Michael
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    Hodgson, Carol
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    Higgins, Alisa M
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    See, Emily J
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    Russ, Vanessa
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    Young, Meredith
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    Maeda, Mikihiro
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    Pilcher, David
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    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
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    Singh, Sunil
    ;
    ; ;
    Tran, Khoa
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    White, Hayden
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    Sheehy, Robert
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    Gibson, Justine
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    Cooke, Robyn
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    Townsend, Shane
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    Apte, Yogesh
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    Winearls, James
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    Ferry, Olivia R
    ;
    Pradhan, Rahul
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    Ziegenfuss, Marc
    ;
    Fong, Kwun M
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    Yang, Ian A
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    McGinnity, Paul
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    Meyer, Jason
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    Walsham, James
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    Boots, Rob
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    Clement, Pierre
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    Bandeshe, Hiran
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    Gracie, Christopher
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    Jarret, Paul
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    Collins, Stephenie
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    Coulston, Caitlin
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    Ng, Melisa
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    Howells, Valerie
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    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
  • Publication
    Clinical Trial Protocol
    PREdiction and Diagnosis using Imaging and Clinical biomarkers Trial in Traumatic Brain Injury (PREDICT-TBI) study protocol: an observational, prospective, multicentre cohort study for the prediction of outcome in moderate-to-severe TBI.
    (2023-04-24)
    Nasrallah F
    ;
    Bellapart J
    ;
    Walsham J
    ;
    Jacobson E
    ;
    To XV
    ;
    Manzanero S
    ;
    Brown N
    ;
    Meyer J
    ;
    Stuart J
    ;
    Evans T
    ;
    Chandra SS
    ;
    Ross J
    ;
    ;
    Senthuran S
    ;
    Newcombe V
    ;
    McCullough J
    ;
    Fleming J
    ;
    Pollard C
    ;
    Reade M
    INTRODUCTION: Traumatic brain injury (TBI) is a heterogeneous condition with a broad spectrum of injury severity, pathophysiological processes and variable outcomes. For moderate-to-severe TBI survivors, recovery is often protracted and outcomes can range from total dependence to full recovery. Despite advances in medical treatment options, prognosis remains largely unchanged. The objective of this study is to develop a machine learning predictive model for neurological outcomes at 6 months in patients with a moderate-to-severe TBI, incorporating longitudinal clinical, multimodal neuroimaging and blood biomarker predictor variables. METHODS AND ANALYSIS: A prospective, observational, cohort study will enrol 300 patients with moderate-to-severe TBI from seven Australian hospitals over 3 years. Candidate predictors including demographic and general health variables, and longitudinal clinical, neuroimaging (CT and MRI), blood biomarker and patient-reported outcome measures will be collected at multiple time points within the acute phase of injury. The predictor variables will populate novel machine learning models to predict the Glasgow Outcome Scale Extended 6 months after injury. The study will also expand on current prognostic models by including novel blood biomarkers (circulating cell-free DNA), and the results of quantitative neuroimaging such as Quantitative Susceptibility Mapping and Dynamic Contrast Enhanced MRI as predictor variables. ETHICS AND DISSEMINATION: Ethical approval has been obtained by the Royal Brisbane and Women's Hospital Human Research Ethics Committee, Queensland. Participants or their substitute decision-maker/s will receive oral and written information about the study before providing written informed consent. Study findings will be disseminated by peer-review publications and presented at national and international conferences and clinical networks. TRIAL REGISTRATION NUMBER: ACTRN12620001360909.
      3566
  • Publication
    Journal Article
    Alcohol Misuse and Critical Care Admissions in the Northern Territory.
    (2021-01-19) ; ;
    Brown, Alex
    ;
    Bailey, Michael
    ;
    Pilcher, David
    BACKGROUND: The Northern Territory (NT) has a long history of heavy alcohol consumption with a correspondingly high attributable morbidity and mortality. AIMS: We aimed to describe the number of admissions to Intensive Care associated with alcohol misuse. METHODS: Prospective case-control study including all admissions to NT Intensive Care Units (ICUs) between 1 July 2018 and 30 June 2019. Characteristics and outcomes of patients who had an admission associated with alcohol misuse (a composite measure of acute and/or chronic misuse) were compared to those who did not. Primary outcome was the number of admissions associated with alcohol misuse. Secondary outcomes included measures of resource use (length of stay (LoS), need for mechanical ventilation) and mortality adjusted for illness severity. RESULTS: Over the sampling period there were 1664 admissions. After exclusions, 1471 admissions were analysed, 307 (21%) of which were associated with alcohol misuse. Acute or chronic misuse was associated with 3.7% and 12.1% of admissions respectively, while 5.1% met criteria for both. Admissions associated with alcohol misuse more frequently required ventilation (38.4% vs 20.7%, p<0.01) and had longer ICU (2.8 vs 2.1 days, p<0.01) and hospital LoS (9.1 vs 7.1 days, p<0.01). There was no difference in hospital mortality (7.2% vs 7.7%, p=0.94), even after adjustment for illness severity, hospital and diagnostic category. CONCLUSIONS: Alcohol misuse is associated with a substantial number of critical care admissions and consume considerable acute care resources. Further policy directed at harm minimisation and epidemiological work at jurisdictional and national level is necessary. This article is protected by copyright. All rights reserved.
      985