Now showing 1 - 9 of 9
  • Publication
    Journal Article
    A clinical audit of the efficacy of tegaserod as a prokinetic agent in the intensive care unit.
    (2007-06) ; ;
    Collins, Sarah J
    ;
    Goldrick, Paul B
    ;
    Fowler, Stephen
    To formally document the effectiveness of tegaserod as a prokinetic agent in intensive care patients. The audit was designed in consultation with the Northern Territory Drug and Therapeutics Committee. Tegaserod was added to the feeding protocol and prokinetic algorithm in the ICU, and a prospective audit was performed of patients receiving the medication between May and September 2006. Over the 5-month period, 40 patients received tegaserod after failing to respond to two doses of metoclopramide. Median daily volume of gastric aspirate was reduced from 1220mL in the 24 hours before tegaserod to 887.5mL in the first 24 hours after its introduction, and to 280mL in the second 24 hours (P=0.01 and P<0.001, respectively). Tegaserod was an effective prokinetic agent in 85% (34) patients. Attributable diarrhoea occurred in 13% (5) patients, but did not require intervention. Tegaserod is an effective alternative prokinetic agent for ICU patients with a safer side-effect profile. We believe it warrants further investigation.
      2379
  • Publication
    Journal Article
    Randomized, double-blind, placebo-controlled trial of granulocyte colony-stimulating factor in patients with septic shock.
    (2008-02)
    Stephens DP
    ;
    ;
    Higgins A
    ;
    Bailey M
    ;
    ; ;
    Cheng AC
    To investigate the effect of early administration of granulocyte colony-stimulating factor (G-CSF) on hospital mortality in nonneutropenic patients with septic shock, excluding patients with melioidosis. A randomized, placebo-controlled, double-blinded clinical trial. Adult patients with septic shock admitted to the Royal Darwin Hospital Intensive Care Unit. Patients were randomized to receive G-CSF or placebo intravenously daily for 10 days, in addition to routine management of septic shock. Primary outcome was hospital mortality. Secondary outcomes included intensive care unit mortality, intensive care unit and hospital length of stay, ventilator hours, and time to resolution of shock. Patient comorbidities, baseline and daily physiology, and organ function were collected. Of 166 patients enrolled, 83 were allocated to receive G-CSF (81 included in analysis) and 83 were allocated to receive placebo. At baseline, 30% of patients had diabetes, 18% were known to have renal impairment or failure, and 38% had a history of hazardous alcohol use. The two groups had similar comorbidities at baseline and a similar severity of illness. The in-hospital mortality was 27% in the G-CSF group and 25% in the placebo group. Secondary end points were not different between groups. There was a higher rate of new organ failure in G-CSF-treated patients than placebo-treated patients (50% vs. 33%, p = .03), most of which was accounted for by new liver dysfunction (11% vs. 1%, p = .007). There was no significant difference in the proportion of patients with troponin I of >0.08 mg/L (78% vs. 66%, p = .09), and the prevalence of acute myocardial infarction (6% vs. 4%, p = .55) was not different during the study. The median peak troponin I level was higher in the G-CSF group (0.5 vs. 0.14 mg/L, p = .007), but baseline levels were not available. G-CSF does not improve outcomes in patients with septic shock, excluding melioidosis. Increased hepatic dysfunction and higher peak troponin levels in patients receiving G-CSF have not been reported in previous clinical trials and warrant further investigation.
      1207
  • Publication
    Journal Article
    The views of first nations people, including first nations Australians, on organ donation: A multi-national perspective
    (2021-04-01)
    Cairnes S
    ;
    Wood L
    ;
    ;
    McLay M
    ;
    Tan K
    ;
    Hill L
    ;
    Jones S
    The number of people waiting for a transplant far outweighs the number of organ donors in Australia. The Northern Territory (NT) of Australia has the highest incidence of end-stage kidney disease (ESKD) in Australia. A large proportion of those with ESKD are First Nations Australians that require renal dialysis and who are more likely to require and benefit from a renal transplant. In 2018, 53% (21/40) of potential organ donors referred to DonateLife NT identified as First Nations Australian; one of these went on to become an organ donor. DonateLife NT coordinates all organ donation activities across the NT and is responsible for increasing community awareness, promoting the importance of organ donation, and discussing willingness to be an organ donor with families. During these activities with First Nations Australians, a variety of views that influence thoughts and decision making about organ donation have become very apparent. To explore this further, a literature review was undertaken to determine the views on organ donation among First Nations People and consider how this compared to the anecdotal experience of DonateLife NT. Findings from the literature review are consistent with the experience of DonateLife NT. To optimise dialogue about organ donation with First Nations People, it must be conducted in a respectful and culturally appropriate way. This serves to empower through enhancing knowledge and understanding and enables the ability to make informed decisions. Further qualitative research is recommended to increase understanding of the views of First Nations Australians about organ donation and ultimately ensure that donation discussions are appropriately informed, culturally secure, and form part of quality end of life care in hospital settings.
      414
  • Publication
    Evaluation Study
    Particulate face masks for protection against airborne pathogens - one size does not fit all: an observational study.
    (2010-03)
    Winter, Susan
    ;
    ; ;
    Davis, Joshua S
    To determine the proportion of hospital staff who pass fit tests with each of three commonly used particulate face masks, and factors influencing preference and fit test results. Observational study. 50 healthy hospital staff volunteers in an 18-bed general intensive care unit in an Australian teaching hospital. Participants were administered a questionnaire about mask use and their preferred mask and underwent qualitative fit-testing with each of three different particulate masks: Kimberly-Clark Tecnol FluidShield N95 particulate filter respirator (KC), 3M Flat Fold 9320 particulate respirator and 3M 8822 particulate respirator with exhalation valve. Participants who failed fittesting were trained in correct mask donning, and fittesting was repeated. Proportion of participants who passed the fit test for each mask and the effect of training. The proportion of participants who passed a fit test was low for all three masks tested (KC, 16%; flat fold, 28%; and valved, 34%). Rates improved after training: the first mask tested fitted in 18% of participants pre-training and 40% post-training (P = 0.02). None of the masks fitted for 28% of participants. There were no significant predictors of fit-test results. A large proportion of individuals failed a fit test with any given mask, and we were not able to identify any factors that predicted mask fit in individuals. Training on mask use improved the rates of adequate fit. Hospitals should carry a range of P2 masks, and should conduct systematic P2 mask training and fit-testing programs for all staff potentially exposed to airborne pathogens.
      1207
  • Publication
    Journal Article
    Meropenem dosing in critically ill patients with sepsis receiving high-volume continuous venovenous hemofiltration.
    (2010-07)
    Bilgrami, I
    ;
    Roberts, J A
    ;
    Wallis, S C
    ;
    ;
    Davis, J
    ;
    Fowler, S
    ;
    Goldrick, P B
    ;
    Lipman, J
    Use of high ultrafiltrate flow rates with continuous venovenous hemofiltration (CVVHF) in critically ill patients is an emerging setting, for which there are few data to guide drug dosing. The objectives of this study were, firstly, to investigate the pharmacokinetics of meropenem in critically ill patients with severe sepsis who are receiving high-volume CVVHF with high-volume exchanges (> or = 4 liters/h); secondly, to determine whether standard dosing regimens (1,000 mg intravenously [i.v.] every 8 h) are sufficient for treatment of less susceptible organisms such as Burkholderia pseudomallei (MIC, 4 mg/liter); and, finally, to compare the clearances observed in this study with data from previous studies using lower-volume exchanges (1 to 2 liters/h). We recruited 10 eligible patients and collected serial pre- and postfilter blood samples and ultrafiltrate and urine samples. A noncompartmental method was used to determine meropenem pharmacokinetics. The cohort had a median age of 56.6 years, a median weight of 70 kg, and a median APACHE II (acute physiology and chronic health evaluation) score of 25. The median (interquartile range) values for meropenem were as follows: terminal elimination half-life, 4.3 h (2.9 to 6.0); terminal volume of distribution, 0.2 liters/kg (0.2 to 0.3); trough concentration, 7.7 mg/liter (6.2 to 12.9); total clearance, 6.0 liters/h (5.2 to 6.2); hemofiltration clearance, 3.5 liters/h (3.4 to 3.9). In comparing the meropenem clearance here with those in previous studies, ultrafiltration flow rate was found to be the parameter that accounted for the differences in clearance of meropenem (R(2) = 0.89). In conclusion, high-volume CVVHF causes significant clearance of meropenem, necessitating steady-state doses of 1,000 mg every 8 h to maintain sufficient concentrations to treat less susceptible organisms such as B. pseudomallei.
      1181
  • Publication
    Journal Article
    The effect of renal replacement therapy and antibiotic dose on antibiotic concentrations in critically ill patients: Data from the multinational SMARRT Study.
    (2020-03-09)
    Roberts JA
    ;
    Joynt G
    ;
    Lee A
    ;
    Choi G
    ;
    Bellome R
    ;
    Kanji S
    ;
    Mudaliar MY
    ;
    Peake SL
    ;
    ;
    Taccone FS
    ;
    Ulldemolins M
    ;
    Valkonen MM
    ;
    Agbeve, Julius
    ;
    Baptista JP
    ;
    Bekos V
    ;
    Boidin C
    ;
    Brinkmann A
    ;
    Buizen L
    ;
    Castro P
    ;
    Cole CL
    ;
    Creteur J
    ;
    De Waele JJ
    ;
    Deans R
    ;
    Eastwood GM
    ;
    Escobar L
    ;
    Gomersall C
    ;
    Gresham R
    ;
    Jamal JA
    ;
    Kluge St
    ;
    König C
    ;
    Koulouras VP
    ;
    Lassig-Smith M
    ;
    Laterre PF
    ;
    Lei K
    ;
    Leung P
    ;
    Lefrant JY
    ;
    Llauradó-Serra M
    ;
    Martin-Loeches I
    ;
    Mat Nor MB
    ;
    Ostermann M
    ;
    Parker SL
    ;
    Rello J
    ;
    Roberts DM
    ;
    Roberts MS
    ;
    Richards B
    ;
    Rodríguez A
    ;
    Roehr AC
    ;
    Roger C
    ;
    Seoane L
    ;
    Sinnollareddy M
    ;
    Sousa E
    ;
    Soy D
    ;
    Spring A
    ;
    Star T
    ;
    ;
    Turnidge J
    ;
    Wallis SC
    ;
    Williams T
    ;
    Wittebole X
    ;
    Zikou XT
    ;
    Paul S
    ;
    Lipman J
    The optimal dosing of antibiotics in critically ill patients receiving renal replacement therapy (RRT) remains unclear. In this study, we describe the variability in RRT techniques and antibiotic dosing in critically ill patients receiving RRT and to relate observed trough antibiotic concentrations to optimal targets. We performed a prospective, observational, multi-national, pharmacokinetic study in 29 intensive care units from 14 countries. We collected demographic, clinical and RRT data. We measured trough antibiotic concentrations of meropenem, piperacillin-tazobactam and vancomycin and related them to high and low target trough concentrations. We studied 381 patients and obtained 508 trough antibiotic concentrations. There was wide variability (4-8 fold) in antibiotic dosing regimens; RRT prescription, and estimated endogenous renal function. The overall median estimated total renal clearance (eTRCL) was 50 mL/min (interquartile range [IQR] 35-65) and higher eTRCL was associated with lower trough concentrations for all antibiotics (p<0.05). The median (IQR) trough concentration for meropenem was 12.1 mg/L (7.9-18.8), piperacillin 78.6 mg/L (49.5-127.3), tazobactam 9.5 mg/L (6.3-14.2) and vancomycin 14.3 mg/L (11.6-21.8). Trough concentrations failed to meet optimal higher limits in 26%, 36%, 72%, and optimal lower limits in 4%, 4%, and 55% of patients for meropenem, piperacillin and vancomycin respectively. In critically ill patients treated with RRT, antibiotic dosing regimens, RRT prescription and eTRCL varied markedly and resulted in highly variable antibiotic concentrations that failed to meet therapeutic targets in many patients.
      944
  • Publication
    Case Reports
    Leptospirosis: an unusual presentation.
    (2006-09-01) ;
    Stephens DP
    Leptospirosis is a common zoonosis that is endemic in the tropical Top End of the Northern Territory. Disease ranges from mild to very severe. We report a patient with anicteric leptospirosis who became critically ill, challenging the view that anicteric leptospirosis is less severe than the icteric form. Despite a typical but non-specific presentation and recreational high-risk activities, diagnosis of leptospirosis was delayed. The patient developed respiratory failure, resulting from pulmonary haemorrhage, and acute renal failure. This case highlights the multiple factors that should prompt health care workers to consider the diagnosis of leptospirosis in non-classical presentations.
      1173
  • Publication
    Journal Article
    Melioidosis Causing Critical Illness: A Review of 24 Years of Experience From the Royal Darwin Hospital ICU.
    Melioidosis is increasing in incidence with newly recognized foci of melioidosis in the Americas, Africa, and elsewhere. This review describes the demographics, management, and outcomes of a large cohort of critically ill patients with melioidosis. Data were extracted from two prospective databases-the Menzies School of Health Research Melioidosis Database (1989-2013) and the Royal Darwin Hospital ICU Melioidosis Database (2001-2013). The Royal Darwin Hospital ICU is the only ICU in the tropical Top End of Northern Territory of Australia, an endemic area for melioidosis. The study included all patients with melioidosis admitted to Royal Darwin Hospital ICU from 1989 to 2013. From 1989 to 2013, 207 patients with melioidosis required admission to ICU. Mortality reduced from 92% (1989-1997) to 26% (1998-2013) (p < 0.001). The reduced mortality coincided with the introduction of an intensivist-led service, meropenem, and adjuvant granulocyte colony-stimulating factor for confirmed melioidosis sepsis in 1998. Pneumonia was the presenting illness in 155 of 207 (75%). ICU melioidosis patients (2001-2013) had an Acute Physiology and Chronic Health Evaluation II score of 23, median length of stay in the ICU of 7 days, and median ventilation hours of 130 and one third required renal replacement therapy. The mortality for critically ill patients with melioidosis in the Top End of the Northern Territory of Australia has substantially reduced over the past 24 years. The reduction in mortality coincided with the introduction of an intensivist-led model of care, the empiric use of meropenem, and adjunctive treatment with granulocyte colony-stimulating factor in 1998.
      1331
  • Publication
    Clinical Trial
    Is inhaled prophylactic heparin useful for prevention and Management of Pneumonia in ventilated ICU patients?: The IPHIVAP investigators of the Australian and New Zealand Intensive Care Society Clinical Trials Group.
    (2016)
    Bandeshe, Hiran
    ;
    Boots, Rob
    ;
    Dulhunty, Joel
    ;
    Dunlop, Rachael
    ;
    Holley, Anthony
    ;
    Jarrett, Paul
    ;
    Gomersall, Charles D
    ;
    Lipman, Jeff
    ;
    Lo, Thomas
    ;
    O'Donoghue, Steven
    ;
    Paratz, Jenny
    ;
    Paterson, David
    ;
    Roberts, Jason A
    ;
    Starr, Therese
    ;
    ;
    Stuart, Janine
    ;
    ;
    Udy, Andrew
    ;
    White, Hayden
    To determine whether prophylactic inhaled heparin is effective for the prevention and treatment of pneumonia patients receiving mechanical ventilation (MV) in the intensive care unit. A phase 2, double blind randomized controlled trial stratified for study center and patient type (non-operative, post-operative) was conducted in three university-affiliated intensive care units. Patients aged ≥18years and requiring invasive MV for more than 48hours were randomized to usual care, nebulization of unfractionated sodium heparin (5000 units in 2mL) or placebo nebulization with 0.9% sodium chloride (2mL) four times daily with the main outcome measures of the development of ventilator associated pneumonia (VAP), ventilator associated complication (VAC) and sequential organ failure assessment scores in patients with pneumonia on admission or who developed VAP. Australian and New Zealand Clinical Trials Registry ACTRN12612000038897. Two hundred and fourteen patients were enrolled (72 usual care, 71 inhaled sodium heparin, 71 inhaled sodium chloride). There were no differences between treatment groups in terms of the development of VAP, using either Klompas criteria (6-7%, P=1.00) or clinical diagnosis (24-26%, P=0.85). There was no difference in the clinical consistency (P=0.70), number (P=0.28) or the total volume of secretions per day (P=.54). The presence of blood in secretions was significantly less in the usual care group (P=0.005). Nebulized heparin cannot be recommended for prophylaxis against VAP or to hasten recovery from pneumonia in patients receiving MV.
      1304