Critical Care - Research Publications

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Type: Journal Article × Author: Eastwood, Glenn × Author: French, Craig × Start date: 2011 × End date: 2019 ×

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    Can pre-hospital administration reduce time to initial antibiotic therapy in septic patients?
    Cudini, D ; Smith, K ; Bernard, S ; Stephenson, M ; Andrew, E ; Cameron, P ; Lum, M ; Udy, A ; Peake, S ; Delaney, A ; Bellomo, R ; Cameron, PA ; Cooper, DJ ; Cross, A ; Gomersall, C ; Graham, C ; Higgins, AM ; Holdgate, A ; Howe, BD ; Jacobs, I ; Johanson, S ; Jones, P ; Kruger, P ; McArthur, C ; Myburgh, J ; Nichol, A ; Pettila, V ; Rajbhandari, D ; Webb, SAR ; Williams, A ; Williams, J ; Williams, P (WILEY, 2019-08)
    OBJECTIVE: To quantify the potential time saved with pre-hospital antibiotic therapy in sepsis. METHODS: Study data for adult patients transported by Ambulance Victoria (AV), and enrolled into the Australasian Resuscitation In Sepsis Evaluation (ARISE), were linked with pre-hospital electronic records. RESULTS: An AV record was identified for 240 of 341 ARISE patients. The pre-hospital case notes referred to potential infection in 165 patients. The median time to first antibiotic administration from loading the patient into the ambulance was 107 (74-160) min. CONCLUSIONS: ARISE patients in Victoria were frequently identified pre-hospital. An opportunity exists to study the feasibility of pre-hospital antibiotic therapy.
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    Long-Term Survival and Dialysis Dependency Following Acute Kidney Injury in Intensive Care: Extended Followup of a Randomized Controlled Trial
    Gallagher, M ; Cass, A ; Bellomo, R ; Finfer, S ; Gattas, D ; Lee, J ; Lo, S ; McGuinness, S ; Myburgh, J ; Parke, R ; Rajbhandari, D ; Remuzzi, G (PUBLIC LIBRARY SCIENCE, 2014-02)
    BACKGROUND: The incidence of acute kidney injury (AKI) is increasing globally and it is much more common than end-stage kidney disease. AKI is associated with high mortality and cost of hospitalisation. Studies of treatments to reduce this high mortality have used differing renal replacement therapy (RRT) modalities and have not shown improvement in the short term. The reported long-term outcomes of AKI are variable and the effect of differing RRT modalities upon them is not clear. We used the prolonged follow-up of a large clinical trial to prospectively examine the long-term outcomes and effect of RRT dosing in patients with AKI. METHODS AND FINDINGS: We extended the follow-up of participants in the Randomised Evaluation of Normal vs. Augmented Levels of RRT (RENAL) study from 90 days to 4 years after randomization. Primary and secondary outcomes were mortality and requirement for maintenance dialysis, respectively, assessed in 1,464 (97%) patients at a median of 43.9 months (interquartile range [IQR] 30.0-48.6 months) post randomization. A total of 468/743 (63%) and 444/721 (62%) patients died in the lower and higher intensity groups, respectively (risk ratio [RR] 1.04, 95% CI 0.96-1.12, p = 0.49). Amongst survivors to day 90, 21 of 411 (5.1%) and 23 of 399 (5.8%) in the respective groups were treated with maintenance dialysis (RR 1.12, 95% CI 0.63-2.00, p = 0.69). The prevalence of albuminuria among survivors was 40% and 44%, respectively (p = 0.48). Quality of life was not different between the two treatment groups. The generalizability of these findings to other populations with AKI requires further exploration. CONCLUSIONS: Patients with AKI requiring RRT in intensive care have high long-term mortality but few require maintenance dialysis. Long-term survivors have a heavy burden of proteinuria. Increased intensity of RRT does not reduce mortality or subsequent treatment with dialysis. TRIAL REGISTRATION: www.ClinicalTrials.govNCT00221013.