ORCID Profile
0000-0001-8042-6084
Current Organisations
Royal Australian Navy
,
Australian and New Zealand Intensive Care Society
,
University of Queensland
,
Royal Brisbane and Women's Hospital
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 29-07-2009
DOI: 10.1111/J.1742-6723.2009.01195.X
Abstract: Despite a decline in the Australian overall asthma mortality, near-fatal/critical asthma continues to be a significant management issue for emergency physicians and intensivists. Near-fatal asthma is a unique subtype of asthma, with a variety of clinical presentations, requiring rapid and aggressive intervention. The pharmacological and non-pharmacological management of near-fatal asthma remains very complex. The present review discusses recent advances and evidence for current available strategies targeting this time critical emergency.
Publisher: Elsevier BV
Date: 08-2019
Publisher: AMPCo
Date: 19-04-2020
DOI: 10.5694/MJA2.50596
Publisher: Wiley
Date: 10-2006
Publisher: Springer Science and Business Media LLC
Date: 23-01-2015
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.JCRC.2016.04.005
Abstract: 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.
Publisher: BMJ
Date: 07-2017
Publisher: Wiley
Date: 24-04-2015
DOI: 10.1111/ANS.13118
Publisher: Wiley
Date: 17-01-2012
DOI: 10.1111/J.1742-6723.2011.01516.X
Abstract: The use of appropriate resuscitation targets or end-points may facilitate early detection and appropriate management of shock. There is a fine balance between oxygen delivery and consumption, and when this is perturbed, an oxygen debt is generated. In this narrative review, we explore the value of global haemodynamic resuscitation end-points, including pulse rate, blood pressure, central venous pressure and mixed/central venous oxygen saturations. The evidence supporting the reliability of these parameters as end-points for guiding resuscitation and their potential limitations are evaluated.
Publisher: Wiley
Date: 17-01-2012
DOI: 10.1111/J.1742-6723.2011.01515.X
Abstract: Haemodynamic targets, such as cardiac output, mean arterial blood pressure and central venous oxygen saturations, remain crude predictors of tissue perfusion and oxygen supply at a cellular level. Shocked patients may appear adequately resuscitated based on normalization of global vital signs, yet they are still experiencing occult hypoperfusion. If targeted resuscitation is employed, appropriate use of end-points is critical. In this review, we consider the value of directing resuscitation at the microcirculation or cellular level. Current technologies available include sublingual capnometry, video microscopy of the microcirculation and near-infrared spectroscopy providing a measure of tissue oxygenation, whereas base deficit and lactate potentially provide a surrogate measure of the adequacy of global perfusion. The methodology and evidence for these technologies guiding resuscitation are considered in this narrative review.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
Publisher: Wiley
Date: 22-10-2021
DOI: 10.5694/MJA2.51318
Publisher: Wiley
Date: 20-06-2019
DOI: 10.1111/BJH.16016
Publisher: Elsevier BV
Date: 03-2021
DOI: 10.51893/2021.1.OA3
Abstract: BACKGROUND: Haemorrhage is a major cause of death in severe trauma. Fibrinogen plays a critical role in maintaining haemostasis in traumatic haemorrhage, and early replacement using fibrinogen concentrate (FC) or cryoprecipitate (Cryo) is recommended by several international trauma guidelines. Limited evidence supports one product over the other, with widespread geographic and institutional variation in practice. Two previous trials have investigated the feasibility of rapid FC administration in severely injured trauma patients, with conflicting results. OBJECTIVE: To compare the time to fibrinogen replacement using FC or Cryo in severely injured trauma patients with major haemorrhage and hypofibrinogenaemia. DESIGN, SETTING, PATIENTS AND INTERVENTIONS: A multicentre controlled pilot trial in which adult trauma patients with haemorrhage were randomly assigned (1:1) to receive FC or Cryo for fibrinogen replacement, guided by FIBTEM A5 (functional fibrinogen assessment at 5 minutes after clot formation, using rotational thromboelastometry). MAIN OUTCOME MEASURES: The primary outcome was time to commencement of fibrinogen replacement. Secondary outcomes included effects of the intervention on plasma fibrinogen levels and clinical outcomes including transfusion requirements and mortality. RESULTS: Of the 100 randomly assigned patients, 62 were hypofibrinogenaemic and received the intervention (n = 37) or Cryo (n = 25). Median (interquartile range [IQR]) time to delivery of FC was 29 min (23–40 min) compared with 60 min (40–80 min) for Cryo (P = 0.0001). All 62 patients were hypofibrinogenaemic before receiving FC or Cryo (FC: median FIBTEM A5, 8 mm [IQR, 7–9 mm] Cryo: median FIBTEM A5, 9 mm [IQR, 5–10 mm]). In the FC arm patients received a median of 3 g FC (IQR, 2–4 g), and in the Cryo arm patients received a median of 8 units of Cryo (IQR, 8–14 units). Restoration of fibrinogen levels was achieved in both arms after the intervention. Blood product transfusion, fluid resuscitation and thromboembolic complications were similar in both arms. Overall mortality was 15.3%, with more deaths in the FC arm. CONCLUSION: Fibrinogen replacement in severely injured trauma patients with major haemorrhage and hypofibrinogenaemia was achieved substantially faster using FC compared with Cryo. Fibrinogen levels increased appropriately using either product. The optimal method for replacing fibrinogen in traumatic haemorrhage is controversial. Our results will inform the design of a larger trial powered to assess patient-centred outcomes.
Publisher: Springer Science and Business Media LLC
Date: 03-2015
Publisher: Elsevier BV
Date: 04-2021
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.51893/2021.4.POV
Publisher: Springer Science and Business Media LLC
Date: 26-05-2017
Publisher: Wiley
Date: 30-09-2007
DOI: 10.1111/J.1445-5994.2007.01489.X
Abstract: We described two rare severe and fulminant clinical presentations of acute Q fever. The first patient had severe multiorgan failure. The second patient had fever and severe cholera-like diarrhoea. Coxiella burnetii polymerase chain reaction on blood or serum can be clinically useful in the diagnosis of acute Q fever before seroconversion.
Publisher: SAGE Publications
Date: 02-2007
DOI: 10.1177/0310057X0703500112
Abstract: We describe the use of nitric oxide as an oxygen-sparing strategy in the context of prior bleomycin exposure. A 27-year-old male, previously treated with bleomycin for a testicular germ cell tumour, presented with severe acute respiratory distress syndrome on the second postoperative day following an extensive retroperitoneal dissection. The mechanism of bleomycin toxicity and potential benefits of nitric oxide in this situation are considered.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-08-2020
DOI: 10.1097/SHK.0000000000001578
Abstract: A dysfunctional microcirculation is universal in shock and is often dissociated from global hemodynamic parameters. Persistent microcirculatory derangements reflect ongoing tissue hypoperfusion and organ injury. The initial microcirculatory dysfunction and subsequent resolution could potentially guide therapy and predict outcomes. We evaluated the microcirculation early in a heterogenous shocked population. Microcirculatory resolution was correlated with measures of tissue perfusion and global hemodynamics. The relationship between the microcirculation over 24 h and outcome were evaluated. We prospectively recruited patients with all forms of shock, based on global hemodynamics and evidence of organ hypoperfusion. A 30-bed adult intensive care unit (ICU). Eighty-two shocked patients. Following the diagnosis of shock, patients underwent a sublingual microcirculation examination using Sidestream Dark Field Imaging. The median age of patients was 66 years old (interquartile range [IQR] 54–71), with an Acute Physiology and Chronic Health Evaluation II of 27 (IQR 20–32). Microcirculatory parameters included Percentage Perfused Vessels (PPV), De Backer Score, and a heterogeneity index in patients with septic shock, according to the second consensus guidelines Additional parameters collected: temperature, heart rate and arterial pressure, cumulative fluid balance, and vasopressor use. Arterial blood s les were taken at the time of microcirculatory assessments, providing HCO 3 , lactate concentrations, PaO 2 , and PaCO 2 measurements. A statistically significant improvement in PPV and the heterogeneity index was demonstrated. This improvement was mirrored by biomarkers of perfusion however, the global hemodynamic parameter changes were not significantly different over the 24-h period. The early microcirculatory improvement was not predictive of an improvement in acute kidney injury, length of stay, ICU, or hospital mortality. Early sequential evaluation of the microcirculation in shocked patients, demonstrated statistically significant improvement in the PPV and microvascular heterogeneity with standard care. These improvements were mirrored by biomarkers of organ perfusion however, the changes in global hemodynamics were not as pronounced in this early phase. Early improvement in the microcirculation did not predict clinical outcome.
Publisher: SAGE Publications
Date: 6
DOI: 10.1177/0310057X1304100104
Abstract: The development of effective cryopreservation techniques for both red blood cells and platelets, which maintain ex vivo biological activity, in combination with frozen plasma, provides for a unique blood banking strategy. This technology greatly enhances the storage life of these products. The rationale and potential advantages of using cryopreservation techniques for the provision of blood products to remote and military environments have been effectively demonstrated in several conflicts over the last decade. Current haemostatic resuscitation doctrine for the exsanguinating patient supports the use of red blood cells, platelets and frozen plasma early in the resuscitation. We believe an integrated fresh–frozen blood bank inventory could facilitate provision of blood products, not only in the military setting but also in regional Australia, by overcoming many logistic and geographical challenges. The processes involved in production and point of care thawing are sufficiently well developed and achievable to make this technology a viable option. The potential limitations of cryopreservation and subsequent product thawing need to be considered if such a strategy is to be developed. A substantial body of international experience using cryopreserved products in remote settings has already been accrued. This experience provides a template for the possible creation of an Australian integrated fresh–frozen blood bank inventory that could conceivably enhance the care of patients in both regional Australia and in the military setting.
Publisher: Informa UK Limited
Date: 11-03-2012
DOI: 10.3109/00365548.2012.664779
Abstract: Infective endocarditis is a common complication of Staphylococcus aureus bacteraemia, but literature reports of community-associated methicillin-resistant S. aureus (CA-MRSA) endocarditis are relatively uncommon and mostly comprise intravenous drug users (IVDUs) with the USA300 strain. We report 5 cases of CA-MRSA endocarditis in previously healthy young Australian adults, 4 in IVDUs. Morbidity was high with frequent septic emboli 3 patients required cardiac surgery and 1 patient died. Typing revealed the 2 most common Australian strains, the Panton-Valentine leukocidin (PVL)-positive ST93 (Queensland) strain and the PVL-negative ST1 (WA-MRSA-1) strain.
Publisher: SAGE Publications
Date: 09-2009
Publisher: Elsevier BV
Date: 03-2021
Publisher: Wiley
Date: 06-2008
DOI: 10.1111/J.1742-6723.2008.01095.X
Abstract: We report the case of a 33-year-old man presenting with seizures following a 3 week, non-specific febrile illness characterized by progressive confusion. Despite the presence of risk factors, his HIV serology was negative and he had no premorbid suggestion of immunocompromise. We describe the difficulties in making the diagnosis of cryptococcal meningitis in the presence of cerebrospinal fluid analysis with the only abnormality initially being hypoglycorrhachia. This case also highlights the importance of measuring an opening pressure, a procedure which should be routine, but is often neglected in the performance of lumbar punctures. Finally, this case reinforces the maxim that cranial CT cannot be relied upon alone to diagnose intracranial hypertension, which also requires clinical examination, including fundoscopy.
Publisher: Wiley
Date: 10-07-2019
DOI: 10.1111/TRF.15423
Abstract: Cryopreservation extends platelet (PLT) shelf life from 5 to 7 days to 2 to 4 years. However, only 73 patients have been transfused cryopreserved PLTs in published randomized controlled trials (RCTs), making safety data insufficient for regulatory approval. The Cryopreserved vs. Liquid Platelet (CLIP) study was a double-blind, pilot, multicenter RCT involving high-risk cardiothoracic surgical patients in four Australian hospitals. The objective was to test, as the primary outcome, the feasibility and safety of the protocol. Patients were allocated to study group by permuted block randomization, with patients and clinicians blinded by use of an opaque shroud placed over each study PLT unit. Up to 3 units of cryopreserved or liquid-stored PLTs were administered per patient. No other aspect of patient care was affected. Adverse events were actively sought. A total of 121 patients were randomized, of whom 23 received cryopreserved PLTs and 18 received liquid-stored PLTs. There were no differences in blood loss (median, 715 mL vs. 805 mL at 24 hr difference between groups 90 mL [95% CI, -343.8 to 163.8 mL], p = 0.41), but the Bleeding Academic Research Consortium criterion for significant postoperative hemorrhage in cardiac surgery composite bleeding endpoint occurred in nearly twice as many patients in the liquid-stored group (55.6% vs. 30.4%, p = 0.10). Red blood cell transfusion requirements were a median of 3 units in the cryopreserved group versus 4 units with liquid-stored PLTs (difference between groups, 1 unit [95% CI, -3.1 to 1.1 units] p = 0.23). Patients in the cryopreserved group were more likely to be transfused fresh-frozen plasma (78.3% vs. 27.8%, p = 0.002) and received more study PLT units (median, 2 units vs. 1 unit difference between groups, 1 unit [95% CI, -0.03 to 2.0 units] p = 0.012). There were no between-group differences in potential harms including deep venous thrombosis, myocardial infarction, respiratory function, infection, and renal function. No patient had died at 28 days, and postoperative length of stay was similar in each group. In this pilot RCT, compared to liquid-stored PLTs, cryopreserved PLTs were associated with no evidence of harm. A definitive study testing safety and hemostatic effectiveness is warranted.
Publisher: Wiley
Date: 03-2011
DOI: 10.1111/J.1445-5994.2010.02413.X
Abstract: We report the case of the case of a 56 year old female with sepsis on a background of rheumatoid arthritis and steroid use manifesting with overt clinical features of scurvy. Ascorbic acid assays were able to demonstrate severe deficiency and confirm a diagnosis of scurvy. Clinical resolution of signs and symptoms following commencement of vitamin C replacement was rapid. The intensivist and dietitian need to consider this diagnosis even in the first world setting, particularly in the presence of sepsis, inflammatory conditions, steroid use and importantly malnutrition.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1016/J.IJANTIMICAG.2008.10.035
Abstract: This multicentre study (i) evaluated geographic and temporal changes in candidaemia ecology in the critically ill, (ii) identified risk factors associated with non-albicans candidaemia and (iii) examined the association of Candida ecology with mortality. A retrospective cohort study of patients who developed candidaemia in four general Intensive Care Units located in Australia, Greece, Belgium and Brazil was performed. Two hundred Candida organisms were identified by positive blood culture in 189 patients, including 112 Candida albicans (56.0%), 38 Candidaglabrata (19.0%), 21 Candidaparapsilosis (10.5%), 18 Candidatropicalis (9.0%), 6 Candidakrusei (3.0%), 1 Candidafamata (0.5%), 1 Candidazeylanoides (0.5%) and 3 non-differentiated Candida spp. (1.5%). No trend towards increased non-albicans species over the study period (P=0.68) or by geographic area (P=0.35) was demonstrated. Independent risk factors for non-albicans candidaemia included: female gender [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.13-3.86] and increased central venous catheter days (OR 1.16 per 5-day interval, 95% CI 1.05-1.28). Mortality in the non-albicans group was non-significantly higher than in the albicans group (65% vs. 53% P=0.10). This study is unique in that a large number of intensive care candidaemias in four geographically erse units have been studied.
Publisher: SAGE Publications
Date: 03-2020
Abstract: Smoke inhalation resulting in acute lung injury is a common challenge facing critical care practitioners caring for patients with severe burns, contributing significantly to morbidity and mortality. The intention of this review is to critically evaluate the published literature and trends in the diagnosis, management, implications and novel therapies in caring for patients with inhalation injury.
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.JCRC.2016.06.022
Abstract: The purpose was to determine the efficacy of prophylactic inhaled heparin for the prevention and treatment of pneumonia in patients receiving mechanical ventilation (MV). A phase 2, double-blind, randomized controlled trial stratified for study center and patient type (nonoperative, postoperative) was conducted in 3 university-affiliated intensive care units. Patients aged at least 18 years and requiring invasive MV for more than 48 hours were randomized to usual care, nebulization of unfractionated sodium heparin (5000 U in 2 mL), or nebulization with 0.9% sodium chloride (2 mL) 4 times daily with the main outcome measures, the development of ventilator-associated pneumonia (VAP), ventilator-associated complication, and Sequential Organ Failure Assessment scores in patients with admission pneumonia or developing VAP. ACTRN12612000038897. A total of 214 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=.85). Low-dose nebulized heparin cannot be recommended for prophylaxis against VAP or to hasten recovery from pneumonia in patients receiving MV.
Publisher: AMPCo
Date: 09-2012
DOI: 10.5694/MJA12.10694
Publisher: SAGE Publications
Date: 11-2010
DOI: 10.1177/0310057X1003800614
Abstract: Commonly in Australia and New Zealand, initial intensive care support of critically ill patients is by non-intensive care trained medical and nursing staff. Basic Assessment and Support in Intensive Care (BASIC) is an internationally run short course to assist practitioners to gain knowledge and skills to manage the early hours of critical illness. The aim of this study was to assess the performance and acceptance of the BASIC course as conducted in an Australian metropolitan teaching hospital and a major regional centre in New Zealand. Performance on pre- and post-course multiple choice examinations and the overall course assessment by all participants attending between 2005 and 2009 was analysed. Of 796 participants, 338 (42%) were in Australia and 458 (58%) in New Zealand. Compared to New Zealand, Australian non-intensive care consultants and junior medical staff attended more commonly at 9% vs 4% and 62% vs 42% respectively, while nurses more frequently attended in New Zealand (47% compared to 12%, P .001). The pre-course open book examination result averaged 79% (95% confidence interval 78 to 80) and the post-course closed book examination was 64% (95% confidence interval 63 to 65). The post-course examination score was predicted by pre-course examination score (β =0.22, 95% confidence interval 0.17 to 0.27), nursing occupation, (β=-3.96, 95% confidence interval -5.03 to -2.90) and the availability of a scenario-based simulation module (β=0.22, 95% confidence interval 0.17 to 0.27, R 2 =0.38, P .001). Participants generally found they had learned a great deal from the program and that the course material was of an appropriate level. The BASIC course was found to be a positive learning experience for health care practitioners inexperienced in the management of the critically ill.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.51893/2021.3.OA7
Abstract: OBJECTIVES: To validate a real-time Intensive Care Unit (ICU) Activity Index as a marker of ICU strain from daily data available from the Critical Health Resource Information System (CHRIS), and to investigate the association between this Index and the need to transfer critically ill patients during the coronavirus disease 2019 (COVID-19) pandemic in Victoria, Australia. DESIGN: Retrospective observational cohort study. SETTING: All 45 hospitals with an ICU in Victoria, Australia. PARTICIPANTS: Patients in all Victorian ICUs and all critically ill patients transferred between Victorian hospitals from 27 June to 6 September 2020. MAIN OUTCOME MEASURE: Acute interhospital transfer of one or more critically ill patients per day from one site to an ICU in another hospital. RESULTS: 150 patients were transported over 61 days from 29 hospitals (64%). ICU Activity Index scores were higher on days when critical care transfers occurred (median, 1.0 [IQR, 0.4–1.7] v 0.6 [IQR, 0.3–1.2] P 0.001). Transfers were more common on days of higher ICU occupancy, higher numbers of ventilated or COVID-19 patients, and when more critical care staff were unavailable. The highest ICU Activity Index scores were observed at hospitals in north-western Melbourne, where the COVID-19 disease burden was greatest. After adjusting for confounding factors, including occupancy and lack of available ICU staff, a rising ICU Activity Index score was associated with an increased risk of a critical care transfer (odds ratio, 4.10 95% CI, 2.34–7.18 P 0.001). CONCLUSIONS: The ICU Activity Index appeared to be a valid marker of ICU strain during the COVID-19 pandemic. It may be useful as a real-time clinical indicator of ICU activity and predict the need for redistribution of critical ill patients.
Publisher: Springer Science and Business Media LLC
Date: 18-10-2017
Publisher: Massachusetts Medical Society
Date: 25-07-2019
Location: Australia
Location: Australia
No related grants have been discovered for Anthony Holley.