ORCID Profile
0000-0002-2436-7654
Current Organisations
Griffith University
,
University of Queensland
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.
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Pattern Recognition and Data Mining | Database Management | Artificial Intelligence and Image Processing
Health and Support Services not elsewhere classified | Application Software Packages (excl. Computer Games) | Electronic Information Storage and Retrieval Services |
Publisher: Wiley
Date: 10-06-2008
DOI: 10.1111/J.1365-2044.2008.05477.X
Abstract: The effect of charcoal haemoperfusion on the pharmacokinetics of diltiazem is described in a patient with severe clinical toxicity following acute overdose. The patient presented within 3 h following acute ingestion of multiple medications including sustained-release diltiazem. Routine resuscitation and supportive care were administered, but hypotension did not resolve despite intravenous fluids and infusions of calcium, adrenaline, noradrenaline and vasopressin. Multiple-doses of activated charcoal, haemodialysis and charcoal haemoperfusion were prescribed to expedite the elimination of diltiazem. The maximum diltiazem concentration (577 microg.l(-1)) was recorded 7 h post ingestion which was followed by an erratic and prolonged elimination phase. The maximum clearance of diltiazem due to haemoperfusion was calculated to be 19.4 and 15.1 ml.min(-1) at different times, equating to removal of approximately 1.5 mg diltiazem during 4 h of haemoperfusion. Haemoperfusion did not appear to remove sufficient diltiazem to recommend its routine use in the treatment of patients with acute diltiazem overdose.
Publisher: Springer Science and Business Media LLC
Date: 11-01-2011
DOI: 10.1007/S10096-010-1146-1
Abstract: Surveillance cultures may detect colonisation with drug-resistant Gram-negative bacteria and can be hypothesised to guide appropriate initial antibiotic treatment for intensive care unit (ICU) patients. We investigated the microbiological data of 228 episodes of nosocomial bloodstream infection (BSI) due to Gram-negative bacteria in an ICU in which piperacillin/tazobactam or meropenem was used empirically for serious infections, to evaluate the contribution of surveillance cultures to an appropriate choice of initial antibiotic therapy. Surveillance cultures were taken in advance of BSI in 218 (95.6%) of 228 episodes. Concordant organisms with identical identification and susceptibilities were found in prior surveillance cultures and subsequent blood cultures in 65 (29.8%) of 218 episodes. Surveillance cultures predicted resistance in 52.9% and 51.4% of BSIs caused by resistant pathogens to piperacillin/tazobactam and meropenem, respectively. The negative predictive value of surveillance cultures negative for a resistant organism also exceeded 90% for piperacillin/tazobactam and meropenem. Given that the overall resistant rates of BSI pathogens of our study were 11.3% to piperacillin/tazobactam and 16.4% to meropenem, surveillance cultures in our setting may provide important information on the probability of drug resistance of the causative pathogens and some utility in aiding empiric antibiotic therapy for ICU patients who subsequently develop BSI.
Publisher: Frontiers Media SA
Date: 02-02-2016
Publisher: Oxford University Press (OUP)
Date: 18-10-2022
Abstract: Amongst patients with critical illness associated new onset AF (CI-NOAF), the risk of subsequent atrial fibrillation (AF) diagnoses and other adverse outcomes is unknown, and the role for long-term anticoagulation is unclear. This study sought to determine the factors associated with subsequent AF diagnoses and other adverse outcomes in this cohort. Admissions to a tertiary general intensive care unit (ICU) between December 2015 and September 2018 were screened for AF episodes through hourly analysis of continuous ECG monitoring. Patients with a prior history of AF were excluded. AF burden was defined as the percentage of monitored ICU hours in AF. The primary endpoint was subsequent AF diagnoses, as collated from the statewide electronic medical records. Secondary endpoints included mortality, embolic events, MACE and subsequent anticoagulation. Of 7030 admissions with 509 303 h of monitoring data, 309 patients with CI-NOAF were identified, and 235 survived to discharge. Subsequent AF diagnoses were identified in 75 (31.9%) patients after a median of 413 days. Increased AF burden had the strongest independent association with AF recurrence (OR = 15.03, P = 0.002), followed by increased left atrial area (OR = 1.12, P = 0.01). Only 128 (54.5%) patients had their AF diagnosis acknowledged at ICU discharge, and 50 (21.3%) received anticoagulation at hospital discharge. CI-NOAF is often under-recognized, and subsequent AF diagnoses are common post-discharge. AF burden during ICU admission has a strong independent association with subsequent AF diagnoses. Left atrial size is also independently associated with subsequent AF.
Publisher: Springer Science and Business Media LLC
Date: 17-08-2016
Publisher: Oxford University Press (OUP)
Date: 2012
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.HRTLNG.2015.09.008
Abstract: To establish the inter-rater reliability of the Acute Care Index of Function (ACIF) in intensive care unit (ICU) patients and determine whether ACIF scores have predictive utility beyond ICU discharge. Accurate and reliable measures of physical function are required to describe the recovery trajectory of ICU survivors. The clinimetric properties of the ACIF are yet to be established in ICU patients. Prospective observational study in a single tertiary ICU. ACIF scores were recorded independently by 2 physiotherapists across a convenience s le of 100 physiotherapy assessments, and at ICU discharge. Inter-rater reliability of total ACIF scores was very strong (ICC = 0.94). ACIF <0.40 at ICU discharge predicted hospital discharge to a destination other than home (area under ROC = 0.79, 95% CI 0.64-0.89) (sensitivity 0.78). The ACIF has excellent inter-rater reliability in ICU patients and scores at ICU discharge predict the likelihood of discharge home. ACTRN12614001008617 (September 18 2014).
Publisher: Springer Science and Business Media LLC
Date: 2010
DOI: 10.2165/11318140-000000000-00000
Abstract: The prescription of pharmaceuticals in the critically ill is complicated by a paucity of knowledge concerning the pharmacokinetic implications of the underlying disease state. Changes in organ function can be dramatic in this population, both as a consequence of the primary pathophysiology and in response to clinical interventions provided. Vascular tone, fluid status, cardiac output and major organ blood flow can be significantly altered from baseline, influencing the volume of distribution and clearance of many commonly prescribed agents. Although measurable endpoints can be used to titrate doses for many drugs in this setting (such as sedatives), for those agents with silent pharmacodynamic indices, enhanced excretory organ function can result in unexpectedly low plasma concentrations, leading to treatment failure. This is particularly relevant to the use of antibacterials in the critically ill, where inadequate, inappropriate and/or delayed prescription can have significant effects on morbidity and mortality. Augmented renal clearance (ARC) refers to enhanced renal elimination of circulating solute and is being described with increasing regularity in the critically ill. However, defining this process in terms of current measures of renal function is problematic, as although the glomerular filtration rate (GFR) is largely considered the best index of renal function, there is no consensus on an upper limit of normal. In addition, the most readily available and accurate estimate of the GFR at the bedside is still widely debated. From a pharmacokinetic point of view, ARC can result in elevated renal elimination and subtherapeutic plasma concentrations of pharmaceuticals, although whether this process solely involves augmented filtration (as opposed to enhanced tubular secretion and/or reabsorption) remains uncertain. The primary contributors to this process are likely to be the innate immune response to infection and inflammation (with its associated systemic and haemodynamic consequences), fluid loading and use of vasoactive medications. The resultant increase in cardiac output and renal blood flow prompts enhanced glomerular filtration and drug elimination. Current evidence suggests that young patients without pre-existing co-morbidity or organ dysfunction who present with trauma are most likely to manifest ARC. As this phenomenon has received little attention in the literature, dose modification has rarely been considered. However, with increasing data supporting the concept, and many investigators demonstrating subtherapeutic concentrations of drugs in the critically ill, consideration of ARC and alternative dosing regimens is now mandatory, both to improve the likelihood of treatment success and to reduce the rate of development of antibacterial resistance.
Publisher: Springer Science and Business Media LLC
Date: 13-11-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2013
Publisher: Springer Berlin Heidelberg
Date: 09-09-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2012
Publisher: Elsevier BV
Date: 10-2005
Abstract: Respiratory muscle weakness and decreased endurance have been demonstrated following mechanical ventilation. However, its relationship to the duration of mechanical ventilation is not known. The aim of this study was to assess respiratory muscle endurance and its relationship to the duration of mechanical ventilation. Prospective study. Tertiary teaching hospital ICU. Twenty subjects were recruited for the study who had received mechanical ventilation for > or = 48 h and had been discharged from the ICU. FEV1, FVC, and maximal inspiratory pressure (P(I(max)) at functional residual capacity were recorded. The P(I(max)) attained following resisted inspiration at 30% of the initial P(I(max)) for 2 min was recorded, and the fatigue resistance index (FRI) [P(I(max)) final/P(I(max))initial] was calculated. The duration of ICU length of stay (ICULOS), duration of mechanical ventilation (MVD), duration of weaning (WD), and Charlson comorbidities score (CCS) were also recorded. Relationships between fatigue and other parameters were analyzed using the Spearman correlations (rho). Subjects were admitted to the ICU for a mean duration of 7.7 days (SD, 3.7 days) and required mechanical ventilation for a mean duration of 4.6 days (SD, 2.5 days). The mean FRI was 0.88 (SD, 0.13), indicating a 12% fall in P(I(max)), and was negatively correlated with MVD (r = -0.65 p = 0.007). No correlations were found between the FRI and FEV1, FVC, ICULOS, WD, or CCS. Patients who had received mechanical ventilation for > 48 h have reduced inspiratory muscle endurance that worsens with the duration of mechanical ventilation and is present following successful weaning. These data suggest that patients needing prolonged mechanical ventilation are at risk of respiratory muscle fatigue and may benefit from respiratory muscle training.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2010
Publisher: Informa UK Limited
Date: 26-08-2016
DOI: 10.1080/02699052.2016.1199894
Abstract: Cerebral microcirculation after head injury is heterogeneous and temporally variable. Regions at risk of infarction such as peri-contusional areas are vulnerable to anaemia. However, direct quantification of the cerebral microcirculation is clinically not feasible. This study describes a novel experimental head injury model correlating cerebral microcirculation with histopathology analysis. To test the hypothesis that cerebral microcirculation at the ischaemic penumbrae is reduced over time when compared with non-injured regions. Merino sheep were instrumented using a transeptal catheter to inject coded microspheres into the left cardiac atrium, ensuring systemic distribution. After a blunt impact over the left parietal region, cytometric analyses quantified cerebral microcirculation and amyloid precursor protein staining identified axonal injury in pre-defined anatomical regions. A mixed effect regression model assessed the hourly blood flow results during 4 hours after injury. Cerebral microcirculation showed temporal reductions with minimal amyloid staining except for the ipsilateral thalamus and medulla. The spatial heterogeneity and temporal reduction of cerebral microcirculation in ovine models occur early, even after mild head injury, independent of the intracranial pressure and the level of haemoglobin. Alternate approaches to ensure recovery of regions with reversible injury require a targeted assessment of cerebral microcirculation.
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: 12-2010
DOI: 10.1016/J.IJANTIMICAG.2010.08.013
Abstract: Pneumonia is a form of lung infection that may be caused by various micro-organisms. The predominant site of infection in pneumonia is debatable. Advances in the fields of diagnostic and therapeutic medicine have had a less than optimal effect on the outcome of pneumonia and one of the many causes is likely to be inadequate antimicrobial concentrations at the site of infection in lung tissue. Traditional antimicrobial therapy guidelines are based on indirect modelling from blood antimicrobial levels. However, studies both in humans and animals have shown the fallacy of this concept in various tissues. Many different methods have been employed to study lung tissue antimicrobial levels with limited success, and each has limitations that diminish their utility. An emerging technique being used to study the pharmacokinetics of antimicrobial agents in lung tissue is microdialysis. Development of microdialysis catheters, along with improvement in analytical techniques, has improved the accuracy of the data. Unfortunately, very few studies have reported the use of microdialysis in lung tissue, and even fewer antimicrobial classes have been studied. These studies generally suggest that this technique is a safe and effective way of assessing the pharmacokinetics of antimicrobial agents in lung tissue. Further descriptive studies need to be conducted to study the pharmacokinetics and pharmacodynamics of different antimicrobial classes in lung tissue. Data emanating from these studies could inform decisions for appropriate dosing schedules of antimicrobial agents in pneumonia.
Publisher: Wiley
Date: 20-06-2011
DOI: 10.1111/J.1399-6576.2011.02477.X
Abstract: The practical and ethical issues in determining authorship in multicenter trials raise significant and unique challenges. This systematic review examines methods of assigning authorship in multicenter clinical trials. A literature search (October 2009) was conducted to identify articles with the terms 'authorship' and 'clinical trial,' 'multicenter' or 'multicentre.' Abstracts were reviewed for potential relevance and the complete manuscript was obtained where indicated. Additional articles were identified by a review of the reference list from sourced articles. Methods for determining authorship were reviewed in terms of practicality, fairness and the time course for decision-making. Eight methods for determining authorship were identified: four used a scoring system, two articles contained guidelines with reference to scoring systems and two articles outlined general guidelines. All methods attempted to provide a fair and practical approach and appeared to achieve this to varying degrees. No one method was applicable across all multicenter trials. The authors propose a guide for determining authorship based on the methods identified and the number of collaborators and anticipated publications. For smaller collaborative groups (e.g. <10 persons), byline inclusion of all authors based on relative contributions is recommended. For larger collaborations (e.g. ≥ 10 persons), authorship guidelines should be explicit from the outset of the trial with consideration of relevant scoring systems.
Publisher: Springer Science and Business Media LLC
Date: 22-02-2011
Publisher: IOP Publishing
Date: 20-07-2011
DOI: 10.1088/0967-3334/32/9/001
Abstract: Biological signals often exhibit self-similar or fractal scaling characteristics which may reflect intrinsic adaptability to their underlying physiological system. This study analysed fractal dynamics of cerebral blood flow in patients supported with ventricular assist devices (VAD) to ascertain if sustained modifications of blood pressure waveform affect cerebral blood flow fractality. Simultaneous recordings of arterial blood pressure and cerebral blood flow velocity using transcranial Doppler were obtained from five cardiogenic shock patients supported by VAD, five matched control patients and five healthy subjects. Computation of a fractal scaling exponent (α) at the low-frequency time scale by detrended fluctuation analysis showed that cerebral blood flow velocity exhibited 1/f fractal scaling in both patient groups (α = 0.95 ± 0.09 and 0.97 ± 0.12, respectively) as well as in the healthy subjects (α = 0.86 ± 0.07). In contrast, fluctuation in blood pressure was similar to non-fractal white noise in both patient groups (α = 0.53 ± 0.11 and 0.52 ± 0.09, respectively) but exhibited 1/f scaling in the healthy subjects (α = 0.87 ± 0.04, P < 0.05 compared with the patient groups). The preservation of fractality in cerebral blood flow of VAD patients suggests that normal cardiac pulsation and central perfusion pressure changes are not the integral sources of cerebral blood flow fractality and that intrinsic vascular properties such as cerebral autoregulation may be involved. However, there is a clear difference in the fractal scaling properties of arterial blood pressure between the cardiogenic shock patients and the healthy subjects.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2006
Publisher: BMJ
Date: 05-2014
Publisher: Wiley
Date: 07-2012
DOI: 10.1111/J.1445-5994.2011.02533.X
Abstract: Previous research at our institution (1988-1998) established an intensive care unit (ICU) and hospital mortality between 70% and 80% in haemopoietic stem cell transplant (HSCT) patients requiring ICU admission. This study explored mortality in a more contemporary cohort while comparing outcomes to published literature and our previous experience. Retrospective chart review of HSCT patients admitted to ICU between December 1998 and June 2008. Of 146 admissions, 53% were male, with a mean age of 44 years, an Acute Physiologic and Chronic Health Evaluation II score of 28 and Sepsis Organ Failure Assessment score of 11. Fifty-six per cent had graft versus host disease (GVHD), with respiratory failure (67%) being the most common admission diagnosis. All but one received mechanical ventilation. The ICU and hospital mortality were 42% (72% 1988-1998 cohort) and 64% (82% 1998-1998 cohort) respectively. The 6- and 12-month survivals were 29% and 24% respectively for the 1998-2008 cohort. Dying in ICU was independently predicted by fungal infection (P= 0.02) and early onset of organ failure (P < 0.001), while GVHD (P= 0.04) predicted survival. Mortality at 12 months was independently predicted by the acute physiology score (P= 0.002), increasing number of organ failures (P= 0.001), and cytomegalovirus positive serology (P= 0.005), while blood stream infection (P= 0.003), an antibiotic change on admission to the ICU (P= 0.007) and a diagnosis of non-Hodgkin lymphoma (P= 0.02) predicted survival. Our study found that acute admission of HSCT patients to the ICU is associated with improved survival compared to our previous experience, with organ failure progression a strong predictor of ICU outcome, and specific disease characteristics contributing to long-term survival.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2001
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-1997
DOI: 10.1097/00003246-199710000-00021
Abstract: To compare the degree of bacterial circuit colonization, frequency of ventilator-associated pneumonia (VAP), character of respiratory secretions, rewarming of hypothermic patients, disposable costs, and air flow resistance in intensive care patients ventilated using either a heat and moisture exchanger (HME) or hot water (HW) humidifier circuit. A prospective, randomized blinded trial of patients in the intensive care unit undergoing mechanical ventilation. A metropolitan teaching hospital. One hundred sixteen patients undergoing mechanical ventilation for a minimum period of 48 hrs were enrolled. Patients were randomized to three ventilation groups using a) an HW circuit with a 2-day circuit change (n = 41) or b) a bacterial-viral filtering HME in the circuit, with either a 2-day (n = 42) or c) a 4-day circuit change (n = 33). Circuit colonization was assessed using quantitative culture of washings taken from the circuit tubing and semiquantitative culture of swabs from the Y connectors. Sixty-seven percent of HW circuits became contaminated compared with 12% in the two HME groups (p < .0001). Median colony counts were lower in the HME groups (p < .0001). If circuits at first circuit change were contaminated in the HW group, 89% of subsequent circuit changes became contaminated compared with 0% and 25% for the 2- and 4-day HME groups, respectively. The frequency of VAP, the time to resolution of admission hypothermia, and the volume and fluidity of secretions were similar for all groups. The resistance of the HME after 24 hrs of use was < 0.025 cm H2O/L at gas flows of 40 L/min. HME use resulted in a cost reduction of $1.48 (Australian)/day. Circuits with a bacterial-viral filtering HME are less readily colonized by bacteria. Contamination is a random event. Humidification technique has no influence on the frequency rate of VAP, the effectiveness of rewarming, nor the character of the respiratory secretions. Breathing resistance is generally low and disposable costs are reduced when an HME is used.
Publisher: Elsevier BV
Date: 04-2007
DOI: 10.1093/BJA/AEM080
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2012
DOI: 10.2215/CJN.12211211
Abstract: Peritonitis is a major infectious complication in peritoneal dialysis patients, and intraperitoneal antibiotic administration is preferred to ensure maximal antibiotic concentrations at the site of infection. This study aimed to describe the plasma and infection site pharmacokinetics of intraperitoneal gentamicin in patients with peritonitis. This prospective pharmacokinetic study of intraperitoneal gentamicin was conducted in peritoneal dialysis patients presenting to hospital with clinically defined signs and symptoms of peritonitis. Twenty-four patients were administered a 0.6-mg/kg dose of intraperitoneal gentamicin, which was allowed to dwell for 6 hours. Serial blood and dialysate s les were collected for 24 hours after the first dose. Gentamicin concentrations in plasma and dialysate were measured using a validated assay. The median percentage of the dose absorbed into the systemic circulation was 76% (interquartile range=69%–82%) and significantly different between patients with low average, high average, and high peritoneal membrane transporter status ( P =0.03). The calculated pharmacokinetic parameters were plasma terminal elimination half-life of 24.7 (20.4–29.9) hours, terminal volume of distribution of 0.30 (0.20–0.36) L/kg, observed peak plasma concentration of 3.1 (2.4–3.4) mg/L, and observed trough plasma concentration of 1.9 (1.4–2.2) mg/L. The peak gentamicin concentration in dialysate was at least eight times the minimum inhibitory concentration of the likely pathogens. The high systemic absorption of gentamicin in patients with peritonitis and prolonged plasma elimination half-life may lead to drug accumulation in the systemic circulation, increasing the risk of toxicity.
Publisher: Elsevier BV
Date: 08-1999
Publisher: American Veterinary Medical Association (AVMA)
Date: 06-2006
DOI: 10.2460/JAVMA.228.11.1757
Abstract: Objective —To evaluate the efficacy of an adjuvanted modified-live bovine viral diarrhea virus (BVDV) vaccine against challenge with a virulent type 2 BVDV strain in calves with or without maternal antibodies against the virus. Design —Challenge study. Animals —23 crossbred dairy calves. Procedures —Calves were fed colostrum containing antibodies against BVDV or colostrum without antiBVDV antibodies within 6 hours of birth and again 8 to 12 hours after the first feeding. Calves were vaccinated with a commercial modified-live virus combination vaccine or a sham vaccine at approximately 5 weeks of age and challenged with virulent type 2 BVDV 3.5 months after vaccination. Clinical signs of BVDV infection, development of viremia, and variation in WBC counts were recorded for 14 days after challenge exposure. Results —Calves that received colostrum free of antiBVDV antibodies and were vaccinated with the sham vaccine developed severe disease (4 of the 7 calves died or were euthanatized). Calves that received colostrum free of anti-BVDV antibodies and were vaccinated and calves that received colostrum with antiBVDV antibodies and were vaccinated developed only mild or no clinical signs of disease. Conclusions and Clinical Relevance —Results indicated that the modified-live virus vaccine induced a strong protective immune response in young calves, even when plasma concentrations of maternal antibody were high. In addition, all vaccinated calves were protected against viral shedding, whereas control calves vaccinated with the sham vaccine shed virus for an extended period of time.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.HRTLNG.2014.10.001
Abstract: The purpose of this study was to establish whether intensive care unit (ICU) patients have impaired inspiratory muscle (IM) endurance immediately following weaning from prolonged mechanical ventilation (MV), and whether IM weakness is related to function or perceived exertion. Impaired IM endurance may hinder recovery from MV, however it is unknown whether this affects patients' function or perceived exertion. Prospective observational study of 43 adult ICU patients following weaning from MV (>7 days duration). IM endurance was measured using the fatigue resistance index (FRI). IM endurance was impaired (FRI = mean 0.90, SD 0.31), with 37% scoring below 0.80. IM strength did not significantly correlate with function (r = 0.24, p = 0.12) or perceived exertion during exercise (r = -0.146, p = 0.37). IM endurance is reduced in one third of patients, while IM weakness does not appear closely associated with function or perceived exertion immediately following successful weaning.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2012
Publisher: BMJ
Date: 02-06-2016
Publisher: Wiley
Date: 06-09-2007
DOI: 10.1111/J.1365-2044.2007.05217.X
Abstract: Severe tetanus is seen infrequently in the developed world, but often requires intensive care support. Mechanical ventilation with neuromuscular blockade and heavy sedation, good wound care and prompt administration of antitoxin are important. The management of autonomic dysfunction remains challenging. We measured serum catecholamine levels in a patient with severe tetanus in whom autonomic crises were a major and persistent feature, and investigated the impact of sedatives plus alpha(2)-agonists on these levels. Serum adrenaline levels were elevated up to 100-fold with clinically observed crises, although noradrenaline levels were much more difficult to interpret. There was no appreciable difference in catecholamine levels following administration of alpha(2)-agonists in the doses we used, although clonidine did allow easier control of crises with other agents. This case highlights some important lessons in the management of severe tetanus.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2009
Publisher: Springer Science and Business Media LLC
Date: 06-2004
DOI: 10.1007/S00134-004-2203-Y
Abstract: To compare the efficacy of two forms of eye care (hypromellose and Lacri-Lube combination vs polyethylene/Cling wrap covers) for intensive care patients. Randomised-controlled trial. University affiliated, tertiary referral hospital. One hundred ten patients with a reduced or absent blink reflex were followed through until they regained consciousness, were discharged from the facility during study enrolment, died or developed a positive corneal ulcer or eye infection. All patients received standard eye cleansing every 2 h. In addition to this, group one ( n=60) received a treatment combining hypromellose drops and Lacri-Lube (HL) to each eye every 2 h. Group two ( n=50) had polyethylene covers only placed over the eye to create a moisture chamber. Corneal ulceration was determined using corneal fluorescein stains and mobile slit l evaluation, performed daily. No patients had corneal ulceration in the polyethylene cover group, but 4 patients had corneal ulceration in the HL group. Polyethylene covers are as effective as HL in reducing the incidence of corneal damage in intensive care patients.
Publisher: Springer Science and Business Media LLC
Date: 02-11-2005
DOI: 10.1007/S00421-005-0019-2
Abstract: Passive tilting increases ventilation in healthy subjects however, controversy surrounds the proposed mechanism. This study is aimed to evaluate the possible mechanism for changes to ventilation following passive head-up tilt (HUT) and active standing by comparison of a range of ventilatory, metabolic and mechanical parameters. Ventilatory parameters (V (T), V (E), V (E)/VO(2), V (E)/VCO(2), f and PetCO(2)), functional residual capacity (FRC), respiratory mechanics with impulse oscillometry oxygen consumption (VO(2)) and carbon dioxide production (VCO(2)) were measured in 20 healthy male subjects whilst supine, following HUT to 70 degrees and unsupported standing. Data were analysed using a linear mixed model. HUT to 70 degrees from supine increased minute ventilation (V (E)) (P<0.001), tidal volume (V (T)) (P=0.001), ventilatory equivalent for O(2) (V (E)/VO(2)) (P=0.020) and the ventilatory equivalent for CO(2) (V (E)/VCO(2)) (P<0.001) with no change in f (P=0.488). HUT also increased FRC (P<0.001) and respiratory system reactance (X5Hz) (P<0.001) with reduced respiratory system resistance (R5Hz) (P=0.004) and end-tidal carbon dioxide (PetCO(2)) (P<0.001) compared to supine. Standing increased V (E) (P<0.001), V (T) (P<0.001) and V (E)/VCO(2) (P=0.020) with no change in respiratory rate (f) (P=0.065), V (E)/VO(2) (P=0.543). Similar changes in FRC (P<0.001), R5Hz (P=0.013), X5Hz (P<0.001) and PetCO(2) (P<0.001) compared to HUT were found. In contrast to HUT, standing increased VO(2) (P=0.002) and VCO(2) (P=0.048). The greater increase in V (E) in standing compared to HUT appears to be related to increased VO(2) and VCO(2) associated with increased muscle activity in the unsupported standing position. This has implications for exercise prescription and rehabilitation of critically ill patients who have reduced cardiovascular and respiratory reserve.
Publisher: Elsevier BV
Date: 03-1997
DOI: 10.1016/S0022-510X(96)05304-X
Abstract: Cerebrospinal fluid (CSF) gas tension measurements have been used as a marker of cerebral oxygenation in animal models and in human studies. Discrepancies in the measurement of PCO2 and PO2 in non-blood solutions by standard blood gas analyzers have been described. The CSF is a physiological non-blood fluid with an ability to carry only dissolved O2 or CO2. The aim of this experiment was to determine the bias and precision of CSF pCO2 and pO2 measurements of a contemporary blood gas analyzer and a continuous gas sensor. CSF from human patients was tonometered to known PCO2 and PO2 using standard calibration gases in a bubble tonometer. Following equilibration, a continuous measurement of the partial pressure of gases in the CSF in the tonometer solution was made using a calibrated Paratrend 7 gas sensor (Biomedical Sensors, Bucks., UK) inserted into the equilibration chamber of the tonometer and continuous CSF pH, PCO2 and PO2 measurements recorded at 1-min intervals. After equilibration, a 3-ml CSF s le was aspirated anaerobically from the tonometer and analysed in duplicate using an ABL 620 (Radiometer, Copenhagen) blood gas analyser. The measured pCO2 and pO2 from the ABL 620 blood gas analyser and the Paratrend 7 sensor were paired with the expected values to calculate bias and precision. Small offsets in PCO2 and large offsets in PO2 measurement were seen with the ABL 620 blood gas analyser. This study brings into question clinical decisions based on CSF PO2 measurements. The implications for calibrating CSF sensors against CSF gas measurements are discussed.
Publisher: Wiley
Date: 12-2005
DOI: 10.1002/PRI.14
Abstract: Inspiratory muscle weakness and fatigue has been documented following prolonged mechanical ventilation despite successful weaning from mechanical ventilation. This report describes the application of inspiratory muscle training in two patients following successful discharge from an intensive care unit (ICU) after prolonged mechanical ventilation. Both patients undertook inspiratory muscle training in conjunction with standard physiotherapy rehabilitation. Improvements in inspiratory muscle strength and endurance, exercise tolerance and functional performance following twice-daily inspiratory muscle training were recorded. In both cases, an improvement in maximal inspiratory pressure (MIP) and maximal tolerated inspiratory load (MIP(load)) was found following training. These positive results indicate further research is needed to investigate the effect of inspiratory muscle training on respiratory function, exercise tolerance and functional performance, for the possible inclusion of inspiratory muscle training into the physiotherapy management of patients following prolonged mechanical ventilation.
Publisher: Wiley
Date: 08-2004
Publisher: Elsevier BV
Date: 08-1999
DOI: 10.1016/S0002-9378(99)70572-7
Abstract: Administration of nitric oxide by means of inhalation during the labor of a woman with Eisenmenger's syndrome caused by an atrial septal defect resulted in improved oxygenation and initial pulmonary arterial pressure. She gave birth to a live infant at 34 weeks' gestation but died of worsening pulmonary hypertension and heart failure 21 days post partum.
Publisher: Springer Science and Business Media LLC
Date: 31-10-2011
Publisher: Bentham Science Publishers Ltd.
Date: 11-2010
Publisher: Springer Science and Business Media LLC
Date: 02-04-2016
Publisher: Springer Science and Business Media LLC
Date: 07-08-2013
DOI: 10.1007/S12028-013-9887-1
Abstract: Cerebral vasospasm complicating subarachnoid hemorrhage causes ischemic stroke and worsens the neurological outcome. The potential role of endothelin-1 in vasospasm pathogenesis may provide therapeutic opportunities. A recent meta-analysis however, did not support the use of endothelin antagonists. Apart from clinical assessment, transcranial Doppler and interval angiography, there are no sensitive screening markers for evolving vasospasm. We investigate the ability of serial measurement of endothelin-1 to predict the development of vasospasm following subarachnoid hemorrhage. Endothelin-1 levels in cerebrospinal fluid and blood were measured daily in 20 patients admitted to the ICU with subarachnoid hemorrhage from days 1 to 10 following the inception bleed. In addition to clinical assessment, patients had daily transcranial Doppler. Digital subtraction angiography was performed on the suspicion of vasospasm based upon clinical or transcranial Doppler assessment. Neuron-specific enolase and SB100 were measured in blood as comparative biomarkers of neurological injury. Mean plasma endothelin-1 on day 5, was 4.2 mcg/L (CI 3.1-5.8) in patients with vasospasm compared to 2.5 mcg/L (CI 1.5-4.0) in those without vasospasm (P = 0.047). There were no time-related differences in cerebrospinal fluid endothelin-1, plasma NSE, or SB100 for patients with and without vasospasm. In patients with subarachnoid hemorrhage and vasospasm, endothelin-1 is significantly higher in plasma than in CSF on day 5. Neither NSE nor SB100 is associated with the development of vasospasm. Measurement of serial plasma endothelin-1 concentration is a potential screening marker of vasospasm.
Publisher: American Society for Microbiology
Date: 11-2005
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1093/BJA/AES035
Abstract: Intensive care delirium is a well-recognized complication in critically ill patients. Delirium is an independent risk factor for death in the intensive care unit (ICU), leading to oversedation, increased duration of mechanical ventilation, and increased length of stay. Although there has not been a direct causal relationship shown between sleep deprivation and delirium, many studies have demonstrated that critically ill patients have an altered sleep pattern, abnormal levels of melatonin, and loss of circadian rhythms. Melatonin has a major role in control of circadian rhythm and sleep regulation and other effects on the immune system, neuroprotection, and oxidant/anti-oxidant activity. There has been interest in the use of exogenous melatonin as a measure to improve sleep. However, there are only a few studies of melatonin in ICU patients and these use heterogeneous methodologies. Therefore, it is not possible at this stage to make any clear recommendations regarding the clinical use of melatonin in this setting. There is a need for well-designed randomized controlled trials examining the role of melatonin in ICU.
Publisher: Elsevier BV
Date: 2007
DOI: 10.1093/BJA/AEL286
Abstract: The central venous catheter (CVC) is associated with numerous complications more so during the process of insertion. We report for the first time how an indwelling catheter was entrapped by a replacement catheter on the same side, after being speared by the introducer needle and guidewire. The diagnosis was made when there was difficulty in removing the old catheter. Subsequently, interventional radiology services were used to define the problem and help in removal of the entrapped catheter. The mechanism of entrapment and the actual procedure used for removal of the catheter is described. The dangers of insertion of a CVC on the same side as a pre-existing one are highlighted.
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: Oxford University Press (OUP)
Date: 21-10-2014
DOI: 10.1093/JAC/DKU413
Abstract: To describe the interstitial fluid (ISF) and plasma pharmacokinetics of meropenem in patients on continuous venovenous haemodiafiltration (CVVHDF). This was a prospective observational pharmacokinetic study. Meropenem (500 mg) was administered every 8 h. CVVHDF was targeted as a 2-3 L/h exchange using a polyacrylonitrile filter with a surface area of 1.05 m2 and a blood flow rate of 200 mL/min. Serial blood (pre- and post-filter), filtrate/dialysate and ISF concentrations were measured on 2 days of treatment (Profiles A and B). Subcutaneous tissue ISF concentrations were determined using microdialysis. A total of 384 s les were collected. During Profile A, the comparative median (IQR) ISF and plasma peak concentrations were 13.6 (12.0-16.8) and 40.7 (36.6-45.6) mg/L and the trough concentrations were 2.6 (2.4-3.4) and 4.9 (3.5-5.0) mg/L, respectively. During Profile B, the ISF trough concentrations increased by ∼40%. Meropenem ISF penetration was estimated at 63% (60%-69%) and 69% (65%-74%) for Profiles A and B, respectively, using comparative plasma and ISF AUCs. For Profile A, the plasma elimination t1/2 was 3.7 (3.3-4.0) h, the volume of distribution was 0.35 (0.25-0.46) L/kg, the total clearance was 4.1 (4.1-4.8) L/h and the CVVHDF clearance was 2.9 (2.7-3.1) L/h. This is the first known report of concurrent plasma and ISF concentrations of a meropenem antibiotic during CVVHDF. We observed that the ISF concentrations of meropenem were significantly lower than the plasma concentrations, although the present dose was appropriate for infections caused by intermediately susceptible pathogens (MIC≤4 mg/L).
Publisher: Springer Science and Business Media LLC
Date: 2013
DOI: 10.1186/CC12544
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: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2008
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: Bentham Science Publishers Ltd.
Date: 11-2010
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.IJANTIMICAG.2014.01.009
Abstract: This prospective pharmacokinetic study aimed to describe plasma and interstitial fluid (ISF) pharmacokinetics of piperacillin and tazobactam in critically ill patients on continuous venovenous haemodiafiltration (CVVHDF). Piperacillin/tazobactam (4g/0.5g) was administered every 8h and CVVHDF was performed as a 3-3.5L/h exchange using a polyacrylonitrile filter with a surface area of 1.05m(2). Serial blood (pre- and post-filter), filtrate/dialysate, urine and ISF concentrations were measured. Subcutaneous tissue ISF concentrations were determined using microdialysis. A total of 407 s les were collected. Median peak plasma concentrations were 210.5 (interquartile range=161.5-229.0) and 29.4 (27.9-32.0) mg/L and median trough plasma concentrations were 64.3 (49.0-68.9) and 12.3 (7.7-13.7) mg/L for piperacillin and tazobactam, respectively. The plasma elimination half-life was 6.4 (4.6-8.7) and 7.3 (4.6-11.8) h, volume of distribution 0.42 (0.29-0.49) and 0.32 (0.24-0.36) L/kg, total clearance 5.1 (4.2-6.2) and 3.8 (3.3-4.2) L/h and CVVHDF clearance 2.5 (2.3-3.1) and 2.5 (2.3-3.2) L/h for piperacillin and tazobactam, respectively. The tissue penetration ratio or ratio of area under the concentration-time curve of the unbound drug in ISF to plasma (unbound AUCISF/AUCplasma) was ca. 1 for both piperacillin and tazobactam. This is the first report of concurrent plasma and ISF concentrations of piperacillin and tazobactam during CVVHDF. For the CVVHDF settings used in this study, a dose of 4.5g piperacillin/tazobactam administered evry 8h resulted in piperacillin concentrations in plasma and ISF >32mg/L throughout most of the dosing interval.
Publisher: Springer Science and Business Media LLC
Date: 12-03-2010
Publisher: Wiley
Date: 2008
DOI: 10.1111/J.1440-1843.2007.01211.X
Abstract: Surveillance cultures may improve the prediction of ventilator-associated pneumonia (VAP) and empirical antibiotic selection. This study examined the utility and patient safety of blind, non-protected, low-volume mini-bronchial lavage (BM-BAL) surveillance cultures in predicting VAP. A prospective, cohort study was performed in a large general intensive care unit. BM-BALs were collected within 12 h of admission then thrice weekly. Each BM-BAL was screened by Gram staining for intracellular organisms and then quantitatively cultured. VAP was diagnosed using the Clinical Pulmonary Infection Score. The concordance for isolates from the BM-BAL was assessed against concurrently collected endotracheal aspirates (EA). Four hundred and twelve patients requiring a minimum of 48 h of mechanical ventilation were enrolled. Fifty patients developed 58 episodes of VAP. Concordant pathogens were found in 85% of BM-BAL specimens collected 2 days prior to VAP onset. Their antibiograms were stable over the preceding 4 days. The isolation of pathogens with colony counts >or=10(4) cfu/mL from BM-BAL performed 2 days prior to the clinical onset of VAP had a sensitivity of 84%, specificity of 50%, positive predictive value of 31% and a negative predictive value of 93% for predicting the development of VAP. BM-BAL WCC, quantification of bacterial growth and the percentage of intracellular organisms were not helpful in predicting VAP diagnosis. BM-BAL surveillance cultures are well tolerated and useful in predicting the pathogens and their antibiograms causing VAP. Diagnostic specimen collection at the time of VAP onset is still required as surveillance cultures may be negative even one day prior to VAP onset.
Publisher: AME Publishing Company
Date: 09-2016
Publisher: Elsevier BV
Date: 12-2004
DOI: 10.1016/J.APMR.2004.03.024
Abstract: To investigate the effect of standing with assistance of the tilt table on ventilatory parameters and arterial blood gases in intensive care patients. Consecutive s le. Tertiary referral hospital. Fifteen adult patients who had been intubated and mechanically ventilated for more than 5 days (3 subjects successfully weaned, 12 subjects being weaned). Passive tilting to 70 degrees from the horizontal for 5 minutes using a tilt table. Minute ventilation (VE), tidal volume (VT), respiratory rate, and arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2). Standing in the tilted position for 5 minutes produced significant increases in VE (P <.001) and produced both increases in respiratory rate (P <.001) and VT (P =.016) compared with baseline levels. These changes were maintained during the tilt intervention and immediately posttilt. Twenty minutes after the tilt, there were no significant changes in ventilatory measures of VE, VT, or arterial blood gases PaO2 and PaCO2 compared with initial values. Standing for 5 minutes with assistance of a tilt table significantly increased ventilation in critical care patients during and immediately after the intervention. There were no improvements in gas exchange posttilt. Using a tilt table provided an effective method to increase ventilation in the short term.
Publisher: Wiley
Date: 04-1995
DOI: 10.1111/J.1445-5994.1995.TB02826.X
Abstract: The clinical presentation, course, and radiological spectrum of bronchiolitis obliterans organising pneumonia (BOOP) is still being characterised to aid differentiation from other causes of organising pneumonia. To define the clinical presentation, response to therapy, and radiological spectrum of BOOP. Fifteen cases of BOOP were retrospectively reviewed. The clinical presenting features, treatment and outcome of each patient were determined. Three independent readers and chest X-rays (CXRs) were blinded. CXRs were scored by a semi-quantitative method. Modal scores were calculated for type and profusion of opacification of each CXR. The mean age of presentation was 64 years and the median duration of follow-up was 12.5 months. Thirteen patients received corticosteroid therapy. Outcome was varied. One patient had progressive loss of lung function, five had persisting symptoms with stable abnormal lung function, and nine were asymptomatic with near normal lung function. Five patients had a disease relapse. Symptoms length prior to presentation, duration and intensity of treatment were not associated with outcome (p = 0.23-0.9). Radiological opacities were alveolar in 73%, large localised infiltrates in 13%, nodular in 20% and mobile in 33% of CXR series. There was no relationship between overall profusion, type of CXR opacities and patient outcome, treatment duration or treatment intensity (p = 0.42-1.0). The clinical spectrum of BOOP includes mild subacute, chronic progressive, and acute life threatening illness. Prognosis and response to treatment is variable. The ersity of radiological findings and clinical presentations should prompt consideration of the diagnosis in patients with undiagnosed respiratory tract symptoms and persisting or varying radiological abnormalities.
Publisher: American Thoracic Society
Date: 15-05-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2014
Publisher: Oxford University Press (OUP)
Date: 13-11-2006
DOI: 10.1093/JAC/DKL478
Abstract: To compare the clinical and bacteriological outcome of critically ill patients with sepsis treated by ceftriaxone administered as a once-a-day intermittent bolus dose or by 24 h continuous infusion. We conducted an open-label, randomized controlled pilot study in 57 patients clinically diagnosed with sepsis (suspected roven infection and systemic inflammatory response syndrome) in a tertiary level intensive care unit. Patients were randomized to receive 2 g of ceftriaxone administered by once-daily intermittent bolus dosing or by 24 h continuous infusion. Clinical and bacteriological outcomes were assessed by blinded clinicians. Fifty-seven patients were enrolled in the study, 50 of whom fulfilled the a priori definition of treatment for 4 or more days. The infusion (n = 29) and bolus groups (n = 28) were similar in terms of demographics, although the median age of those receiving the infusion was younger. Intention-to-treat analysis found no statistically significant differences in the primary outcomes for clinical response (P = 0.17), clinical cure [infusion n = 13/29 versus bolus n = 5/28 adjusted odds ratio (AOR) = 3.74 95% confidence interval (95% CI) = 1.11-12.57 P = 0.06], bacteriological response (P = 0.41) and bacteriological cure (infusion n = 18/29 versus bolus 14/28 AOR = 1.64 95% CI = 0.57-4.70 P = 0.52). However, logistic regression in patients that complied with the a priori definitions who received ceftriaxone by continuous infusion (AOR = 22.8 95% CI = 2.24-232.3 P = 0.008) or patients with a low Acute Physiology and Chronic Health Evaluation (APACHE) II score (AOR = 0.70 95% CI = 0.54-0.91 P = 0.008) were associated with an improved clinical outcome when age and Sepsis Organ Failure Assessment (SOFA) score at time of study entry were controlled for. This pilot study suggests clinical and bacteriological advantages of continuous infusion of ceftriaxone over bolus administration in critically ill patients in patients requiring 4 or more days of treatment. This sets the scene for a large multicentre double-blind randomized controlled trial to confirm these findings.
Publisher: Springer Science and Business Media LLC
Date: 08-04-2015
DOI: 10.1007/S00134-015-3763-8
Abstract: Survivors of sepsis syndromes have poor outcomes for physical and cognitive function. No investigations of early physical rehabilitation in the intensive care unit have specifically targeted patients with sepsis syndromes. To determine whether early physical rehabilitation improves physical function and associated outcomes in patients with sepsis syndromes. Fifty critically ill adults admitted to a general intensive care unit with sepsis syndromes were recruited into a prospective double-blinded randomised controlled trial investigating early physical rehabilitation. Primary outcomes of physical function (acute care index of function) and self-reported health-related quality of life were recorded at ICU discharge and 6 months post-hospital discharge, respectively. Secondary measures included inflammatory biomarkers Interleukin-6, Interleukin-10 and tumour necrosis factor-α, blood lactate, fat-free muscle mass, exercise capacity, muscle strength and anxiety. A significant increase in patient self-reported physical function (81.8 ± 22.2 vs. 60.0 ± 29.4), p = 0.04) and physical role (61.4 ± 43.8 vs. 17.1 ± 34.4, p = 0.005) for the SF-36 at 6 months was found in the exercise group. Physical function scores were not significantly different between groups. Muscle strength scores were (51.9 ± 10.5 vs. 47.3 ± 13.6, p = 0.24) with the standard care mean Medical Research Council Muscle Score (MRC) <48/60. The mean change of Interleukin-10 increased and was significantly higher in the exercise group (1.8 pg/ml, 180 % vs. 0.9 pg/ml, 90 %, p = 0.04). There was no significant difference between groups for lactate, Interleukin-6, tumour necrosis factor-α, muscle strength, exercise capacity, fat-free mass or hospital anxiety. Implementation of early physical rehabilitation can improve self-reported physical function and induce systemic anti-inflammatory effects.
Publisher: Wiley
Date: 04-2009
DOI: 10.1111/J.1445-5994.2009.01699.X
Abstract: Medical school and resident training programmes offer different learning opportunities and outcomes. The aim of the study was to assess medical student and intern experience in common clinical procedures. Interns employed in a metropolitan teaching hospital from 2000 to 2004 completed a survey of experience and confidence in clinical procedures at the beginning and end of their intern year. Attendance at and the contribution to procedural confidence of a voluntary procedural skill-training programme were examined. For the 314 interns, clinical experience before and during internship varied for each procedure and between year cohorts as did training programme attendance (44-84%). Student procedural confidence was predicted by pre-intern experience either on patients or by simulation (beta = 0.17, 95% confidence interval (CI) 0.02-0.21, P = 0.03) and age >30 years on commencing internship (beta = 8.44, 95%CI 3.03-14.06, P = 0.003. Adjusted R(2) = 0.08, P = 0.002). Intern procedural confidence by year's end was predicted by attendance at the training programme (beta = 0.48, 95%CI 0.34-0.62, P < 0.001), intern experience with patient procedures (beta = 0.34, 95%CI 0.21-0.47, P < 0.001) and a clear decision to enter a postgraduate training programme (beta = 0.13, 95%CI 0.04-0.22, P = 0.007, Adjusted R(2) = 0.50, P < 0.001). Interns and students receive variable experience to carry out procedural skills on patients. This makes designing training programmes difficult as training needs vary each year. Both mandatory supervision of key skills and opportunities to supplement limited experience are needed during the intern year to ensure a uniform experience.
Publisher: Walter de Gruyter GmbH
Date: 2016
Abstract: Loss of circadian rhythms and reduced concentrations of endogenous melatonin are common in critically ill patients. After exogenous administration, supra-physiological concentrations in serum are only ephemeral, which may explain the absence of significant therapeutic effect on sleep. The aim of this study is to describe the pharmacokinetics of enteral melatonin in critically ill patients administered in a novel regimen aiming to simulate endogenous release. Thirteen patients in the recovery phase of critical illness were randomised to receive enteral melatonin or placebo. In the melatonin group, a total of 6 mg was administered as solution through their feeding tube, commencing with a 3 mg loading dose at 9 pm and six subsequent 0.5 mg doses hourly. The placebo was administered using a similar regimen. Serial blood s les were taken and measured using a validated chromatographic method. The concentration-time data for serum melatonin concentrations were described using non-linear mixed-effects modelling. The observed concentrations in the melatonin patients were significantly higher than that observed in the placebo patients. The concentrations in the patients administered melatonin were also higher than endogenous melatonin concentrations previously reported in non-critically ill patients. The patients administered melatonin had a mean clearance, volume of distribution and absorption rate constant of melatonin was 55.2 L/h, 767 L and 0.76 h Exogenous administration of melatonin with a loading dose of 3 mg followed by an hourly dose of 0.5 mg demonstrates good oral bioavailability and results in supra-physiological and sustained concentrations of serum melatonin during 12 h overnight.
Publisher: Springer Berlin Heidelberg
Date: 2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
Publisher: Elsevier BV
Date: 12-2020
DOI: 10.51893/2020.4.OA9
Abstract: Objective: To investigate the environment and care in the intensive care unit (ICU) and its relationship to patient circadian temperature disruption. Design: 30-day, prospective period prevalence study. Setting: 27-bed tertiary ICU. Participants: Patients expected to remain in the ICU for at least 24 hours. Main outcome measures: Temperature, relative humidity, light and sound intensity in the ICU nursing interventions (using the Therapeutic Intervention Scoring System-28) and core body temperature of ICU patients. Results: Of 28 patients surveyed, 20 (71%) were mechanically ventilated. Median (interquartile range [IQR]) light intensity peaked at 07:00 at 165 (12–1218) lux with a trough at 23:00 of 15 (12–51) lux and was consistently 100 lux between 21:00 and 06:00. Peak median (IQR) sound intensity was at 07:00 (62.55 [57.87–68.03] dB) while 58.84 (54.81–64.71) dB at 02:00. Ambient temperature and humidity varied with median (IQR) peaks of 23.11°C (22.74–23.31°C) at 16:00 and 44.07% (32.76–51.08%) at 11:00 and median troughs of 22.37°C (21.79–22.88°C) at 05:00 and 39.95% (31.53–47.95%) at 14:00, respectively. Disturbances to sleep during the night occurred due to care activities including linen changes (15 patients, 54%) and bathing (13, 46%). On the day before and the day of the study, 13 patients (47%) and 10 patients (36%), respectively, had a circadian rhythm on core body temperature without an association with illness severity, nursing intervention or environmental measures. Conclusions: The ICU has low light intensity with relative humidity and ambient temperature not aligned to normal human circadian timing. Noise levels are commonly equivalent to conversational speech while patient care procedures interrupt overnight sleep. The contribution of these factors to disrupted CBT rhythmicity is unclear.
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.BURNS.2008.01.011
Abstract: Excessive fluid resuscitation of large burn injuries has been associated with adverse outcomes. We reviewed our experience in patients with major-burn injury to assess the relationship between fluid, clinical outcome and cause of variance from expected resuscitation volumes as defined by the Parkland formula. Eighty patients with new burns > or =15% total body surface area (TBSA) admitted to the intensive care unit within 48 h of injury were included. Mean fluid volume was 6.0+/-2.3 mL/kg/% TBSA at 24h. Bolus fluids for hypotension and oliguria explained 39% of excess variance from Parkland estimates and inaccurate burn size and weight assessment explained 9% of variance. Higher fluid volume was associated with pneumonia (adjusted odds ratio [AOR]=2.0 95% confidence interval [CI] 1.2-3.4) and extremity compartment syndrome (AOR=7.9 95% CI 2.4-26). Colloid use during the first 24h reduced the risk of extremity compartment syndrome (AOR=0.06 95% CI 0.007-0.49) and renal failure (AOR=0.11 95% CI 0.014-0.82). In-hospital mortality was low (10%) and not associated with >125% Parkland resuscitation (P=0.39). Although fluid resuscitation in excess of the Parkland formula was associated with several adverse events, mortality was low. A multi-centre trial is needed to more specifically define the indications and volumes needed for burns fluid resuscitation and revise traditional formulae emphasising patient outcome. Improved training in burn size assessment is needed.
Publisher: Springer Science and Business Media LLC
Date: 14-06-1999
Abstract: To determine the feasibility and usefulness of continuous cerebrospinal fluid pH and gas tension monitoring in critically ill neurosurgical patients. Prospective, observational study. Neurosurgical intensive care unit in a teaching hospital. Five critically ill neurosurgical patients (GCS < 8) requiring intensive care intracranial pressure monitoring and intermittent positive pressure ventilation. Placement of a Paratrend 7 sensor into the external ventricular drain. The cerebrospinal fluid (CSF) pH, PCO2 and PO2 were recorded at 1-min intervals. Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were recorded at 15-min intervals. The mean baseline CSF pH, O2 and PO2 values were 7.28 +/- 0.08 pH units, 44 +/- 6 torr and 43 +/- 27 torr, respectively. The ranges of CSF pH, PCO2 and PO2 observed during the study were 6.3-7.8 pH units, 37-150 torr and 4-150 torr, respectively. A statistically significant correlation between ICP, CPP and CSF gas tensions occurred in patient 3. Significant changes in CSF PO2 and pH were observed with augmentation of CPP and preceded clinical improvement in patient 4. There were no complications attributable to sensor placement. CSF gas tensions and pH values obtained from patients 3 and 4 suggest that these measurements may be an indicator of cerebral perfusion. Continuous CSF gas tension measurements in critically ill patients are possible and may be an indicator of adequacy of cerebral perfusion. The relative merits and limitations of the technique are discussed.
Publisher: Elsevier BV
Date: 1997
DOI: 10.1016/S0140-6736(96)06162-4
Abstract: In September, 1994, an outbreak of severe respiratory disease affected 18 horses, their trainer, and a stablehand in Queensland, Australia. Fourteen horses and one human being died. A novel virus was isolated from those affected and named equine morbillivirus (EMV). We report a case of encephalitis caused by this virus. A 35-year-old man from Queensland had a brief aseptic meningitic illness in August, 1994, shortly after caring for two horses that died from EMV infection and then assisting at their necropsies. He then suffered severe encephalitis 13 months later, characterised by uncontrolled focal and generalised epileptic activity. Rising titres of neutralising antibodies to EMV in the patient's serum at the time of the second illness suggested an anamnestic response. Distinctive cortical changes were shown on magnetic resonance neuroimaging and histopathological examination of the brain at necropsy. Immunohistochemistry and electronmicroscopy of brain tissue revealed pathology characteristic of the earlier cases of EMV infection. PCR on cerebrospinal fluid taken during the second illness, brain tissue, and serum retained from the original illness resulted in an lified product identical to that previously described from EMV. The results of serology, PCR, electronmicroscopy, and immunohistochemistry strongly suggest that EMV was the cause of this patient's encephalitis, and that exposure to the virus occurred 3 months before the fatal illness.
Publisher: Wiley
Date: 07-2000
DOI: 10.1046/J.1365-2923.2000.00567.X
Abstract: The factors determining intern attendance at 'resident rounds' training programmes are not known. This study aimed to use a behavioural model (the Triandis theory of social behaviour) to predict intern attendance at the resident round programme at a metropolitan teaching hospital. These included 109 interns in a large metropolitan teaching hospital, in the 1996 and 1997 cohorts. Tabulated responses from a structured interview administered to 10 randomly selected interns were used to develop survey items related to the Triandis variables. Attendance was monitored using a sessional logbook and by self-report. Item analysis was conducted for each variable scale. Stepwise multiple regression models were constructed to predict attendance and intention. The average proportion of resident rounds attended was 43% (95% confidence intervals (CI) 40-47%) from logbook attendance, and 63% (95% CI 61-65%) by self-report. Cronbach's alpha for the subscales ranged from 0.62 to 0.91. Intern attendance was predicted by the habit of attendance and negatively predicted by facilitating conditions (AdjR2=0.26, P<0.0001). The intention to attend was only independently predicted by perceived consequences (AdjR2= 0.19, P < 0.0001). The establishment of resident education programmes within teaching hospitals requires attention to and modification of facilitating conditions that may allow improvements in attendance and in quality of the programme.
Publisher: Springer Science and Business Media LLC
Date: 2014
DOI: 10.1186/CC13767
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-1999
DOI: 10.1097/00003246-199906000-00047
Abstract: To characterize the incidence and severity of splanchnic ischemia, as defined by gastric tonometry, in patients with isolated severe head injury and to examine the relationship between cerebral hemodynamics and splanchnic ischemia. Prospective observational study. Neurosurgical intensive care unit in a tertiary referral center. Ten patients with severe neurotrauma. None. The mean arterial pressure, intracranial pressure, and gastric mucosal P(CO2) measurements were recorded at 15-min intervals. Intramucosal pH was calculated every 3 hrs. All patients received stress ulcer prophylaxis. Nine patients received noradrenaline infusions to maintain a target cerebral perfusion pressure of 70 mm Hg. The mean baseline gastric mucosal P(CO2) and intramucosal pH were 38+/-10 torr and 7.38+/-0.1 pH units, respectively. Nine patients manifested low intramucosal pH during the study period. Gastric mucosal P(CO2) values ranged from 36 to 132 torr. Intramucosal pH measurements ranged from 6.9 to 7.47. The mucosal gap ranged from -12 to +93 torr (mean +/- SD, 17+/-17 torr). The pH gap ranged from -0.1 to +0.54 pH units (mean +/- SD, 0.14+/-0.11 pH units). There was no statistically significant relationship between cerebral hemodynamics, the use of inotropes, and gastric mucosal P(CO2), or intramucosal pH. Splanchnic ischemia (intramucosal pH, <7.3) occurs commonly in isolated neurotrauma, with a statistically nonsignificant trend toward development of mucosal ischemia with decreased cerebral perfusion.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2009
Publisher: BMJ
Date: 2012
Publisher: Elsevier BV
Date: 10-2016
Publisher: Bentham Science Publishers Ltd.
Date: 11-2010
Publisher: Bentham Science Publishers Ltd.
Date: 12-2011
DOI: 10.2174/138920111798808446
Abstract: In-hospital and intensive care unit mortality rates for sepsis remain un-acceptably high, and have prompted the publication of international guidelines on best practice. Crucial to this is the application of early appropriate antibacterial therapy, in the correct dose. However, antibacterial regimes in this setting have largely been extrapolated from those in healthy volunteers, and fail to consider the unique pathophysiology and treatment provided to this population. As such, augmented renal clearance (ARC) - the enhanced renal elimination of circulating solute - is likely to be one of the more common physiological changes encountered in this setting, although to date remains largely under-appreciated. Significantly this may alter the pharmacokinetics of many routinely prescribed agents in this setting, pre-disposing to subtherapeutic levels or treatment failure. This review paper examines this phenomenon in detail, providing a summary of the likely underlying mechanisms, those patients at greatest risk, and the implications for antibacterial dosing in the critically ill.
Publisher: Hindawi Limited
Date: 2013
DOI: 10.1155/2013/595838
Abstract: The use of microspheres for the determination of regional microvascular blood flow (RMBF) has previously used different approaches. This study presents for the first time the intracardiac injection of microspheres using transeptal puncture under intracardiac echocardiography guidance. Five Merino sheep were instrumented and cardiovascularly supported according to local guidelines. Two catheter sheaths into the internal jugular vein facilitated the introduction of an intracardiac probe and transeptal catheter, respectively. Five million colour coded microspheres were injected into the left atrium via this catheter. After euthanasia the brain was used as proof of principle and the endpoint for determination of microcirculation at different time points. Homogeneous allocation of microspheres to different regions of the brain was found over time. Alternate slices from both hemispheres showed the following flow ranges: for slice 02 0.57–1.02 mL/min/g, slice 04 0.45–1.42 mL/min/g, slice 06 0.35–1.87 mL/min/g, slice 08 0.46–1.77 mL/min/g, slice 10 0.34–1.28 mL/min/g. A mixed effect regression model demonstrated that the confidence interval did include zero suggesting that the apparent variability intra- and intersubject was not statistically significant, supporting the stability and reproducibility of the injection technique. This study demonstrates the feasibility of the transeptal injection of microspheres, showing a homogeneous distribution of blood flow through the brain unchanged over time and has established a new interventional model for the measurement of RMBF in ovine models.
Location: Australia
Start Date: 2014
End Date: 04-2017
Amount: $411,000.00
Funder: Australian Research Council
View Funded Activity