ORCID Profile
0000-0003-4376-6682
Current Organisations
College of Intensive Care Medicine
,
Campbelltown Hospital
,
South Western Sydney Local Health District
,
Savitribai Phule Pune University
,
Liverpool Hospital
,
Macquarie University Hospital
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Publisher: Springer Science and Business Media LLC
Date: 31-07-1997
Abstract: To study the out-of-hospital quality of life and long-term survival of critically ill patients with combined multiple organ failure and acute renal failure treated with continuous renal replacement therapy (CRRT). Study based on responses to postal questionnaire and clinical information obtained during treatment in the intensive care unit (ICU). ICUs of two tertiary institutions. 85 survivors from a pool of 250 patients with combined acute multiple organ and renal failure who were treated with CRRT. Anonymous postal questionnaire based on an activity index, mental function index, and a simplified version of the Nottingham Health Profile. Of the 250 patients, 85 (34%) survived to be discharged from hospital: 57 males (67%) and 28 females (33%), mean age 56.9 years (range 13.4-81). Mean duration of ICU stay was 10.9 days (range 2-52), mean admission Acute Physiology and Chronic Health Evaluation II score was 24.2 (range 15-41), and mean duration of CRRT was 6.2 days (range 1-34). Mean follow-up time was 2.5 years (range 0.1-5.3). Thirty-three of the 85 patients (38.8%) did not reply to the questionnaire 35 patients (41.7%) were alive at the time of response and 17 (20%) were deceased. Of the 35 responders, 68.5% were satisfied with their present state of health, despite 60.6% stating that their mobility had been affected, with 41.9% being unable to walk more than 200 metres. Most (94.5%) survivors, however, felt that their treatment had been worthwhile, and 91.2% said that they would undergo the same treatment again if necessary. The approximate cost for each year of survival was U.S. $ 50000. In the majority of patients who survived to be discharged from hospital after combined acute multiple organ and renal failure, the overall state of health and quality of life seemed acceptable. Most patients felt that their treatment was worthwhile and that they would undergo the same treatment again if necessary. Our findings suggest that the cost and effort associated with CRRT and ICU care in these patients are high but broadly comparable to those associated with the care of other serious illnesses. They are also seen as worthwhile by survivors, who consider their life to be of acceptable quality.
Publisher: Springer Science and Business Media LLC
Date: 04-09-2019
DOI: 10.1007/S12028-019-00835-Z
Abstract: Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the Point PRevalence In Neurocritical CarE (PRINCE) study, a prospective, cross-sectional, observational study. We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and in-hospital mortality. We present descriptive statistics to summarize data from the case report form. We tested differences between geographically grouped data using parametric and nonparametric testing as appropriate. We used a multivariable logistic regression model to evaluate factors associated with in-hospital mortality. We analyzed data from 1545 patients admitted to 147 participating sites from 31 countries of which most were from North America (69%, N = 1063). Globally, there was variability in patient characteristics, admission diagnosis, ICU treatment team and resource allocation, and in-hospital mortality. Seventy-three percent of the participating centers were academic, and the most common admitting diagnosis was subarachnoid hemorrhage (13%). The majority of patients were male (59%), a half of whom had at least two comorbidities, and median Glasgow Coma Scale (GCS) of 13. Factors associated with in-hospital mortality included age (OR 1.03 95% CI, 1.02 to 1.04) lower GCS (OR 1.20 95% CI, 1.14 to 1.16 for every point reduction in GCS) pupillary reactivity (OR 1.8 95% CI, 1.09 to 3.23 for bilateral unreactive pupils) admission source (emergency room versus direct admission [OR 2.2 95% CI, 1.3 to 3.75] admission from a general ward versus direct admission [OR 5.85 95% CI, 2.75 to 12.45 and admission from another ICU versus direct admission [OR 3.34 95% CI, 1.27 to 8.8]) and the absence of a dedicated neurocritical care unit (NCCU) (OR 1.7 95% CI, 1.04 to 2.47). PRINCE is the first study to evaluate care patterns of neurocritical patients worldwide. The data suggest that there is a wide variability in clinical care resources and patient characteristics. Neurological severity of illness and the absence of a dedicated NCCU are independent predictors of in-patient mortality.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-07-2008
Publisher: SAGE Publications
Date: 03-1999
DOI: 10.1177/039139889902200306
Abstract: Continuous renal replacement therapy is increasingly used in the management of acute renal failure in critically ill patients. The advantages of continuous renal replacement therapy (CRRT) over intermittent hemodialysis (IHD), however, are not yet fully documented. In particular, it is unknown whether continuous veno-venuous hemodiafiltration (CVVHDF) provides better control of azotemia than IHD. To study the effect on azotemic control of changing acute renal failure treatment from IHD to CVVHDF. Tertiary intensive care unit. Forty seven consecutive critically ill patients with multiorgan failure and acute renal failure treated with IHD and 47 similar patients treated with CVVHDF. Analysis of daily morning urea and creatinine concentrations over the period of renal replacement therapy in the ICU. Statistical comparison of data. The two groups of patients were comparable for mean age (55 years for IHD vs. 60 years for CVVHDF NS) and number of failing organs prior to therapy (mean of 4.2 for IHD vs. 3.7 for CVVHDF NS). Severity of illness at admission as assessed by APACHE II score, however, was greater for patients receiving CVVHDF (29.4 vs 25.7 p .003). CVVHDF was associated with a significantly lower plasma urea (p 0.0001) and serum creatinine (p .01) level at 24 hours of treatment despite similar levels at the start of therapy. Throughout the duration of therapy, mean urea levels (35.0 mmol/L for IHD vs 23.4 mmol/L for CVVHDF) and mean serum creatinine levels (513 micromoles/L for IHD and 263 micromoles/L for CVVHDF) showed significantly (p .0001) better control of uremia with CRRT. Changing the form of renal replacement therapy from intermittent hemodialysis to continuous hemofiltration is associated with improved control of azotemia. The superior adequacy of small solute clearance achieved during CVVHDF provides additional support for its preferential use in the management of acute renal failure in the ICU.
Publisher: Springer Science and Business Media LLC
Date: 07-06-2019
Publisher: Springer New York
Date: 25-09-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2012
Publisher: Springer Science and Business Media LLC
Date: 12-07-2021
Publisher: Wiley
Date: 03-2021
DOI: 10.1111/IMJ.14812
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-07-2008
Publisher: Springer Science and Business Media LLC
Date: 2014
DOI: 10.1186/CC13767
Publisher: Springer Science and Business Media LLC
Date: 15-10-2020
DOI: 10.1186/S13054-020-03318-2
Abstract: Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients, an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. This study is part of a Delirium in Intensive Care (Deli) Study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50 years or more acute episodes of delirium and the outcomes of intensive care and hospital stay were explored. During the 6-month baseline period, 997 patients, aged 50 years or more, were included in this study. The average age was 71 years (IQR, 63–79) 55% were male ( n = 537). Among these patients, 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% ( n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted rate ratio ( adj RR) = 1.71, 95% confidence interval (CI) 1.20–2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009) and had a higher risk of hospital mortality (19% versus 7%, adj RR = 2.54, 95% CI 1.72–3.75, p 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality versus 10% among non-frail patients who also experienced delirium in the ICU. Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it is important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium and, importantly, to discuss these issues in an open and empathetic way with the patient and their families.
Publisher: SAGE Publications
Date: 07-2017
DOI: 10.1177/0310057X1704500415
Abstract: Blood tests are ordered on a daily basis in intensive care units (ICU). There are no widely accepted guidelines for testing requirements. This study investigated the impact on ICU laboratory test costs of a multi-strategy change in practice involving routine blood testing. A single centre, prospective, interventional study using historical controls was undertaken to investigate the impact of ICU specialist authorisation of high-volume routine tests on ICU laboratory test costs. Prior to commencement of the study, ICU nursing and junior ICU doctors were able to order tests. During the six-month intervention period, the ICU specialists authorised routine blood tests. Adverse events related to not performing blood tests were also recorded. Overall ICU laboratory test costs decreased by 12.3% over the six months (P=0.0022 versus historical control) with a mean compliance of 51% with the test authorisation protocol. The costs of frequently ordered tests (classified as high-volume) decreased by 20% (P=0.0022 versus historical control). These accounted for an average of 54 ± 3% of the overall ICU blood test costs (blood gas analyses 17%, simple chemistry tests consisting of electrolytes, liver function, calcium, phosphate, magnesium 14%, coagulation 12% and full blood count 11%). Two protocol-related adverse events were recorded and judged as minor and were resolved by ordering tests during the day. No adverse patient outcomes resulted from these two events. Blood testing authorisation by an ICU specialist was associated with significant cost savings in ICU and no adverse patient outcomes.
Publisher: Elsevier BV
Date: 03-2021
Publisher: SAGE Publications
Date: 05-2015
DOI: 10.1177/0310057X1504300314
Abstract: Rapid Response Teams (RRTs) are specialised teams introduced into hospitals to improve the outcomes of deteriorating ward patients. Although Rapid Response Systems (RRSs) were developed by the intensive care unit (ICU) community, there is variability in their delivery, and consultant involvement, supervision and leadership appears to be relatively infrequent. In July 2014, the Australian and New Zealand Intensive Care Society (ANZICS) convened the first conference on the role of intensive care medicine in RRTs in Australia and New Zealand. The conference explored RRSs in the broader role of patient safety, resourcing and staffing of RRTs, effect on ICU workload, different RRT models, the outcomes of RRT patients and original research projects in the area of RRSs. Issues around education and training of both ICU registrars and nurses were examined, and the role of team training explored. Measures to assess the effectiveness of the RRS and RRT at the level of health system and hospital, team performance and team effectiveness were discussed, and the need to develop a bi-national ANZICS RRT patient database was presented. Strategies to prevent patient deterioration in the ‘pre-RRT’ period were discussed, including education of ward nurses and doctors, as well as an overarching governance structure. The role of the ICU in deteriorating ward patients was debated and an integrated model of acute care presented. This article summarises the findings of the conference and presents recommendations on the role of intensive care medicine in RRTs in Australia and New Zealand.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Massachusetts Medical Society
Date: 03-12-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-07-2010
Publisher: Public Library of Science (PLoS)
Date: 11-02-2014
Publisher: Wiley
Date: 08-2020
Publisher: Frontiers Media SA
Date: 08-2009
Publisher: S. Karger AG
Date: 2008
DOI: 10.1159/000148400
Abstract: i Background/Aims: /i The optimal dose of renal replacement therapy (RRT) in acute renal failure (ARF) is uncertain. i Methods: /i The Randomized Evaluation of Normal versus Augmented Level Replacement Therapy Trial tests the hypothesis that higher dose continuous veno-venous hemodiafiltration (CVVHDF) at an effluent rate of 40 ml/kg/h will increase survival compared to CVVHDF at 25 ml/kg/h of effluent dose. i Results: /i This trial is currently randomizing critically ill patients in 35 intensive care units in Australia and New Zealand with a planned s le size of 1,500 patients. This trial will be the largest trial ever conducted on acute blood purification in critically ill patients. i Conclusion: /i A trial of this magnitude and with demanding technical requirements poses design difficulties and challenges in the logistics, conduct, data collection, data analysis and monitoring. Our report will assist in the development of future trials of blood purification in intensive care. This study was registered with ClinicalTrials.gov (NCT00221013).
Publisher: Oxford University Press (OUP)
Date: 06-1997
Abstract: HLA-DQ8 (A1*0301, B1*0302) and -DQ2 (A1*0501, B1*0201) are both associated with diseases such as insulin-dependent diabetes mellitus and coeliac disease. We used the technique of pool sequencing to look at the requirements of peptides binding to HLA-DQ8, and combined these data with naturally sequenced ligands and in vitro binding assays to describe a novel motif for HLA-DQ8. The motif, which has the same basic format as many HLA-DR molecules, consists of four or five anchor regions, in the positions from the N-terminus of the binding core of n, n + 3, n + 5/6 and n + 8, i.e. P1, P4, P6/7 and P9. P1 and P9 require negative or polar residues, with mainly aliphatic residues at P4 and P6/7. The features of the HLA-DQ8 motif were then compared to a pool sequence of peptides eluted from HLA-DQ2. A consensus motif for the binding of a common peptide which may be involved in disease pathogenesis is described. Neither of the disease-associated alleles HLA-DQ2 and -DQ8 have Asp at position 57 of the beta-chain. This Asp, if present, may form a salt bridge with an Arg at position 79 of the alpha-chain and so alter the binding specificity of P9. HLA-DQ2 and -DQ8 both appear to prefer negatively charged amino acids at P9. In contrast, HLA-DQ7 (A1*0301, B1*0301), which is not associated with diabetes, has Asp at beta 57, allowing positively charged amino acids at P9. This analysis of the sequence features of DQ-binding peptides suggests molecular characteristics which may be useful to predict epitopes involved in disease pathogenesis.
Publisher: SAGE Publications
Date: 04-2002
DOI: 10.1177/039139880202500403
Abstract: To study the effect of combined continuous veno-venous hemodiafiltration (CVVHDF) and high (2.5 g/kg/day) parenteral amino acid supplementation on nitrogen balance, amino acid losses and azotemic control in a cohort of patients with severe acute renal failure (ARF). We administered 2.5 grams/kg/day of amino acids intravenously to seven critically ill patients with ARF. We obtained paired blood and ultrafiltrate (UF) s les (n=20) and calculated amino acid clearances and losses, nitrogen balance, protein catabolic rate and total nitrogen losses. The median total serum amino acid concentration was high at 5.2 mmol/L with particularly high concentrations of ornithine, lysine, and phenylalanine, but a low level of histidine. The median overall amino acid clearance was 18.6 ml/min (range: 12 to 29 ml/min). UF losses as percentage of administered dose were high for tyrosine (53.6 %) but low for methionine (3.0 %) and arginine (2.3 %). A positive nitrogen balance was achieved in 7 (35%) of the 20 study days with an overall median nitrogen balance of -1.8 g/day. Urea levels were maintained at a median of 26.6 mmol/L. High protein intake increases the serum concentrations of most amino acids. Such protein supplementation, when coupled with CVVHDF, achieves a slightly negative overall nitrogen balance in extremely catabolic patients while still allowing adequate azotemic control.
No related grants have been discovered for Deepak Bhonagiri.