ARDC Research Link Australia

Publication

Protein-bound drugs are prone to sequestration in the extracorporeal membrane oxygenation circuit: results from an ex vivo study

Publisher: Springer Science and Business Media LLC

Date: 12-2015

Abstract: Vital drugs may be degraded or sequestered in extracorporeal membrane oxygenation (ECMO) circuits, with lipophilic drugs considered to be particularly vulnerable. However, the circuit effects on protein-bound drugs have not been fully elucidated. The aim of this experimental study was to investigate the influence of plasma protein binding on drug disposition in ex vivo ECMO circuits. Four identical ECMO circuits comprising centrifugal pumps and polymethylpentene oxygenators and were used. The circuits were primed with crystalloid, albumin and fresh human whole blood and maintained at a physiological pH and temperature for 24 hours. After baseline s ling, known quantities of study drugs (ceftriaxone, ciprofloxacin, linezolid, fluconazole, caspofungin and thiopentone) were injected into the circuit to achieve therapeutic concentrations. Equivalent doses of these drugs were also injected into four polypropylene jars containing fresh human whole blood for drug stability testing. Serial blood s les were collected from the controls and the ECMO circuits over 24 hours, and the concentrations of the study drugs were quantified using validated chromatographic assays. A regression model was constructed to examine the relationship between circuit drug recovery as the dependent variable and protein binding and partition coefficient (a measure of lipophilicity) as explanatory variables. Four hundred eighty s les were analysed. There was no significant loss of any study drugs in the controls over 24 hours. The average drug recoveries from the ECMO circuits at 24 hours were as follows: ciprofloxacin 96%, linezolid 91%, fluconazole 91%, ceftriaxone 80%, caspofungin 56% and thiopentone 12%. There was a significant reduction of ceftriaxone ( P = 0.01), caspofungin ( P = 0.01) and thiopentone ( P = 0.008) concentrations in the ECMO circuit at 24 hours. Both protein binding and partition coefficient were highly significant, with the model possessing a high coefficient of determination ( R 2 = 0.88, P .001). Recovery of the highly protein-bound drugs ceftriaxone, caspofungin and thiopentone was significantly lower in the ECMO circuits at 24 hours. For drugs with similar lipophilicity, the extent of protein binding may determine circuit drug loss. Future clinical population pharmacokinetic studies should initially be focused on drugs with greater lipophilicity and protein binding, and therapeutic drug monitoring should be strongly considered with the use of such drugs.

Publication

A comprehensive ovine model of blood transfusion.

Publisher: Wiley

Date: 02-09-2014

DOI: 10.1111/VOX.12076

Abstract: The growing awareness of transfusion-associated morbidity and mortality necessitates investigations into the underlying mechanisms. Small animals have been the dominant transfusion model but have associated limitations. This study aimed to develop a comprehensive large animal (ovine) model of transfusion encompassing: blood collection, processing and storage, compatibility testing right through to post-transfusion outcomes. Two units of blood were collected from each of 12 adult male Merino sheep and processed into 24 ovine-packed red blood cell (PRBC) units. Baseline haematological parameters of ovine blood and PRBC cells were analysed. Biochemical changes in ovine PRBCs were characterized during the 42-day storage period. Immunological compatibility of the blood was confirmed with sera from potential recipient sheep, using a saline and albumin agglutination cross-match. Following confirmation of compatibility, each recipient sheep (n = 12) was transfused with two units of ovine PRBC. Procedures for collecting, processing, cross-matching and transfusing ovine blood were established. Although ovine red blood cells are smaller and higher in number, their mean cell haemoglobin concentration is similar to human red blood cells. Ovine PRBC showed improved storage properties in saline-adenine-glucose-mannitol (SAG-M) compared with previous human PRBC studies. Seventy-six compatibility tests were performed and 17·1% were incompatible. Only cross-match compatible ovine PRBC were transfused and no adverse reactions were observed. These findings demonstrate the utility of the ovine model for future blood transfusion studies and highlight the importance of compatibility testing in animal models involving homologous transfusions.

Publication

Publisher: Wiley

Date: 26-10-2021

DOI: 10.1111/VOX.13020

Publication

Venoarterial extracorporeal membrane oxygenation: A systematic review of selection criteria, outcome measures and definitions of complications

Publisher: Elsevier BV

Date: 10-2019

DOI: 10.1016/J.JCRC.2019.05.011

Abstract: The purpose of this study was to systematically investigate the reporting of selection criteria and outcome measures, and to examine definitions of complications used in venoarterial extracorporeal membrane oxygenation studies (V-A ECMO). Medline, EMBASE and the Cochrane central register were searched for V-A ECMO studies from January 2005 to July 2017. Studies with ≤99 patients or without patient centered outcomes were excluded. Two reviewers independently assessed search results and undertook data extraction. Forty-six studies met the inclusion criteria, and all were retrospective, observational studies. Inconsistent reporting of selection criteria, ECMO management and outcome measures was common. In-hospital mortality was the most common primary outcome (41% of studies), followed by 30-day mortality (11%). Bleeding was the most frequent complication reported, most commonly defined as "bleeding requiring transfusion" (median ≥ 2 Units/day). Significant variation in reporting and definitions was also evident for vascular, neurological renal and infectious complications. This systematic review provides clinicians with the most commonly reported selection criteria, outcome measures and complications used in ECMO practice. However non-standardized definitions and inconsistent reporting limits their ability to inform practice. New consensus driven definitions of complications and patient centred outcomes are urgently needed.

Publication

Publisher: Frontiers Media SA

Date: 23-01-2019

DOI: 10.3389/FPED.2019.00538

Publication

Transcriptomic profiling of cardiac tissues from SARS‐CoV‐2 patients identifies DNA damage

Publisher: Wiley

Date: 27-09-2023

DOI: 10.1111/IMM.13577

Abstract: The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is known to present with pulmonary and extra‐pulmonary organ complications. In comparison with the 2009 pandemic (pH1N1), SARS‐CoV‐2 infection is likely to lead to more severe disease, with multi‐organ effects, including cardiovascular disease. SARS‐CoV‐2 has been associated with acute and long‐term cardiovascular disease, but the molecular changes that govern this remain unknown. In this study, we investigated the host transcriptome landscape of cardiac tissues collected at rapid autopsy from seven SARS‐CoV‐2, two pH1N1, and six control patients using targeted spatial transcriptomics approaches. Although SARS‐CoV‐2 was not detected in cardiac tissue, host transcriptomics showed upregulation of genes associated with DNA damage and repair, heat shock, and M1‐like macrophage infiltration in the cardiac tissues of COVID‐19 patients. The DNA damage present in the SARS‐CoV‐2 patient s les, were further confirmed by γ‐H2Ax immunohistochemistry. In comparison, pH1N1 showed upregulation of interferon‐stimulated genes, in particular interferon and complement pathways, when compared with COVID‐19 patients. These data demonstrate the emergence of distinct transcriptomic profiles in cardiac tissues of SARS‐CoV‐2 and pH1N1 influenza infection supporting the need for a greater understanding of the effects on extra‐pulmonary organs, including the cardiovascular system of COVID‐19 patients, to delineate the immunopathobiology of SARS‐CoV‐2 infection, and long term impact on health.

Publication

Identifying and evaluating functional connectivity for building urban ecological networks

Publisher: Acta Ecologica Sinica

Date: 2015

DOI: 10.5846/STXB201402160263

Publication

Publisher: Springer Science and Business Media LLC

Date: 12-03-2010

DOI: 10.1186/1471-2253-10-3

Publication

Publisher: Springer Science and Business Media LLC

Date: 2010

DOI: 10.1186/CC9342

Publication

Transcatheter aortic valve implantation (TAVI): Valve design and evolution

Publisher: Elsevier BV

Date: 10-2013

DOI: 10.1016/J.IJCARD.2013.07.117

Abstract: The efficacy of transcatheter aortic valve implantation (TAVI) in high surgical risk and inoperable patients with severe aortic stenosis (AS) is rapidly gaining credibility with an ever-expanding body of supporting evidence. The potential of TAVI to be a treatment option for a significant cohort of patients with aortic stenosis has fuelled a drive for the optimum device and resulted in exponential advances in the technology with a focus on adverse event minimization and procedural simplification. Consequently, a plethora of new transcatheter valve choices are now available for clinical study or in the pipeline. The evaluation of past, current and emerging devices allows for an appreciation of the design considerations involved in this process and an insight to the future direction of the technology.

Publication

Respiratory support for infants with bronchiolitis, a narrative review of the literature

Publisher: Elsevier BV

Date: 04-2019

DOI: 10.1016/J.PRRV.2018.10.001

Abstract: Bronchiolitis is a common viral disease that significantly affects infants less than 12 months of age. The purpose of this review is to present a review of the current knowledge of the uses of respiratory support in the management of infants with bronchiolitis presenting to hospital. We electronically searched MEDLINE, Cochrane, CINAHL and EMBASE (inception to 25th March 2018), to manually search for clinical trials that address the management strategies for respiratory support of infants with bronchiolitis. We identified 120 papers who met the inclusion criteria, of which 33 papers were relevant for this review with only nine randomized controlled trials. This review demonstrated that non-invasive respiratory support reduced the need for escalation of therapy, particularly the proportion of intubations required for infants with bronchiolitis. Additionally, clear economic benefits have been demonstrated when non-invasive ventilation has been used. The potential early use of non-invasive respiratory supports such as nasal high flow therapy and non-invasive ventilation may have an impact on health care costs and reduction in ICU admissions and intubation rates. High-grade evidence demonstrates safety and quality of high flow therapy in general ward settings.

Publication

Publisher: Institute of Electrical and Electronics Engineers (IEEE)

Date: 03-2020

DOI: 10.1109/JSYST.2019.2904383

Publication

Oxidative stress during extracorporeal circulation

Publisher: Oxford University Press (OUP)

Date: 30-01-2014

DOI: 10.1093/EJCTS/EZT637

Abstract: There is an increased oxidative stress response in patients having cardiac surgery, haemodialysis or extracorporeal membrane oxygenation that is related to poorer outcomes and increased mortality. Exposure of the patients' blood to the artificial surfaces of these extracorporeal devices, coupled with inflammatory responses, hyperoxia and the pathophysiological aspects of the underlying illness itself, all contribute to this oxidative stress response. Oxidative stress occurs when there is a disruption of redox signalling and loss of control of redox balance. Ongoing oxidative stress occurring during extracorporeal circulation (ECC) results in damage to lipids, proteins and DNA and contributes to morbidity and mortality. This review discusses reactive species generation and the potential clinical consequences of oxidative stress during ECC as well as provides an overview of some current antioxidant compounds that are available to potentially mitigate the oxidative stress response.

Publication

Application of an adaptive Bayesian‐based model for probabilistic and deterministic PV forecasting

Publisher: Institution of Engineering and Technology (IET)

Date: 04-06-2021

DOI: 10.1049/RPG2.12194

Publication

Publisher: Springer Science and Business Media LLC

Date: 2012

DOI: 10.1186/CC11178

Publication

Publisher: Wiley

Date: 15-08-2020

DOI: 10.1111/AOR.13783

Publication

Evaluation of Physiological Control Systems for Rotary Left Ventricular Assist Devices: An In-Vitro Study

Publisher: Springer Science and Business Media LLC

Date: 02-2016

DOI: 10.1007/S10439-016-1552-3

Abstract: Rotary left ventricular assist devices (LVADs) show weaker response to preload and greater response to afterload than the native heart. This may lead to ventricular suction or pulmonary congestion, which can be deleterious to the patient's recovery. A physiological control system which optimizes responsiveness of LVADs may reduce adverse events. This study compared eight physiological control systems for LVAD support against constant speed mode. Pulmonary (PVR) and systemic (SVR) vascular resistance changes, a passive postural change and exercise were simulated in a mock circulation loop to evaluate the controller's ability to prevent suction and congestion and to increase exercise capacity. Three active and one passive control systems prevented ventricular suction at high PVR (500 dyne s cm(-5)) and low SVR (600 dyne s cm(-5)) by decreasing LVAD speed (by 200-515 rpm) and by increasing LVAD inflow cannula resistance (up to 1000 dyne s cm(-5)) respectively. These controllers increased LVAD preload sensitivity (to 0.196-2.415 L min(-1) mmHg(-1)) compared to the other control systems and constant speed mode (0.039-0.069 L min(-1) mmHg(-1)). The same three active controllers increased pump speed (600-800 rpm) and thus LVAD flow by 4.5 L min(-1) during exercise which increased exercise capacity. Physiological control systems that prevent adverse events and/or increase exercise capacity may help improve LVAD patient conditions.

Publication

Excellent Cardiac Surgical Outcomes in Paediatric Indigenous Patients, but Follow-up Difficulties

Publisher: Elsevier BV

Date: 09-2010

DOI: 10.1016/J.HLC.2010.03.008

Abstract: Indigenous Australians' infant mortality is three times that of non-Indigenous Australians. Indigenous children's mortality from rheumatic heart disease is 17-21 times that of non-Indigenous male and female children, respectively. No studies have looked specifically at the operative outcomes of cardiac surgery in paediatric Indigenous patients in Australia and little is known about their follow-up. To describe operative outcomes of all Indigenous paediatric cardiac surgical patients at a single Australian tertiary hospital and assess their follow-up. Database review of retrospectively collected data of all Indigenous paediatric patients who had cardiac surgery performed at The Prince Charles Hospital, Brisbane between 2002 and 2009 (112 patients, 123 operations). Follow-up was assessed by chart review and time to first post-discharge echocardiogram recorded in the hospital database. Eighty-one percent of operations were congenital heart disease related and 19% of operations were rheumatic heart disease related. Common co-morbidities included respiratory (9.7%) and renal dysfunction (0.8%). Common complications were, bleeding/t onade 4.1%, cardiac arrest 4.1% and new atrial arrhythmia 2.4%. Mortality was 1% for congenital operations and 4.4% for rheumatic operations. Only 33% of patients had follow-up within eight weeks documented through letters or chart entry. Only 77.5% of patients had a documented follow-up echocardiogram. Operative outcome in Indigenous paediatric patients is similar to that found in the global literature. The follow-up for such an excellent surgical outcome has been disappointing. A coordinated action within and between health, health related and social institutions with sufficient resources will assist.

Publication

Publisher: Elsevier BV

Date: 12-2018

DOI: 10.1016/J.JCRC.2018.09.007

Publication

A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis

Publisher: Massachusetts Medical Society

Date: 22-03-2018

DOI: 10.1056/NEJMOA1714855

Publication

Publisher: Wiley

Date: 04-08-2020

DOI: 10.1111/AOR.13771

Publication

Hurdles to cardioprotection in the critically ill

Publisher: MDPI AG

Date: 05-08-2019

DOI: 10.3390/IJMS20153823

Abstract: Cardiovascular disease is the largest contributor to worldwide mortality, and the deleterious impact of heart failure (HF) is projected to grow exponentially in the future. As heart transplantation (HTx) is the only effective treatment for end-stage HF, development of mechanical circulatory support (MCS) technology has unveiled additional therapeutic options for refractory cardiac disease. Unfortunately, despite both MCS and HTx being quintessential treatments for significant cardiac impairment, associated morbidity and mortality remain high. MCS technology continues to evolve, but is associated with numerous disturbances to cardiac function (e.g., oxidative damage, arrhythmias). Following MCS intervention, HTx is frequently the destination option for survival of critically ill cardiac patients. While effective, donor hearts are scarce, thus limiting HTx to few qualifying patients, and HTx remains correlated with substantial post-HTx complications. While MCS and HTx are vital to survival of critically ill cardiac patients, cardioprotective strategies to improve outcomes from these treatments are highly desirable. Accordingly, this review summarizes the current status of MCS and HTx in the clinic, and the associated cardiac complications inherent to these treatments. Furthermore, we detail current research being undertaken to improve cardiac outcomes following MCS/HTx, and important considerations for reducing the significant morbidity and mortality associated with these necessary treatment strategies.

Publication

Mineralocorticoid receptor antagonism induces browning of white adipose tissue through impairment of autophagy and prevents adipocyte dysfunction in high‐fat‐diet‐fed mice

Publisher: Wiley

Date: 07-05-2014

DOI: 10.1096/FJ.13-245415

Abstract: The mineralocorticoid receptor (MR) controls adipocyte function, but its role in the conversion of white adipose tissue (WAT) into thermogenic fat has not been elucidated. We investigated responses to the MR antagonists spironolactone (spiro 20 mg/kg/d) and drospirenone (DRSP 6 mg/kg/d) in C57BL/6 mice fed a high-fat (HF) diet for 90 d. DRSP and spiro curbed HF diet-induced impairment in glucose tolerance, and prevented body weight gain and white fat expansion. Notably, either MR antagonist induced up-regulation of brown adipocyte-specific transcripts and markedly increased protein levels of uncoupling protein 1 (UCP1) in visceral and inguinal fat depots when compared with the HF diet group. Positron emission tomography and magnetic resonance spectroscopy confirmed acquisition of brown fat features in WAT. Interestingly, MR antagonists markedly reduced the autophagic rate both in murine preadipocytes in vitro (10(-5) M) and in WAT depots in vivo, with a concomitant increase in UCP1 protein expression. Moreover, the autophagy repressor bafilomycin A1 (10(-8) M) mimicked the effect of MR antagonists, increasing UCP1 protein expression in primary preadipocytes. Hence, we showed that adipocyte MR regulates brown remodeling of WAT through a modulation of autophagy. These results provide a rationale for the use of MR antagonists to prevent the adverse metabolic consequences of adipocyte dysfunction.

Publication

Effect of ex vivo extracorporeal membrane oxygenation flow dynamics on immune response

Publisher: SAGE Publications

Date: 04-2019

DOI: 10.1177/0267659119830012

Abstract: Extracorporeal membrane oxygenation is a life-saving support for heart and/or lung failure patients. Despite technological advancement, abnormal physiology persists and has been associated with subsequent adverse events. These include thrombosis, bleeding, systemic inflammatory response syndrome and infection. However, the underlying mechanisms are yet to be elucidated. We aimed to investigate whether the different flow dynamics of extracorporeal membrane oxygenation would alter immune responses, specifically the overall inflammatory response, leukocyte numbers and activation/adhesion surface antigen expression. An ex vivo model was used with human whole blood circulating at 37°C for 6 hours at high (4 L/minute) or low (1.5 L/minute) flow dynamics, with serial blood s les taken for analysis. During high flow, production of interleukin-1β (p 0.0001), interleukin-6 (p = 0.0075), tumour necrosis factor-α (p = 0.0013), myeloperoxidase (p 0.0001) and neutrophil elastase (p 0.0001) were significantly elevated over time compared to low flow, in particular at 6 hours. While the remaining assessments exhibited minute changes between flow dynamics, a consistent trend of modulation in leukocyte subset numbers and phenotype was observed at 6 hours. We conclude that prolonged circulation at high flow triggers a prominent pro-inflammatory cytokine response and activates neutrophil granule release, but further research is needed to better characterize the effect of flow during extracorporeal membrane oxygenation.

Publication

Early high flow nasal cannula therapy in bronchiolitis, a prospective randomised control trial (protocol): A Paediatric Acute Respiratory Intervention Study (PARIS)

Publisher: Springer Science and Business Media LLC

Date: 14-11-2015

DOI: 10.1186/S12887-015-0501-X

Publication

Campfire burns in children: an Australian experience

Publisher: Elsevier BV

Date: 06-2002

DOI: 10.1016/S0305-4179(02)00019-0

Abstract: To document and describe the effects of c fire burns on children. To identify the sources of danger contributing to such injuries, so that a prevention strategy can be devised. Departmental database and case note review of all children with c fire burns seen at the Burns Unit of a tertiary referral children's hospital between January 1999 and June 2001. Number and ages of children burned risk factors contributing to the accidents injuries sustained treatment required and long-term sequelae. Thirty-three children, median age 2.5 years, sustained burns, usually to the hands and feet, with eight requiring surgery and the majority requiring some form of scar therapy. Seventy-four percent of the children were burned by hot ashes and coals, usually from the previous night's fire, rather than by open flames. C fires cause serious injuries to children. In particular, hot ashes and coals from inadequately extinguished c fires pose the greatest danger. Increasing the awareness of this easily preventable problem amongst c ers is intended through a public education c aign.

Publication

The Australasian Resuscitation In Sepsis Evaluation

Publisher: Wiley

Date: 10-02-2020

DOI: 10.1111/1742-6723.13469

Publication

Children with burn injuries-assessment of trauma, neglect, violence and abuse

Publisher: Journal of Injury and Violence Research

Date: 06-2011

DOI: 10.5249/JIVR.V3I2.91

Publication

Experiences of Anticholinesterase Pesticide Poisonings in an Australian Tertiary Hospital

Publisher: SAGE Publications

Date: 08-2005

DOI: 10.1177/0310057X0503300408

Abstract: There is limited information regarding the management and outcomes of patients presenting with anticholinesterase pesticide poisoning in Australia. Patients presenting to a tertiary referral hospital with anticholinesterase exposures were identified by discharge coding. The medical records of each patient were retrospectively reviewed. Based on clinical outcome, patients were classified as severe or non-severe poisonings. Forty-one presentations were noted between 1990 and 2003. Eight patients (20%) had severe poisoning of which tachycardia, fasciculations with weakness and metabolic acidosis were common manifestations. The diagnosis was delayed in four patients due to the absence of a clear history, which did not influence patient outcomes or put hospital staff at risk of nosocomial poisoning. The median length of hospital stay was prolonged in severe poisonings (20 days) compared to 12 hours in other patients. Two cases of intermediate syndrome were attributed to fenthion and diazinon, and one case of delayed polyneuropathy to trichlorfon. Cholinesterase activities were performed in only 49% of presentations. The overall mortality was 2.4% (1 death) and the mortality in patients with severe poisoning was 12.5%. The incidence of anticholinesterase poisoning in Australia is low. These outcomes were favourable and comparable with other published data. Measures to enhance the knowledge of medical staff supplemented by validated treatment protocols should be developed. For less significant exposures, an emphasis on adequate documentation of cholinergic signs and cholinesterase activities is necessary for rapid triage and may also have potential forensic implications if not performed.

Publication

The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology

Publisher: Springer Science and Business Media LLC

Date: 28-11-2016

DOI: 10.1186/S13054-016-1570-4

Publication

Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): a pragmatic, randomised controlled, superiority trial

Publisher: Elsevier BV

Date: 08-2018

DOI: 10.1016/S0140-6736(18)31380-1

Publication

The morning after the night before: campfires revisited

Publisher: AMPCo

Date: 2003

DOI: 10.5694/J.1326-5377.2003.TB05037.X

Abstract: Even eight hours after a c fire has been extinguished with sand, it retains sufficient heat to cause a full-thickness burn with contact of one second. Because extinguishing with sand disguises the danger, this is a particular hazard for children. The only safe way to extinguish a c fire is with water.

Publication

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 30-08-2023

DOI: 10.1097/MAT.0000000000002041

Publication

Reconceptualizing post‐intensive care syndrome: Do we need to unpick our PICS?

Publisher: Wiley

Date: 09-2020

DOI: 10.1111/NICC.12545

Publication

Mesenchymal stromal cells and the acute respiratory distress syndrome (ARDS): challenges for clinical application

Publisher: BMJ

Date: 19-05-2015

DOI: 10.1136/THORAXJNL-2015-207121

Publication

Veno-Arterial ECMO in the Setting of Post-Infarct Ventricular Septal Defect: A Bridge to Surgical Repair

Publisher: Elsevier BV

Date: 11-2016

DOI: 10.1016/J.HLC.2016.02.024

Abstract: Extracorporeal membrane oxygenation (ECMO) is a complex rescue therapy utilised to provide circulatory and/or respiratory support to critically ill patients who have failed maximal conventional therapy. The use of ECMO in adult cardiac surgery is not routine, occurring in a minority of critically ill patients, typically postoperatively. Presented here are three cases of post-infarct ventricular septal defect with cardiogenic shock managed preoperatively with ECMO support as a bridge to definitive surgical closure. We present a review of ECMO in the adult cardiac surgical population and highlight the potential role of preoperative ECMO for cardiogenic shock in the setting of post-infarct ventricular septal defect (PI VSD) as a bridge to definitive closure.

Publication

The perceived barriers and facilitators to implementation of ECMO services in acute hospitals

Publisher: Springer Science and Business Media LLC

Date: 23-07-2020

DOI: 10.1007/S00134-020-06187-Z

Publication

Frank-starling control of a left ventricular assist device

Publisher: IEEE

Date: 08-2011

DOI: 10.1109/IEMBS.2011.6090314

Publication

Contrast Microsphere Destruction by a Continuous Flow Ventricular Assist Device: An In Vitro Evaluation Using a Mock Circulation Loop

Publisher: Hindawi Limited

Date: 2017

DOI: 10.1155/2017/4907898

Abstract: Objectives . Transthoracic echocardiography (TTE) is fundamental in managing patients supported with ventricular assist devices (VAD). However imaging can be difficult in these patients. Contrast improves image quality but they are hydrodynamically fragile agents. The aim was to assess contrast concentration following passage through a VAD utilising a mock circulation loop (MCL). Methods . Heartware continuous flow (CF) VAD was incorporated into a MCL. Definity® contrast was infused into the MCL with imaging before and after CF-VAD. 5 mm 2 regions of interest were used to obtain signal intensity (decibels), as a surrogate of contrast concentration. Results . Four pump speeds revealed significant reduction in contrast signal intensity after CF-VAD compared to before CF-VAD (all p 0.0001 ). Combined pre- and postpump data at all speeds showed a 22.2% absolute reduction in contrast signal intensity across the CF-VAD (14.8 ± 0.8 dB prepump versus 11.6 ± 1.4 dB postpump p 0.0001 ). Mean signal intensity reduction at each speed showed an inverse relationship between speed and relative reduction in signal intensity. Conclusion . Contrast microsphere transit through a CF-VAD within a MCL resulted in significant reduction in signal intensity, consistent with destruction within the pump. This was evident at all CF-VAD pump speeds but relative signal drop was inversely proportional to pump speed.

Publication

Partial liquid ventilation for preventing death and morbidity in adults with acute lung injury and acute respiratory distress syndrome

Publisher: John Wiley & Sons, Ltd

Date: 18-10-2004

DOI: 10.1002/14651858.CD003707.PUB2

Publication

Reply to Zhang and Hei: Mesenchymal Stem Cell-derived Exosomes: Are They Another Therapeutic Method for Extracorporeal Membrane Oxygenation-supported Acute Respiratory Distress Syndrome?

Publisher: American Thoracic Society

Date: 12-2020

DOI: 10.1164/RCCM.202007-2995LE

Publication

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-05-2020

DOI: 10.1097/TP.0000000000003217

Publication

Publisher: Ferrata Storti Foundation (Haematologica)

Date: 24-05-2018

DOI: 10.3324/HAEMATOL.2018.191932

Publication

Ex vivo models for research in extracorporeal membrane oxygenation: a systematic review of the literature

Publisher: SAGE Publications

Date: 05-2020

DOI: 10.1177/0267659120907439

Abstract: With ongoing progress of components of extracorporeal membrane oxygenation including improvements of oxygenators, pumps, and coating materials, extracorporeal membrane oxygenation became increasingly accepted in the clinical practice. A suitable testing in an adequate setup is essential for the development of new technical aspects. Relevant tests can be conducted in ex vivo models specifically designed to test certain aspects. Different setups have been used in the past for specific research questions. We conducted a systematic literature review of ex vivo models of extracorporeal membrane oxygenation components. MEDLINE and Embase were searched between January 1996 and October 2017. The inclusion criteria were ex vivo models including features of extracorporeal membrane oxygenation technology. The exclusion criteria were clinical studies, abstracts, studies in which the model of extracorporeal membrane oxygenation has been reported previously, and studies not reporting on extracorporeal membrane oxygenation components. A total of 50 studies reporting on different ex vivo extracorporeal membrane oxygenation models have been identified from the literature search. Models have been grouped according to the specific research question they were designed to test for. The groups are focused on oxygenator performance, pump performance, hemostasis, and pharmacokinetics. Pre-clinical testing including use of ex vivo models is an important step in the development and improvement of extracorporeal membrane oxygenation components and materials. Furthermore, ex vivo models offer valuable insights for clinicians to better understand the consequences of choice of components, setup, and management of an extracorporeal membrane oxygenation circuit in any given condition. There is a need to standardize the reporting of pre-clinical studies in this area and to develop best practice in their design.

Publication

Publisher: Institute of Electrical and Electronics Engineers (IEEE)

Date: 09-2020

DOI: 10.1109/JSYST.2019.2961172

Publication

Initial ELSO Guidance Document: ECMO for COVID-19 Patients with Severe Cardiopulmonary Failure

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 05-2020

DOI: 10.1097/MAT.0000000000001173

Abstract: Disclaimer: ECMO has, and will certainly continue, to play a role in the management of COVID-19 patients. It should be emphasized that this initial guidance is based on the current best evidence for ECMO use during this pandemic. Guidance documents addressing additional portions of ECMO care are currently being assembled for rapid publication and distribution to ECMO centers worldwide.

Publication

An improved liquid chromatography tandem mass spectrometry (LC-MS/MS) method for quantification of dexmedetomidine concentrations in samples of human plasma.

Publisher: Elsevier BV

Date: 2017

DOI: 10.1016/J.JCHROMB.2017.12.006

Abstract: Dexmedetomidine (DMET) is a sedative, analgesic and anxiolytic with minimum adverse respiratory effects. An LC-MS/MS bioanalytical method has been developed and validated to accurately measure DMET concentrations in s les of human plasma. The method overcomes difficulties in the extraction and quantification of DMET due to the fact that it binds strongly to glass and plastic tubes, as well as solid phase extraction (SPE) cartridges. Human plasma (50 μL) was mixed with the internal standard (IS) (DMET-d4) solution (100 μL) and 0.1% formic acid (50 μL) and extracted using Oasis HLB 1 CC (30 mg) solid phase extraction (SPE) cartridges (Waters

Publication

Direct extubation onto high-flow nasal cannulae post-cardiac surgery versus standard treatment in patients with a BMI ≥30: a randomised controlled trial

Publisher: Springer Science and Business Media LLC

Date: 08-04-2015

DOI: 10.1007/S00134-015-3765-6

Abstract: Patients with a body mass index (BMI) ≥30 kg/m(2) experience more severe atelectasis following cardiac surgery than those with normal BMI and its resolution is slower. This study aimed to compare extubation of patients post-cardiac surgery with a BMI ≥30 kg/m(2) onto high-flow nasal cannulae (HFNC) with standard care to determine whether HFNC could assist in minimising post-operative atelectasis and improve respiratory function. In this randomised controlled trial, patients received HFNC or standard oxygen therapy post-extubation. The primary outcome was atelectasis on chest X-ray. Secondary outcomes included oxygenation, respiratory rate (RR), subjective dyspnoea, and failure of allocated treatment. One hundred and fifty-five patients were randomised, 74 to control, 81 to HFNC. No difference was seen between groups in atelectasis scores on Days 1 or 5 (median scores = 2, p = 0.70 and p = 0.15, respectively). In the 24-h post-extubation, there was no difference in mean PaO2/FiO2 ratio (HFNC 227.9, control 253.3, p = 0.08), or RR (HFNC 17.2, control 16.7, p = 0.17). However, low dyspnoea levels were observed in each group at 8 h post-extubation, median (IQR) scores were 0 (0-1) for control and 1 (0-3) for HFNC (p = 0.008). Five patients failed allocated treatment in the control group compared with three in the treatment group [Odds ratio 0.53, (95 % CI 0.11, 2.24), p = 0.40]. In this study, prophylactic extubation onto HFNC post-cardiac surgery in patients with a BMI ≥30 kg/m(2) did not lead to improvements in respiratory function. Larger studies assessing the role of HFNC in preventing worsening of respiratory function and intubation are required.

Publication

The effects of normovolemic anemia and blood transfusion on cerebral microcirculation after severe head injury.

Publisher: Springer Science and Business Media LLC

Date: 08-11-2018

DOI: 10.1186/S40635-018-0210-5

Publication

Publisher: Elsevier BV

Date: 07-2016

DOI: 10.1016/J.IJCARD.2016.04.141

Publication

In Vitro Hemocompatibility Evaluation of Modified Rotary Left to Right Ventricular Assist Devices in Pulmonary Flow Conditions

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 15-07-2020

DOI: 10.1097/MAT.0000000000001049

Publication

Impact of Blood Product Transfusion on Short and Long-Term Survival After Cardiac Surgery: More Evidence

Publisher: Elsevier BV

Date: 08-2012

DOI: 10.1016/J.ATHORACSUR.2012.04.005

Abstract: Despite the proven benefits in hemorrhagic shock, blood transfusions have been linked to increased morbidity and mortality. The short-term adverse effects of blood transfusion in cardiac surgical patients are well documented but there are very few studies that adequately assess the long-term survival. This study was undertaken to evaluate the effects of transfusion on both short-term and long-term survival after cardiac surgery. Data from 5,342 patients who underwent a cardiac surgical procedure from January 2002 to December 2005 at our institution were reviewed. The effect of transfusion of packed red blood cells (PRBC) and other blood products was tested in a 2-level approach of transfusion (any) versus no transfusion, and also a 4-level approach of transfusion (PRBC, other blood products, and both blood and blood products) versus no transfusion. Long-term survival data of these patients were obtained. Cox proportional hazard models, Kaplan-Meier survival plots, and hazard functions were used to compare the groups. A total of 3,013 of the 5,342 study patients (56.4%) received transfusion during or within 72 hours of their cardiac surgery. Median time to death was significantly lower for patients who received transfusions 1.15 years for PRC and 0.83 years for any transfusion, compared with 4.68 years in the non-transfused group. The overall 30-day mortality was 1.7%, but in patients who received transfusions (3.6%) was significantly higher than the non-transfused group (0.3%, p<0.001). The 1-year mortality (overall 3.9%) in the transfused group (7.3%, p<0.001) was also significantly higher than that in the non-transfused group (1.3%). The 5-year mortality rate in the transfused group was more than double that in the non-transfused group (16% vs 7%). After correction for comorbidities and other factors, transfusion was still associated with a 66% increase in mortality. This study suggests that blood or blood product transfusion during or after cardiac surgery is associated with increased short-term and long-term mortality. It reinforces the need for prospective randomized controlled studies for evaluation of restrictive transfusion triggers and objective clinical indicators for transfusion in the cardiac surgical patient population.

Publication

Publisher: Springer Science and Business Media LLC

Date: 10-2014

DOI: 10.1186/S13054-014-0619-5

Publication

Global infectious disease research collaborations in crises: building capacity and inclusivity through cooperation

Publisher: Springer Science and Business Media LLC

Date: 26-07-2021

DOI: 10.1186/S12992-021-00731-2

Abstract: The initial research requirements in pandemics are predictable. But how is it possible to study a disease that is so quickly spreading and to rapidly use that research to inform control and treatment? In our view, a dilemma with such wide-reaching impact mandates multi-disciplinary collaborations on a global scale. International research collaboration is the only means to rapidly address these fundamental questions and potentially change the paradigm of data sharing for the benefit of patients throughout the world. International research collaboration presents significant benefits but also barriers that need to be surmounted, especially in low- and middle-income countries. Facilitating international cooperation, by building capacity in established collaborative platforms and in low- and middle-income countries, is imperative to efficiently answering the priority clinical research questions that can change the trajectory of a pandemic.

Publication

Publisher: Elsevier BV

Date: 04-2019

DOI: 10.1016/J.THROMRES.2019.02.015

Publication

rFVIIa FOR REFRACTORY BLEEDING AFTER LUNG TRANSPLANTATION

Publisher: Wiley

Date: 31-07-2012

DOI: 10.1111/J.1537-2995.2012.03801.X

Abstract: Recombinant activated factor VIIa (rFVIIa) has been increasingly used to stop massive bleeding after cardiothoracic surgical procedures. However, the risk : benefit profile of such a potent hemostatic agent remains unclear in the postsurgical patient, and the cost benefit is even less clear. In patients after lung transplantation, volume of blood transfused is of major concern, and all attempts are made to minimize large blood transfusions in this cohort. We report our experience with rFVIIa in patients with refractory bleeding after lung transplant surgery. All lung transplant patients who underwent single- or double-lung transplantation who received rFVIIa in the 5-year period, from January 2005 to June 2011, were included. A total of 15 patients were identified from a total of 95 lung transplant cases operated during this study period. Patient demographics, intra- and postoperative records were reviewed to assess the efficacy and safety of rFVIIa treatment. Patients with major bleeding treated with rFVIIa showed improved hemostasis with rapid normalization of coagulation variables. rFVIIa treatment was not associated with an increase in mechanical ventilation time, length of intensive care unit stay, or hospital stay compared to other lung transplant patients. In addition, the use of rFVIIa was associated with reduction in transfusion requirements of red blood cells, fresh-frozen plasma, and platelets (all p < 0.001). No definite thromboembolic-related event was recorded in our cohort. These data demonstrate that rFVIIa was associated with reduced blood loss, improvement of coagulation variables, and decreased need for transfusions. This reduction in losses led to a reduced requirement for blood transfusion, which may translate to a decrease in transfusion-related complications. Further investigation is needed to determine rFVIIa's safety and its efficacy in improving postoperative morbidity and mortality specifically in the field of post-lung transplantation surgery.

Publication

Platelet Storage Lesions: What More Do We Know Now?

Publisher: Elsevier BV

The intensive care unit environment from the perspective of medical, allied health and nursing clinicians: A qualitative study to inform design of the ‘ideal’ bedspace

Publisher: Elsevier BV

Date: 2021

DOI: 10.1016/J.AUCC.2020.06.003

Publication

Transcranial Doppler Assessment of Cerebral Autoregulation

Publisher: Elsevier BV

Publisher: Springer Science and Business Media LLC

Date: 26-05-2017

DOI: 10.1186/S13063-017-1980-X

Publication

Publisher: Springer Science and Business Media LLC

Date: 19-11-2020

DOI: 10.1186/S13054-020-03386-4

Publication

Hydrodynamic evaluation of aortic cardiopulmonary bypass cannulae using particle image velocimetry

Publisher: SAGE Publications

Date: 18-05-2016

DOI: 10.1177/0267659115586282

Abstract: The high velocity jet from aortic arterial cannulae used during cardiopulmonary bypass potentially causes a “sandblasting” injury to the aorta, increasing the possibility of embolisation of atheromatous plaque. We investigated a range of commonly available dispersion and non-dispersion cannulae, using particle image velocimetry. The maximum velocity of the exit jet was assessed 20 and 40 mm from the cannula tip at flow rates of 3 and 5 L/min. The dispersion cannulae had lower maximum velocities compared to the non-dispersion cannulae. Dispersion cannulae had fan-shaped exit profiles and maximum velocities ranged from 0.63 to 1.52 m/s when measured at 20 mm and 5 L/min. Non-dispersion cannulae had maximum velocities ranging from 1.52 to 3.06 m/s at 20 mm and 5 L/min, with corresponding narrow velocity profiles. This study highlights the importance of understanding the hydrodynamic performance of these cannulae as it may help in selecting the most appropriate cannula to minimize the risk of thromboembolic events or aortic injury.

Publication

Adaptive multi-infusion decision support for the multivariable circulatory management of critically ill patients

Publisher: IEEE

Date: 08-2010

DOI: 10.1109/IEMBS.2010.5627373

Publication

Appraisal of the endotracheal tube as an alternative to the intercostal catheter

Publisher: Wiley

Date: 12-2010

DOI: 10.1111/J.1742-6723.2010.01359.X

Publication

Publisher: Institute of Electrical and Electronics Engineers (IEEE)

Date: 2022

DOI: 10.1109/TIA.2021.3118661

Publication

Evaluation of inflow cannulation site for implantation of right-sided rotary ventricular assist device

Publisher: Wiley

Date: 29-04-2013

DOI: 10.1111/AOR.12067

Abstract: Right heart dysfunction is one of the most serious complications following implantation of a left ventricular assist device, often leading to the requirement for short- or long-term right ventricular assist device (RVAD) support. The inflow cannulation site induces major hemodynamic changes and so there is a need to optimize the site used depending on the patient's condition. Therefore, this study evaluated and compared the hemodynamic influence of right atrial cannulation (RAC) and right ventricular cannulation (RVC) inflow sites. An in vitro variable heart failure mock circulation loop was used to compare RAC and RVC in mild and severe biventricular heart failure (BHF) conditions. In the severe BHF condition, higher ventricular ejection fraction (RAC: 13.6%, RVC: 32.7%) and thus improved heart chamber and RVAD washout were observed with RVC, which suggested this strategy might be preferable for long-term support (i.e., bridge-to-transplant or destination therapy) to reduce the risk of thrombus formation. In the mild BHF condition, higher pulmonary valve flow (RAC: 3.33 L/min, RVC: 1.97 L/min) and lower right ventricular stroke work (RAC: 0.10 W, RVC: 0.13 W) and volumes were recorded with RAC. These results indicate an improved potential for myocardial recovery, thus RAC should be chosen in this condition. This in vitro study suggests that RVAD inflow cannulation site should be chosen on a patient-specific basis with a view to the support strategy to promote myocardial recovery or reduce the risk of long-term complications.

Publication

Studying the Endothelial Glycocalyx in vitro: What Is Missing?

Publisher: Frontiers Media SA

Date: 14-04-2021

DOI: 10.3389/FCVM.2021.647086

Abstract: All human cells are coated by a surface layer of proteoglycans, glycosaminoglycans (GAGs) and plasma proteins, called the glycocalyx. The glycocalyx transmits shear stress to the cytoskeleton of endothelial cells, maintains a selective permeability barrier, and modulates adhesion of blood leukocytes and platelets. Major components of the glycocalyx, including syndecans, heparan sulfate, and hyaluronan, are shed from the endothelial surface layer during conditions including ischaemia and hypoxia, sepsis, atherosclerosis, diabetes, renal disease, and some viral infections. Studying mechanisms of glycocalyx damage in vivo can be challenging due to the complexity of immuno-inflammatory responses which are inextricably involved. Previously, both static as well as perfused in vitro models have studied the glycocalyx, and have reported either imaging data, assessment of barrier function, or interactions of blood components with the endothelial monolayer. To date, no model has simultaneously incorporated all these features at once, however such a model would arguably enhance the study of vasculopathic processes. This review compiles a series of current in vitro models described in the literature that have targeted the glycocalyx layer, their limitations, and potential opportunities for further developments in this field.

Publication

Anatomic fitting of total artificial hearts for in vivo evaluation

Publisher: Wiley

Date: 05-03-2013

DOI: 10.1111/AOR.12060

Abstract: Successful anatomic fitting of a total artificial heart (TAH) is vital to achieve optimal pump hemodynamics after device implantation. Although many anatomic fitting studies have been completed in humans prior to clinical trials, few reports exist that detail the experience in animals for in vivo device evaluation. Optimal hemodynamics are crucial throughout the in vivo phase to direct design iterations and ultimately validate device performance prior to pivotal human trials. In vivo evaluation in a sheep model allows a realistically sized representation of a smaller patient, for which smaller third-generation TAHs have the potential to treat. Our study aimed to assess the anatomic fit of a single device rotary TAH in sheep prior to animal trials and to use the data to develop a three-dimensional, computer-aided design (CAD)-operated anatomic fitting tool for future TAH development. Following excision of the native ventricles above the atrio-ventricular groove, a prototype TAH was inserted within the chest cavity of six sheep (28-40 kg). Adjustable rods representing inlet and outlet conduits were oriented toward the center of each atrial chamber and the great vessels, with conduit lengths and angles recorded for future analysis. A three-dimensional, CAD-operated anatomic fitting tool was then developed, based on the results of this study, and used to determine the inflow and outflow conduit orientation of the TAH. The mean diameters of the sheep left atrium, right atrium, aorta, and pulmonary artery were 39, 33, 12, and 11 mm, respectively. The center-to-center distance and outer-edge-to-outer-edge distance between the atria, found to be 39 ± 9 mm and 72 ± 17 mm in this study, were identified as the most critical geometries for successful TAH connection. This geometric constraint restricts the maximum separation allowable between left and right inlet ports of a TAH to ensure successful alignment within the available atrial circumference.

Publication

Gas reservoir simulation for enhanced gas recovery with nitrogen injection in low permeability coal seams

Publisher: Inderscience Publishers

Date: 2015

DOI: 10.1504/IJOGCT.2015.071514

Publication

Publisher: Springer Science and Business Media LLC

Date: 2011

DOI: 10.1186/CC10122

Publication

Risk Factors and Survival in Patients With Respiratory Failure After Cardiac Operations

Publisher: Elsevier BV

Date: 11-2011

DOI: 10.1016/J.ATHORACSUR.2011.04.019

Abstract: Respiratory failure is a known complication of cardiac operations and contributes to postoperative morbidity and death. This study assessed the relevance of risk factors in the development of respiratory failure, defined as postoperative ventilation exceeding 48 hours, and looked at the effect of respiratory failure on short-term and long-term mortality rates. De-identified data for patients who underwent cardiac surgical procedures at The Prince Charles Hospital between January 2002 and December 2007 were collected prospectively and analyzed using logistic regression to identify significant risk factors associated with respiratory failure. Long-term mortality data were analyzed for patients who underwent operations between 1994 and 2005 using Kaplan-Meier survival curves. The risk factor analysis included 7,440 patients. Identified risk factors for respiratory failure included critical preoperative state, neurologic dysfunction, poor left ventricular function, active endocarditis, chronic obstructive pulmonary disease, elevated preoperative creatinine, previous cardiac operation, and age. Survival was assessed in 18,488 patients and demonstrated increased short-term and long-term mortality rates when respiratory failure developed and increased mortality rates with increasing duration of respiratory failure. Respiratory failure is complication of cardiac operations associated with increased mortality and cost. Identification of patients at risk of respiratory failure may help select surgical candidates and aid resource planning and optimization.

Publication

Publisher: Springer Science and Business Media LLC

Date: 2014

DOI: 10.1186/1477-5956-12-12

Publication

Postcolonialism, Indigeneity and Struggles for Food Sovereignty

Publisher: Routledge

Date: 04-10-2016

DOI: 10.4324/9781315686769

Publication

Low preoperative selenium is associated with post-operative atrial fibrillation in patients having intermediate-risk coronary artery surgery

Publisher: Springer Science and Business Media LLC

Date: 13-07-2016

DOI: 10.1038/EJCN.2016.125

Abstract: Post-operative atrial fibrillation (POAF) is a frequent complication of cardiac surgery. Oxidative stress and reduced antioxidant function have major roles in its development. Selenium is a key to normal antioxidant function, and levels are often low before cardiac surgery. This study investigated whether low preoperative selenium levels were associated with POAF in cardiac surgical patients. Using the Society of Thoracic Surgeons (STS) Mortality risk score, 50 patients having primary coronary artery bypass grafts (CABG) surgery were ided into two groups: (i) low-risk group (STS ⩽0.5% n=26) and (ii) intermediate-risk group (STS ⩾2.0% n=24). Plasma levels of selenium, glutathione peroxidase (GPx) and malondialdehyde (MDA) were measured in all patients at anaesthetic induction, after aortic cross-cl removal, 3 h post cardiopulmonary bypass and on post-operative days 1 and 5. Multiple logistic regression was used to assess whether selenium levels were associated with POAF development. Seventeen patients developed POAF (14 patients in the intermediate-risk group and 3 patients in the low-risk group). Preoperative selenium was lower in patients who developed POAF compared with those with normal sinus rhythm (0.73±0.16 vs 0.89±0.13 μmol/l, P=0.005), and this was independently associated with POAF (PR 0.32 95% confidence credible interval (95%cI) 0.06-0.85, P=0.016). Regardless of POAF, preoperative selenium was lower in the intermediate-risk patients than in the low-risk patients (0.77±0.15 vs 0.89±0.14 μmol/l P=0.004). Intermediate-risk patients with low preoperative selenium levels may be at a greater risk of developing POAF following CABG. This raises the question of whether selenium supplementation in select cardiac surgical patients may reduce their POAF risk.

Publication

Publisher: Springer Science and Business Media LLC

Date: 16-06-2020

DOI: 10.1007/S13239-020-00471-1

Publication

The assessment of regional lung mechanics with electrical impedance tomography: a pilot study during recruitment manoeuvres

Publisher: Springer Science and Business Media LLC

Date: 11-10-2008

DOI: 10.1007/S00134-008-1324-0

Abstract: The purpose of lung recruitment manoeuvres is to open collapsed lung regions, improve gas exchange and optimise regional lung mechanics. This study investigates the efficacy of recruitment manoeuvres for improving regional ventilation distribution as characterised using electrical impedance tomography (EIT). DESIGN, SUBJECTS, INTERVENTIONS: A ventilated ovine smoke inhalation lung injury model was used. Respiratory mechanics and regional filling capacity of the lung were measured using EIT pre- and post- recruitment and compared to a control group. EIT, expressed as the time course relation of the regional versus the global impedance change, measured the regional filling capacities of the lung. After smoke inhalation injury, the dependent lung showed a significantly larger area of collapse and a reduced filling capacity compared to the non-dependent lung. After recruitment the ventilated volume increased and the dependent lung showed improved respiratory mechanics, whereas the non-dependent lung was more likely to be hyper-inflated during tidal breathing. Lung recruitment manoeuvres have a significant impact on regional lung mechanics and in idual measurement of ventilation distribution using EIT may assist to improve ventilatory management.

Publication

Enteral hydration in high‐flow therapy for infants with bronchiolitis: Secondary analysis of a randomised trial

Publisher: Wiley

Date: 11-02-2020

DOI: 10.1111/JPC.14799

Publication

e-Screening revolution: A novel approach to developing a delirium screening tool in the intensive care unit

Publisher: Wiley

Date: 30-03-2018

DOI: 10.1111/AJAG.12525

Abstract: Delirium is common in the intensive care unit (ICU), often affecting older patients. A bedside electronic tool has the potential to revolutionise delirium screening. Our group describe a novel approach to the design and development of delirium screening questions for the express purpose of use within an electronic device. Preliminary results are presented. Our group designed a series of tests which targeted the clinical criteria for delirium according to Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) criteria against predefined requirements, including applicability to older patients. Candidate questions, including tests of attention and awareness, were devised and then refined by an expert multidisciplinary group, including geriatricians. A scoring scheme was constructed, with testing to failure an indicator of delirium. The device was tested in healthy controls, aged 20-80 years, who were recorded as being without delirium. e-Screening for delirium requires a novel approach to instrument design but may revolutionise recognition of delirium in ICU.

Publication

Assessing potential for aortoiliac vascular injury from venoarterial extracorporeal membrane oxygenation cannulae: An in vitro particle image velocimetry study

Publisher: Wiley

Date: 15-10-2020

DOI: 10.1111/AOR.13807

Publication

IN-YOLO: Real-Time Detection of Outdoor High Voltage Insulators Using UAV Imaging

Publisher: Institute of Electrical and Electronics Engineers (IEEE)

Date: 06-2020

DOI: 10.1109/TPWRD.2019.2944741

Publication

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 17-04-2020

DOI: 10.1097/MAT.0000000000001102

Publication

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 02-2016

DOI: 10.1097/AOG.0000000000001236

Publication

High-flow oxygen via tracheostomy improves oxygenation in patients weaning from mechanical ventilation

Publisher: Springer Science and Business Media LLC

Date: 30-11-2017

DOI: 10.1007/S00134-016-4634-7

Publication

Publisher: Elsevier BV

Date: 12-2018

DOI: 10.1016/J.JPHA.2018.07.003

Publication

How can we prevent and treat cardiogenic shock in patients who present to non‐tertiary hospitals with myocardial infarction? A systematic review

Publisher: AMPCo

Date: 04-2009

DOI: 10.5694/J.1326-5377.2009.TB02495.X

Abstract: To evaluate current evidence in support of therapies for preventing and treating cardiogenic shock (CS) after acute myocardial infarction that can be initiated in hospitals without invasive cardiac facilities. Systematic review. MEDLINE and PubMed were searched from January 1985 to May 2008 using the MeSH terms "myocardial infarction", "thrombolytic therapy", "shock, cardiogenic", "angioplasty, transluminal, percutaneous coronary", "intra-aortic balloon pumping" and "platelet aggregation inhibitors". Additional keyword and reference list searches were performed. Articles in English relating to adults were included. Meta-analyses and comparative studies were included if they reported mortality or prevention of CS as an endpoint. In total, 35 articles were analysed (four meta-analyses, eight randomised controlled trials and 23 cohort studies). Studies were summarised by the first author and the level of evidence graded. Each study was checked by the second author and consensus was reached about inclusion and levels of evidence. In the management and prevention of CS, the following are supported by high-level evidence: prehospital thrombolysis, transfer for emergency revascularisation (patients aged or = 75 years). In established CS, evidence supporting inhospital thrombolysis and intra-aortic balloon pump use in patients aged < 75 years and emergency revascularisation in older patients is limited to subgroup analyses and observational studies. In regional centres, prevention of CS is achieved with early fibrinolysis, preferably before hospital arrival. Patients of all ages should be considered for thrombolysis, early transfer for coronary revascularisation, and intra-aortic balloon pump insertion unless contraindicated. Glycoprotein inhibitors have no role in the management of CS in non-tertiary hospitals.

Publication

Respiratory burst function of ovine neutrophils.

Publisher: Springer Science and Business Media LLC

Date: 2009

DOI: 10.1186/1471-2172-10-25

Publication

Stacked Ensemble Deep Learning for Outdoor Insulator Surface Condition Classification: A Profound Study on Water Droplets

Publisher: Institute of Electrical and Electronics Engineers (IEEE)

Date: 2023

DOI: 10.1109/ACCESS.2023.3315599

Publication

Publisher: Springer Science and Business Media LLC

Date: 07-10-2016

DOI: 10.1186/S13054-016-1448-5

Publication

Ethical factors determining ECMO allocation during the COVID-19 pandemic.

Publisher: Springer Science and Business Media LLC

Date: 06-2021

DOI: 10.1186/S12910-021-00638-Y

Abstract: ECMO is a particularly scarce resource during the COVID-19 pandemic. Its allocation involves ethical considerations that may be different to usual times. There is limited pre-pandemic literature on the ethical factors that ECMO physicians consider during ECMO allocation. During the pandemic, there has been relatively little professional guidance specifically relating to ethics and ECMO allocation although there has been active ethical debate about allocation of other critical care resources. We report the results of a small international exploratory survey of ECMO clinicians’ views on different patient factors in ECMO decision-making prior to and during the COVID-19 pandemic. We then outline current ethical decision procedures and recommendations for rationing life-sustaining treatment during the COVID-19 pandemic, and examine the extent to which current guidelines for ECMO allocation (and reported practice) adhere to these ethical guidelines and recommendations. An online survey was performed with responses recorded between mid May and mid August 2020. Participants (n = 48) were sourced from the ECMOCard study group—an international group of experts (n = 120) taking part in a prospective international study of ECMO and intensive care for patients during the COVID-19 pandemic. The survey compared the extent to which certain ethical factors involved in ECMO resource allocation were considered prior to and during the pandemic. When initiating ECMO during the pandemic, compared to usual times, participants reported giving more ethical weight to the benefit of ECMO to other patients not yet admitted as opposed to those already receiving ECMO, ( p 0.001). If a full unit were referred a good candidate for ECMO, participants were more likely during the pandemic to consider discontinuing ECMO from a current patient with low chance of survival (53% during pandemic vs. 33% prior p = 0.002). If the clinical team recommends that ECMO should cease, but family do not agree, the majority of participants indicated that they would continue treatment, both in usual circumstances (67%) and during the pandemic (56%). We found differences during the COVID-19 pandemic in prioritisation of several ethical factors in the context of ECMO allocation. The ethical principles prioritised by survey participants were largely consistent with ECMO allocation guidelines, current ethical decision procedures and recommendations for allocation of life-sustaining treatment during the COVID-19 pandemic.

Publication

Nursing team leader handover in the intensive care unit contains diverse and inconsistent content: An observational study

Publisher: Elsevier BV

Date: 09-2016

DOI: 10.1016/J.IJNURSTU.2016.05.006

Abstract: Despite a proliferation of evidence and the development of standardised tools to improve communication at handover, evidence to guide the handover of critical patient information between nursing team leaders in the intensive care unit is limited. The study aim was to determine the content of information handed over during intensive care nursing team leader shift-to-shift handover. A prospective observational study. A 21-bed medical/surgical adult intensive care unit specialising in cardiothoracic surgery at a tertiary referral hospital in Queensland, Australia. Senior nurses (Grade 5 and 6 Registered nurses) working in team leader roles, employed in the intensive care unit were s led. After obtaining consent from nursing staff, team leader handovers were audiotaped over 20 days. Audio recordings were transcribed and analysed using deductive and inductive content analysis. The frequency of content discussed at handover that fell within the a priori categories of the ISBAR schema (Identify-Situation-Background-Assessment-Recommendation) was calculated. Forty nursing team leader handovers were recorded resulting in 277 patient handovers and a median of 7 (IQR 2) patients discussed at each handover. The majority of nurses discussed the Identity (99%), Situation (96%) and Background (88%) of the patient, however Assessment (69%) content was varied and patient Recommendations (60%) were discussed less frequently. A erse range of additional information was discussed that did not fit into the ISBAR schema. Despite universal acknowledgement of the importance of nursing team leader handover, there are no previous studies assessing its content. Study findings indicate that nursing team leader handovers contain erse and inconsistent content, which could lead to inadequate handovers that compromise patient safety. Further work is required to develop structured handover processes for nursing team leader handovers.

Publication

Neural network imaging to characterize brain injury in cardiac procedures: the emerging utility of connectomics

Publisher: Elsevier BV

Date: 05-2017

DOI: 10.1093/BJA/AEX088

Abstract: Cognitive dysfunction is a poorly understood but potentially devastating complication of cardiac surgery. Clinically meaningful assessment of cognitive changes after surgery is problematic because of the absence of a means to obtain reproducible, objective, and quantitative measures of the neural disturbances that cause altered brain function. By using both structural and functional connectivity magnetic resonance imaging data to construct a map of the inter-regional connections within the brain, connectomics has the potential to increase the specificity and sensitivity of perioperative neurological assessment, permitting rational in idualized assessment and improvement of surgical techniques.

Publication

Publisher: Springer Science and Business Media LLC

Date: 2013

DOI: 10.1186/CC12802

Publication

Improved EMD-Based Complex Prediction Model for Wind Power Forecasting

Publisher: Institute of Electrical and Electronics Engineers (IEEE)

Date: 10-2020

DOI: 10.1109/TSTE.2020.2976038

Publication

Publisher: Frontiers Media SA

Date: 23-01-2019

DOI: 10.3389/FPED.2018.00425

Publication

Effects of volume resuscitation on the microcirculation in animal models of lipopolysaccharide sepsis: a systematic review.

Publisher: Springer Science and Business Media LLC

Date: 21-11-2016

DOI: 10.1186/S40635-016-0112-3

Publication

Safety and Putative Benefits of Tracheostomy Tube Placement in Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience

Publisher: SAGE Publications

Date: 21-03-2020

DOI: 10.1177/0885066619837939

Abstract: Patients supported with extracorporeal membrane oxygenation (ECMO) have been reported to have increased sedation requirements. Tracheostomies are performed in intensive care to facilitate longer term mechanical ventilation, reduce sedation, improve patient comfort, secretion clearance, and ability to speak and swallow. We aimed to investigate the safety of tracheostomy (TT) placement on ECMO, its impact on fluid intake, and the use of sedative, analgesic, and vasoactive drugs. Prospective data were collated for all ECMO patients over a 5.5-year period. Data included the cumulative dose of sedatives and analgesics, fluid balance, inotrope and vasopressor requirements, and number of packed red cell (PRC) units transfused. Data were analyzed to determine the differences in the aforementioned between 5 days pre-TT and post-TT insertion. Thirty-one (22.1%) of 140 patients underwent TT while on ECMO in the study period. Inotrope and vasopressor use was significantly less in the post-TT period compared to pre-TT dose ( P value = .01). This was in the setting of Sequential Organ Failure Assessment scores the day before TT placement being significantly greater than those on days 2, 3, and 4. There was a trend toward reduction in analgesic usage in the post-TT period. No major complications of TT were reported. There was no significant difference ( P value = .46) in the amount of PRC used post-TT. These data indicate that TT may result in a reduction in vasopressor and inotropic requirement. Data do not suggest increased major bleeding with placement of TT in patients on ECMO. The potential risk and benefits of inserting a TT in ECMO patients need further validation in prospective clinical studies.

Publication

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 11-2014

DOI: 10.1161/STROKEAHA.114.005919

Publication

Increased sedation requirements in patients receiving extracorporeal membrane oxygenation for respiratory and cardio-respiratory failure

Publisher: SAGE Publications

Date: 07-2012

DOI: 10.1177/0310057X1204000411

Abstract: Critically ill patients receiving extracorporeal membrane oxygenation (ECMO) are often noted to have increased sedation requirements. However, data related to sedation in this complex group of patients is limited. The aim of our study was to characterise the sedation requirements in adult patients receiving ECMO for cardiorespiratory failure. A retrospective chart review was performed to collect sedation data for 30 consecutive patients who received venovenous or venoarterial ECMO between April 2009 and March 2011. To test for a difference in doses over time we used a regression model. The dose of midazolam received on ECMO support increased by an average of 18 mg per day (95% confidence interval 8, 29 mg, P=0.001), while the dose of morphine increased by 29 mg per day (95% confidence interval 4, 53 mg, P=0.021) The venovenous group received a daily midazolam dose that was 157 mg higher than the venoarterial group (95% confidence interval 53, 261 mg, P=0.005). We did not observe any significant increase in fentanyl doses over time (95% confidence interval 1269, 4337 μg, P=0.94). There is a significant increase in dose requirement for morphine and midazolam during ECMO. Patients on venovenous ECMO received higher sedative doses as compared to patients on venoarterial ECMO. Future research should focus on mechanisms behind these changes and also identify drugs that are most suitable for sedation during ECMO.

Publication

Novel 24-h ovine model of brain death to study the profile of the endothelin axis during cardiopulmonary injury

Publisher: Springer Science and Business Media LLC

Date: 24-11-2015

DOI: 10.1186/S40635-015-0067-9

Publication

The combined effects of extracorporeal membrane oxygenation and renal replacement therapy on meropenem pharmacokinetics: a matched cohort study

Publisher: Springer Science and Business Media LLC

Date: 12-2014

DOI: 10.1186/S13054-014-0565-2

Publication

A Review of Coronary Artery Bypass Grafting in the Indigenous Australian Population

The use of Acticoat™ in neonatal burns

Publisher: Elsevier BV

Date: 11-2005

DOI: 10.1016/J.BURNS.2005.04.030

Abstract: To evaluate the safety and efficacy of Acticoat use in primary burn injuries and other skin injuries in premature neonates. An audit of eight premature neonates who sustained burn injuries and other cutaneous injuries from various agents were treated with Acticoat. Serum silver levels were measured in three neonates. Wounds were assessed for infection and blood cultures were taken where sepsis was suspected. Neonates ranged from 23 to 28 weeks gestation (weight: 578-1078 g). Causative injury mechanisms included: alcoholic chlorhexidine, alcoholic wipes, electrode jelly, extravasated intravenous fluids, artery illuminator, temperature probe and adhesive tape removal. Total burned body surface area ranged from 1 to 30%. All neonates were treated with Acticoat dressing changed every 3-7 days. All wounds re-epithelialised by day 28 and scar management was not required. There were four mortalities secondary to problems associated with extreme prematurity. Serum silver levels ranged from 0 to 1 micromol/L. There were no wound infections or positive blood cultures during the treatment period. Acticoat is a suitable dressing for premature neonates who have sustained burn injury, with the advantage of minimal handling as the dressing need only be changed every 3-7 days.

Publication

Cardiac Surgery in Indigenous Australians: Early Onset Cardiac Disease with follow-up Challenges

Publisher: Elsevier BV

Date: 06-2014

DOI: 10.1016/J.HLC.2014.01.004

Abstract: To review the risk factors, complications and follow-up of Indigenous patients post cardiac surgery. This was a retrospective study of Indigenous patients who underwent cardiac surgery at an Australian tertiary hospital between 2002 and 2009. Patients' medical notes were reviewed and data collected and analysed. There were 220 Indigenous patients who had cardiac surgery. Non-elective surgery was performed in 45.0% (99/220). A history of smoking was reported by 76.8% (169/220). The most common operation was coronary artery bypass grafting with a mean age of 55 years. Of the 71 valve operations, 31.0% had rheumatic heart disease. Mechanical valves were given to 56.3% (40/71) of patients with a mean age of 45 years. The rate of peri-operative bleeding requiring blood transfusion or reoperation was 8.6% (19/220) and 28-day mortality was 0.45% (1/220). Of the patients with mechanical valves, 10.0% (4/40) did not present for outpatient review. Late anticoagulation related complications were haemorrhagic stroke 7.5% (3/40) and ischaemic bowel 2.5% (1/40). Late mortality was 9.5% (21/220). Late anticoagulation related deaths were in 1.8% (4/220), of whom 0.9% (2/220) had mechanical valves. The mean age of 52 years at which Indigenous patients have cardiac surgery is significantly low compared to non-Indigenous patients. Indigenous patients have multiple risk factors for cardiac disease and with a large number requiring emergency surgery. Although surgical outcome in the short term is favourable, a large number of patients are lost to follow-up. The use of mechanical valve and warfarin should be in idualised. Strategic post-operative follow-up mechanisms are needed to address these issues.

Publication

Transcatheter Aortic-Valve Replacement in Clinical Practice

Publisher: Massachusetts Medical Society

Date: 28-04-2016

DOI: 10.1056/NEJMC1601697

Publication

Donation after cardiac death in Queensland: Review of the pilot project

Publisher: SAGE Publications

Date: 05-2012

DOI: 10.1177/0310057X1204000319

Abstract: Organ transplantation is a viable therapeutic option for patients with endstage organ failure when other therapies have been exhausted. Donation after cardiac death (DCD) is re-emerging as a potential option to expand the donor pool in order to meet an increasing demand for organ transplantation. In this review, we evaluate the evolution of the Queensland DCD pilot project since its inception in August 2008. A retrospective analysis of registry data from Australia and New Zealand Organ Donation (ANZOD) and DonateLife Queensland was performed to collect information relating to donor characteristics, DCD process and outcomes. Data was compared with the ANZOD registry annual reports from 2008 to 2010. Twenty-three (82%) out of 28 potential DCD organ donors were successful in donating their organs. The median time from presentation to reaching consensus to withdraw cardiorespiratory support was four days (interquartile range three to eight days). The median time from withdrawal to death was 20 minutes (interquartile range 18 to 25 minutes), and the median warm ischaemia time was 17 minutes (interquartile range 14 to 19 minutes). DCD donors represented 16% (23) of the 144 deceased donors over the study period and provided approximately 10% (48) of the 505 deceased organs in Queensland. The DCD pilot project resulted in an increase in solid organ transplantation in Queensland. It allowed the development of policies to facilitate DCD, in accordance with state's legislation and DonateLife practices. If implemented state-wide, the program has the potential to be an effective way to improve organ donation rates in Queensland.

Publication

Publisher: Springer Science and Business Media LLC

Date: 05-2021

DOI: 10.1007/S00134-021-06385-3

Publication

Effects of packed red blood cell storage duration on post-transfusion clinical outcomes: a meta-analysis and systematic review.

Publisher: Springer Science and Business Media LLC

Date: 05-10-2015

DOI: 10.1007/S00134-015-4078-5

Abstract: There is substantial conjecture regarding the clinical significance of packed red blood cell (PRBC) changes that occur during in vitro storage. Here, we present a meta- and systematic analysis of adult studies published between 1994 and 2015 with the aim of updating existing quantitative reviews and providing a comprehensive cover of the six most commonly studied outcomes-mortality, infection, renal dysfunction, multiple organ dysfunction syndrome (MODS), thrombotic complications and prolonged hospital length of stay. Computerised searches of Pubmed and EMBASE identified publications that reported target outcomes and PRBC storage duration prior to transfusion. Bibliographies of relevant literature were manually searched to incorporate missed studies. Randomised controlled trial (RCT) data was meta-analysed using a random effects model with Cochrane Collaboration Review Manager (RevMan) version 5.1 software. Observational investigations were systematically reviewed. Sixty-four papers were selected covering 462,581 patients with the majority of studies being observational in nature. Meta-analysis of eight RCTs demonstrated a trend towards decreased mortality with stored PRBC transfusion albeit this effect was not statistically significant (OR 0.91, 95 % CI 0.78-1.05, p = 0.20). In a small subset of intensive care unit (ICU), cardiac surgery and trauma patients observational studies suggested that prolonged storage may be correlated with increased mortality. Trauma and cardiac surgery patients appeared to be most susceptible to the potential infectious complications of stored PRBCs. Stored PRBCs were unlikely to affect thrombotic complications or hospital length of stay. There were inadequate data to determine whether stored PRBCs had clinically relevant effects on renal dysfunction and MODS. Although literature presents a concerning picture of potential storage complications, current findings are too inconsistent to drive changes in clinical practice. Results from current RCTs will likely play a role in PRBC age guidelines for cardiac surgery and ICU patients. However, these studies may be less efficacious at detecting small effects that are limited to specific subpopulations.

Publication

Lest We Forget: Heparin-Induced Hyperkalemia

Publisher: Elsevier BV

Date: 02-2012

DOI: 10.1053/J.JVCA.2010.11.016

Publication

The effects of the introduction of an adult ECMO program on statewide referral patterns, casemix and outcomes in patients with acute respiratory distress syndrome or pneumonia.

Publisher: Springer Science and Business Media LLC

Date: 22-03-2017

DOI: 10.1007/S00134-017-4771-7

Publication

Position Paper for the Organization of Extracorporeal Membrane Oxygenation Programs for Acute Respiratory Failure in Adult Patients

Publisher: American Thoracic Society

Date: 09-2014

DOI: 10.1164/RCCM.201404-0630CP

Publication

Are pressure injuries related to skin failure in critically ill patients?

Publisher: Elsevier BV

Date: 09-2018

DOI: 10.1016/J.AUCC.2017.07.004

Abstract: Pressure injuries contribute significantly to patient morbidity and healthcare costs. Critically ill patients are a high risk group for pressure injury development and may suffer from skin failure secondary to hypoperfusion. The aim of this study was to report hospital acquired pressure injury incidence in intensive care and non-intensive care patients and assess the clinical characteristics and outcomes of ICU patients reported as having a hospital acquired pressure injury to better understand patient factors associated with their development in comparison to ward patients. The setting for this study was a 630 bed, government funded, tertiary referral teaching hospital. A secondary data analysis was undertaken on all patients with a recorded PI on the hospital's critical incident reporting systems and admitted patient data collection between July 2006 to March 2015. There were a total of 5280 reports in 3860 patients 726 reports were intensive care patients and 4554 were non-intensive care patients, with severe hospital acquired PI reported in 22 intensive care patients and 54 non-intensive care patients. Pressure injury incidence increased in intensive care patients and decreased in non-intensive care patients over the study period. There were statistically significant differences in the anatomical location of severe hospital acquired pressure injuries between these groups (p=0.008). Intensive care patients have greater than 10-fold higher hospital acquired pressure injury incidence rates compared to other hospitalised patients. The predisposition of critically ill patients leaves them susceptible to pressure injury development despite implementation of pressure injury prevention strategies. Skin failure appears to be a significant phenomenon in critically ill patients and is associated with the use of vasoactive agents and support systems such as extra corporeal membrane oxygenation and mechanical ventilation.

Publication

Publisher: BMJ

Date: 2013

DOI: 10.1136/BMJOPEN-2013-002799

Publication

An advanced mock circulation loop for in vitro cardiovascular device evaluation

Publisher: Wiley

Date: 03-02-2020

DOI: 10.1111/AOR.13636

Abstract: Controlled and repeatable in vitro evaluation of cardiovascular devices using a mock circulation loop (MCL) is essential prior to in vivo or clinical trials. MCLs often consist of only a systemic circulation with no autoregulatory responses and limited validation. This study aimed to develop, and validate against human data, an advanced MCL with systemic, pulmonary, cerebral, and coronary circulations with autoregulatory responses. The biventricular MCL was constructed with pneumatically controlled hydraulic circulations with Starling responsive ventricles and autoregulatory cerebral and coronary circulations. Hemodynamic repeatability was assessed and complemented by validation using impedance cardiography data from 50 healthy humans. The MCL successfully simulated patient scenarios including rest, exercise, and left heart failure with and without cardiovascular device support. End-systolic pressure-volume relationships for respective healthy and heart failure conditions had slopes of 1.27 and 0.54 mm Hg mL

Publication

Date: 10-2004

DOI: 10.1093/BJA/AEH236

Publication

The Pulmonary Artery Catheter in Australasia: A Survey Investigating Intensive Care Physicians’ Knowledge and Perception of Future Trends in Use

Publisher: SAGE Publications

Date: 2008

DOI: 10.1177/0310057X0803600115

Abstract: A survey was conducted to assess the knowledge and trends of use of the pulmonary artery catheter amongst intensive care practitioners in Australasia. A 31-item multiple choice questionnaire, identical to one previously trialled in studies in the United States and Europe, was distributed to all registered intensive care specialists and trainees working in intensive care units in Australasia. Five-hundred-and-forty-one questionnaires were distributed and 151 (27.9%) were returned, with an average mark of 82.7%±9.3% and a range of 53.3 to 100%. Total score was significantly associated with years of experience in intensive care (P .04), number of pulmonary artery catheters inserted (P .015) and whether or not the respondent had passed the Joint Faculty of Intensive Care Medicine examination (P .01). Scores were significantly higher amongst trainees (P .0001) and physicians who had passed the Joint Faculty of Intensive Care Medicine examination (P .0001). Overall, 44.9% of respondents indicated their use of the pulmonary artery catheter was decreasing, with 42.6% indicating their use was the same over the past five years. Sixty-one percent of respondents indicated they either agreed or strongly agreed with the statement that the use of echocardiography should supersede the use of the pulmonary artery catheter by intensive care specialists in the future. We concluded that in this study, knowledge of the pulmonary artery catheter and its use is better in Australasia than in previous studies in North America and Europe. The majority of respondents in Australasia believe that echocardiography will supersede the use of the pulmonary artery catheter in the future.

Publication

Publisher: Elsevier BV

Date: 11-2014

DOI: 10.1016/J.ADDR.2014.11.002

Publication

Study protocol for a pilot, open-label, prospective, and observational study to evaluate the pharmacokinetics of drugs administered to patients during extracorporeal circulation; potential of in vivo cytochrome p450 phenotyping to optimise pharmacotherapy

Publisher: MDPI AG

Date: 13-05-2019

DOI: 10.3390/MPS2020038

Abstract: Pharmacokinetic alterations of medications administered during surgeries involving cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) have been reported. The impact of CPB on the cytochrome P450 (CYP) enzymes’ activity is the key factor. The metabolic rates of caffeine, dextromethorphan, midazolam, omeprazole, and Losartan to the CYP-specific metabolites are validated measures of in vivo CYP 1A2, 2D6, 3A4, 2C19, and 2C9 activities, respectively. The study aim is to assess the activities of major CYPs in patients on extracorporeal circulation (EC). This is a pilot, prospective, open-label, observational study in patients undergoing surgery using EC and patients undergoing laparoscopic cholecystectomy as a control group. CYP activities will be measured on the day, and 1–2 days pre-surgery/3–4 days post-surgery (cardiac surgery and Laparoscopic cholecystectomy) and 1–2 days after starting ECMO, 1–2 weeks after starting ECMO, and 1–2 days after discontinuation from ECMO. Aforementioned CYP substrates will be administered to the patient and blood s les will be collected at 0, 1, 2, 4, and 6 h post-dose. Major CYP enzymes’ activities will be compared in each participant on the day, and before/after surgery. The CYP activities will be compared in three study groups to investigate the impact of CYPs on EC.

Publication

Combined Mesenchymal Stromal Cell Therapy and Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome. A Randomized Controlled Trial in Sheep

Publisher: American Thoracic Society

Date: 08-2020

DOI: 10.1164/RCCM.201911-2143OC

Publication

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 07-2015

DOI: 10.1097/SHK.0000000000000372

Publication

Fibrinogen in traumatic haemorrhage: A narrative review

Publisher: Elsevier BV

Date: 02-2017

DOI: 10.1016/J.INJURY.2016.12.012

Abstract: Haemorrhage in the setting of severe trauma is associated with significant morbidity and mortality. There is increasing awareness of the important role fibrinogen plays in traumatic haemorrhage. Fibrinogen levels fall precipitously in severe trauma and the resultant hypofibrinogenaemia is associated with poor outcomes. Hence, it has been postulated that early fibrinogen replacement in severe traumatic haemorrhage may improve outcomes, although, to date there is a paucity of high quality evidence to support this hypothesis. In addition there is controversy regarding the optimal method for fibrinogen supplementation. We review the current evidence regarding the role of fibrinogen in trauma, the rationale behind fibrinogen supplementation and discuss current research.

Publication

The Use of Recombinant Activated Factor VII for Refractory Bleeding Post Complex Cardiothoracic Surgery

Publisher: SAGE Publications

Publisher: OMICS Publishing Group

Date: 2014

DOI: 10.4172/2155-9899.1000218

Publication

Biventricular Assist Devices: A Technical Review

Publisher: Springer Science and Business Media LLC

Date: 08-07-2011

DOI: 10.1007/S10439-011-0348-8

Abstract: The optimal treatment option for end stage heart failure is transplantation however, the shortage of donor organs necessitates alternative treatment strategies such as mechanical circulatory assistance. Ventricular assist devices (VADs) are employed to support these cases while awaiting cardiac recovery or transplantation, or in some cases as destination therapy. While left ventricular assist device (LVAD) therapy alone is effective in many instances, up to 50% of LVAD recipients demonstrate clinically significant postoperative right ventricular failure and potentially need a biventricular assist device (BiVAD). In these cases, the BiVAD can effectively support both sides of the failing heart. This article presents a technical review of BiVADs, both clinically applied and under development. The BiVADs which have been used clinically are predominantly first generation, pulsatile, and paracorporeal systems that are bulky and prone to device failure, thrombus formation, and infection. While they have saved many lives, they generally necessitate a large external pneumatic driver which inhibits normal movement and quality of life for many patients. In an attempt to alleviate these issues, several smaller, implantable second and third generation devices that use either immersed mechanical blood bearings or hydrodynamic/magnetic levitation systems to support a rotating impeller are under development or in the early stages of clinical use. Although these rotary devices may offer a longer term, completely implantable option for patients with biventricular failure, their control strategies need to be refined to compete with the inherent volume balancing ability of the first generation devices. The BiVAD systems potentially offer an improved quality of life to patients with total heart failure, and thus a viable alternative to heart transplantation is anticipated with continued development.

Publication

Low flow rate alters haemostatic parameters in an ex-vivo extracorporeal membrane oxygenation circuit

Publisher: Springer Science and Business Media LLC

Date: 20-08-2019

DOI: 10.1186/S40635-019-0264-Z

Publication

The experiences of health care workers employed in an Australian intensive care unit during the H1N1 Influenza pandemic of 2009: A phenomenological study

Publisher: Elsevier BV

Date: 05-2010

DOI: 10.1016/J.IJNURSTU.2009.11.015

Publication

Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review

Publisher: SAGE Publications

Date: 29-06-2016

DOI: 10.1177/0885066616656333

Abstract: Extracorporeal membrane oxygenation (ECMO) offers therapeutic options in refractory respiratory and/or cardiac failure. Systemic anticoagulation with heparin is routinely administered. However, in patients with heparin-induced thrombocytopenia or heparin resistance, the direct thrombin inhibitor bivalirudin is a valid option and has been increasingly used for ECMO anticoagulation. We aimed at evaluating its safety and its optimal dosing for ECMO. Systematic web-based literature search of PubMed and EMBASE performed via National Health Service Library Evidence and manually, updated until January 30, 2016. The search revealed 8 publications relevant to the topic (5 case reports). In total, 58 patients (24 pediatrics) were reported (18 received heparin as control groups). Bivalirudin was used with or without loading dose, followed by infusion at different ranges (lowest 0.1-0.2 mg/kg/h without loading dose highest 0.5 mg/kg/h after loading dose). The strategies for monitoring anticoagulation and optimal targets were dissimilar (activated partial thromboplastin time 45-60 seconds to 42-88 seconds activated clotting time 180-200 seconds to 200-220 seconds thromboelastography in 1 study). Bivalirudin loading dose was not always used infusion range and anticoagulation targets were different. In this systematic review, we discuss the reasons for this variability. Larger studies are needed to establish the optimal approach with the use of bivalirudin for ECMO.

Publication

Nasal high flow oxygen therapy in patients with COPD reduces respiratory rate and tissue carbon dioxide while increasing tidal and end-expiratory lung volumes: A randomised crossover trial

Publisher: BMJ

Date: 25-03-2016

DOI: 10.1136/THORAXJNL-2015-207962

Publication

Speaking valves in tracheostomised ICU patients weaning off mechanical ventilation - do they facilitate lung recruitment?

Publisher: Springer Science and Business Media LLC

Date: 04-2016

DOI: 10.1186/S13054-016-1249-X

Publication

Long-term clinical outcomes after aortic valve replacement using cryopreserved aortic allograft

Publisher: Elsevier BV

Date: 07-2014

DOI: 10.1016/J.JTCVS.2013.07.038

Abstract: Although the frequency of biological valve use in treating aortic valve disease is increasing, the critical limiting factor, "structural deterioration," remains unresolved. Analysis of long-term outcomes after implantation of cryopreserved aortic allografts will yield further information related to the durability of the aortic allograft, possibly suggesting mechanisms underlying or strategies to prevent or treat the structural deterioration of biological valve substitutes. A total of 840 cryopreserved aortic allografts implanted in the last 35 years were reviewed with clinical follow-up completed in 99% of the consecutive series. By June 2010, 285 implanted allografts had been surgically explanted, 288 patients died before allograft removal, and 267 patients are under continued follow-up. Cryopreserved aortic allografts were durable for more than 15 years in the middle-aged and older patient population. The estimated median time until structural deterioration was 20 years post-implantation, and 2 allografts have been functioning well for more than 30 years. Structural deterioration was independently related to the young age of the recipient, elderly age of the donor, severe obesity in the recipient, history of blood transfusion in the recipient, and full-root implantation technique. Infection of the implanted allograft necessitating reintervention rarely occurred. Reintervention for the allograft demonstrated 2% in-hospital mortality. Cryopreserved aortic allografts were durable for more than 15 years. Structural deterioration of aortic allografts was related to multiple factors. The age of the recipient and the donor, obesity and blood transfusion history of the recipient, and implantation technique were identified as the most important factors contributing to allograft failure.

Publication

Cannula and circuit management in peripheral extracorporeal membrane oxygenation

Publisher: Public Library of Science (PLoS)

Date: 30-12-2019

DOI: 10.1371/JOURNAL.PONE.0227248

Publication

Publisher: AMPCo

Date: 02-2013

DOI: 10.5694/MJA12.11502

Publication

Compromised right ventricular contractility in an ovine model of heart transplantation following 24 h donor brain stem death

Publisher: Elsevier BV

Date: 07-2021

DOI: 10.1016/J.PHRS.2021.105631

Abstract: Heart failure is an inexorably progressive disease with a high mortality, for which heart transplantation (HTx) remains the gold standard treatment. Currently, donor hearts are primarily derived from patients following brain stem death (BSD). BSD causes activation of the sympathetic nervous system, increases endothelin levels, and triggers significant inflammation that together with potential myocardial injury associated with the transplant procedure, may affect contractility of the donor heart. We examined peri-transplant myocardial catecholamine sensitivity and cardiac contractility post-BSD and transplantation in a clinically relevant ovine model. Donor sheep underwent BSD (BSD, n = 5) or sham (no BSD) procedures (SHAM, n = 4) and were monitored for 24h prior to heart procurement. Orthotopic HTx was performed on a separate group of donor animals following 24h of BSD (BSD-Tx, n = 6) or SHAM injury (SH-Tx, n = 5). The healthy recipient heart was used as a control (HC, n = 11). A cumulative concentration-effect curve to (-)-noradrenaline (NA) was established using left (LV) and right ventricular (RV) trabeculae to determine β Our data showed reduced basal and maximal (-)-noradrenaline induced contractility of the RV (but not LV) following BSD as well as HTx, regardless of whether the donor heart was exposed to BSD or SHAM. The potency of (-)-noradrenaline was lower in left and right ventricles for BSD-Tx and SH-Tx compared to HC. These studies show that the combination of BSD and transplantation are likely to impair contractility of the donor heart, particularly for the RV. For the donor heart, this contractile dysfunction appears to be independent of changes to β

Publication

Effect of infusion set replacement intervals on catheter-related bloodstream infections (RSVP): a randomised, controlled, equivalence (central venous access device)–non-inferiority (peripheral arteria

Publisher: Elsevier BV

Date: 04-2021

DOI: 10.1016/S0140-6736(21)00351-2

Publication

Publisher: Elsevier BV

Date: 10-2015

DOI: 10.1016/J.JCRC.2015.06.015

Publication

Effect of smoke inhalation on viscoelastic properties and ventilation distribution in sheep

Publisher: American Physiological Society

Date: 09-2006

DOI: 10.1152/JAPPLPHYSIOL.01635.2005

Abstract: Smoke inhalation injuries are the leading cause of mortality from burn injury. Airway obstruction due to mucus plugging and bronchoconstriction can cause severe ventilation inhomogeneity and worsen hypoxia. Studies describing changes of viscoelastic characteristics of the lung after smoke inhalation are missing. We present results of a new smoke inhalation device in sheep and describe pathophysiological changes after smoke exposure. Fifteen female Merino ewes were anesthetized and intubated. Baseline data using electrical impedance tomography and multiple-breath inert-gas washout were obtained by measuring ventilation distribution, functional residual capacity, lung clearance index, dynamic compliance, and stress index. Ten sheep were exposed to standardized cotton smoke insufflations and five sheep to sham smoke insufflations. Measured carboxyhemoglobin before inhalation was 3.87 ± 0.28% and 5 min after smoke was 61.5 ± 2.1%, range 50–69.4% ( P 0.001). Two hours after smoke functional residual capacity decreased from 1,773 ± 226 to 1,006 ± 129 ml and lung clearance index increased from 10.4 ± 0.4 to 14.2 ± 0.9. Dynamic compliance decreased from 56.6 ± 5.5 to 32.8 ± 3.2 ml/cmH 2 O. Stress index increased from 0.994 ± 0.009 to 1.081 ± 0.011 ( P 0.01) (all means ± SE, P 0.05). Electrical impedance tomography showed a shift of ventilation from the dependent to the independent lung after smoke exposure. No significant change was seen in the sham group. Smoke inhalation caused immediate onset in pulmonary dysfunction and significant ventilation inhomogeneity. The smoke inhalation device as presented may be useful for interventional studies.

Publication

Ventilation distribution in rats: Part 2 – A comparison of electrical impedance tomography and hyperpolarised helium magnetic resonance imaging

Publisher: Springer Science and Business Media LLC

Date: 2012

DOI: 10.1186/1475-925X-11-68

Publication

PostAc : A Visual Interactive Search, Exploration, and Analysis Platform for PhD Intensive Job Postings

Publisher: Association for Computational Linguistics

Date: 2019

DOI: 10.18653/V1/P19-3008

Publication

Understanding current intensive care unit nursing handover practices

Publisher: Wiley

Date: 04-2013

DOI: 10.1111/IJN.12058

Abstract: Clinical handover is critical to clinical decision-making and the provision of safe, high quality, continuing care. Incomplete and inaccurate transfer of information can result in poor outcomes. To assess the content and completeness of the intensive care unit nursing shift-to-shift handover, a prospective, observational study design was used. A semistructured observation sheet based on 10 key principles for handover was used to overtly observe 20 bedside nursing handovers. Descriptive statistics were used to analyse the data. Overall, the content handed over was consistent with the key principles of clinical handover. However, there were some key principles that were minimally addressed or absent from clinical handovers. Development and implementation of a handover tool specific to intensive care will assist in ensuring that all key principles are adhered to so that adverse events associated with miscommunication during clinical handover are reduced and a high standard of care is maintained.

Publication

Publisher: Wiley

Date: 25-07-2018

DOI: 10.1111/AOR.12967

Publication

Mesenchymal stem cells may ameliorate inflammation in an ex vivo model of extracorporeal membrane oxygenation

Publisher: SAGE Publications

Date: 04-2019

DOI: 10.1177/0267659119830857

Abstract: Mesenchymal stem cells exhibit immunomodulatory properties which are currently being investigated as a novel treatment option for Acute Respiratory Distress Syndrome. However, the feasibility and efficacy of mesenchymal stem cell therapy in the setting of extracorporeal membrane oxygenation is poorly understood. This study aimed to characterise markers of innate immune activation in response to mesenchymal stem cells during an ex vivo simulation of extracorporeal membrane oxygenation. Ex vivo extracorporeal membrane oxygenation simulations (n = 10) were conducted using a commercial extracorporeal circuit with a CO 2 -enhanced fresh gas supply and donor human whole blood. Heparinised circuits (n = 4) were injected with 40 × 10 6 -induced pluripotent stem cell–derived human mesenchymal stem cells, while the remainder (n = 6) acted as controls. Simulations were maintained, under physiological conditions, for 240 minutes. Circuits were s led at 15, 30, 60, 120 and 240 minutes and assessed for levels of interleukin-1β, interleukin-6, interleukin-8, interleukin-10, tumour necrosis factor-α, transforming growth factor-β1, myeloperoxidase and α-Defensin-1. In addition, haemoglobin, platelet and leukocyte counts were performed. There was a trend towards reduced levels of pro-inflammatory cytokines in mesenchymal stem cell–treated circuits and a significant increase in transforming growth factor-β1. Blood cells and markers of neutrophil activation were reduced in mesenchymal stem cell circuits during the length of the simulation. As previously reported, the addition of mesenchymal stem cells resulted in a reduction of flow and increased trans-oxygenator pressures in comparison to controls. The addition of mesenchymal stem cells during extracorporeal membrane oxygenation may cause an increase in transforming growth factor-β1. This is despite their ability to adhere to the membrane oxygenator. Further studies are required to confirm these findings.

Publication

On the modelling, analysis, and design of a suboptimal controller for a class of wind/PV/battery based DC microgrid

Publisher: Institution of Engineering and Technology (IET)

Date: 19-11-2021

DOI: 10.1049/RPG2.12338

Publication

Administration of mesenchymal stem cells during ECMO results in a rapid decline in oxygenator performance.

Publisher: BMJ

Date: 05-04-2018

DOI: 10.1136/THORAXJNL-2017-211439

Abstract: Mesenchymal stem cells (MSCs) have attracted attention as a potential therapy for Acute Respiratory Distress Syndrome (ARDS). At the same time, the use of extracorporeal membrane oxygenation (ECMO) has increased among patients with severe ARDS. To date, early clinical trials of MSCs in ARDS have excluded patients supported by ECMO. Here we provide evidence from an ex-vivo model of ECMO to suggest that the intravascular administration of MSCs during ECMO may adversely impact the function of a membrane oxygenator. The addition of clinical grade MSCs resulted in a reduction of flow through the circuit in comparison to controls (0.6 ±0.35 L min -1 vs 4.12 ± 0.03 L min -1 , at 240 minutes) and an increase in the transoygenator pressure gradient (101±9 mmHg vs 21±4 mmHg, at 240 minutes). Subsequent immunohistochemistry analysis demonstrated quantities of MSCs highly adherent to membrane oxygenator fibres. This study highlights the potential harm associated with MSC therapy during ECMO and suggests further areas of research required to advance the translation of cell therapy in this population.

Publication

Comparative lung distribution of radiolabeled tobramycin between nebulized and intravenous administration in a mechanically-ventilated ovine model, an observational study

Publisher: Elsevier BV

Date: 02-2021

DOI: 10.1016/J.IJANTIMICAG.2020.106232

John Fraser

Researcher

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Publications

Protein-bound drugs are prone to sequestration in the extracorporeal membrane oxygenation circuit: results from an ex vivo study

A comprehensive ovine model of blood transfusion.

Cerebral Microcirculation during Experimental Normovolaemic Anemia.

ECMO use in COVID-19: Lessons from past respiratory virus outbreaks - A narrative review

Wrist acupressure for post-operative nausea and vomiting (WrAP)

Cerebral microcirculation during mild head injury after a contusion and acceleration experimental model in sheep.

Transfusion of packed red blood cells reduces selenium levels and increases lipid peroxidation in an in vivo ovine model.

Effect of preoperative renal function on long-term survival after cardiac surgery

Maintaining Oxygenation Successfully with High Flow Nasal Cannula during Diagnostic Bronchoscopy on a Postoperative Lung Transplant Patient in the Intensive Care.

Effects of transfusing older red blood cells and platelets on obstetric patient outcomes: A retrospective cohort study.

Improving skin integration around long‐term percutaneous devices using fibrous scaffolds in a reconstructed human skin equivalent model

Design and rationale of the COVID-19 Critical Care Consortium international, multicentre, observational study

Endothelialized flow models for blood transfusion research.

Execution of synthetic Bayesian model average for solar energy forecasting

Mechanical circulatory support in the new era: an overview.

Allostasis and sedation practices in intensive care evaluation: an observational pilot study

Area Under Trough Concentrations of Tacrolimus as a Predictor of Progressive Renal Impairment After Liver Transplantation

Differential Protein Expression among Two Different Ovine ARDS Phenotypes—A Preclinical Randomized Study

Modeling, Control, and Operation of an M-DAB DC–DC Converter for Interconnection of HVDC Grids

Lung Pharmacokinetics of Tobramycin by Intravenous and Nebulized Dosing in a Mechanically Ventilated Healthy Ovine Model

Development and validation of ELISAs for the quantitation of interleukin (IL)-1β, IL-6, IL-8 and IL-10 in ovine plasma.

Deep dermal burn injury results in scarless wound healing in the ovine fetus

Improving In vitro Evaluation Capabilities of Cardiac Assist Devices through a Validated Exercise Simulation

In Vitro Evaluation of Aortic Insufficiency With a Rotary Left Ventricular Assist Device

Nasal High Flow in Room Air for Hypoxemic Bronchiolitis Infants

Characterization and bioactivity of essential oils from novel chemotypes of Eremophila longifolia (F. Muell) (Myoporaceae): a highly valued traditional Australian medicine

Ovine red cell concentrates for transfusion research – is the storage lesion comparable to human red cell concentrates?

Venoarterial extracorporeal membrane oxygenation: A systematic review of selection criteria, outcome measures and definitions of complications

Altered antibiotic pharmacokinetics during extracorporeal membrane oxygenation: cause for concern?

Cardiac Surgery in Indigenous Australians – How Wide is ‘The Gap’?

The effects of the 2009 dust storm on emergency admissions to a hospital in Brisbane, Australia

Lack of agreement for defining ‘clinical suspicion of rejection’ in liver transplantation: a model to select candidates for liver biopsy

Sepsis: Changing Definitions, Unchanging Treatment

Transcriptomic profiling of cardiac tissues from SARS‐CoV‐2 patients identifies DNA damage

Identifying and evaluating functional connectivity for building urban ecological networks

High-flow nasal cannulae for respiratory support in adult intensive care patients

Hemodynamic Response to Exercise and Head‐Up Tilt of Patients Implanted With a Rotary Blood Pump: A Computational Modeling Study

The potential prognostic utility of salivary galectin-3 concentrations in heart failure.

Intraaortic Balloon Pump Counterpulsation and Cerebral Autoregulation: An observational study

Airborne spread of SARS-CoV-2 while using high-flow nasal cannula oxygen therapy: myth or reality?

The Complex Relationship of Extracorporeal Membrane Oxygenation and Acute Kidney Injury: Causation or Association?

The use of tracheostomy speaking valves in mechanically ventilated patients results in improved communication and does not prolong ventilation time in cardiothoracic intensive care unit patients.

Untapped potential in Australian hospitals for organ donation after circulatory death

Collagen in the scarless fetal skin wound: detection with picrosirius-polarization.

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Protocol guided bleeding management improves cardiac surgery patient outcomes

A Starling‐like total work controller for rotary blood pumps: An in vitro evaluation

Intracardiac echocardiography guided transeptal catheter injection of microspheres for assessment of cerebral microcirculation in experimental models.

Evaluation of an intraventricular balloon pump for short‐term support of patients with heart failure

Transcriptomic profiling of cardiac tissues from SARS-CoV-2 patients identifies DNA damage

Stored blood transfusion induces transient pulmonary arterial hypertension without impairing coagulation in an ovine model of nontraumatic haemorrhage.

Inflammation and lung injury in an ovine model of fluid resuscitated endotoxemic shock.

A New Diagnostic Technique for Reliable Decision-Making on Transformer FRA Data in Interturn Short-Circuit Condition

Interleukin-6 inhibitors in non-COVID-19 ARDS: analyzing the past to step into the post-COVID-19 era

Nursing Challenges in Interactions with Patients Receiving Mechanical Circulatory and Respiratory Support

Ventilator-Induced Lung Injury

A New Reconfigured Electricity Market Bidding Strategy in View of Players' Concerns

The ECMO PK Project: an incremental research approach to advance understanding of the pharmacokinetic alterations and improve patient outcomes during extracorporeal membrane oxygenation

Ceftazidime improves hemodynamics and oxygenation in ovine smoke inhalation injury and septic shock

High-throughput assay for simultaneous quantification of the plasma concentrations of morphine, fentanyl, midazolam and their major metabolites using automated SPE coupled to LC–MS/MS

Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues

The effect of ventricular assist devices on cerebral blood flow and blood pressure fractality

Children’s Oxygen Administration Strategies Trial (COAST): A randomised controlled trial of high flow versus oxygen versus control in African children with severe pneumonia

Recombinant human activated protein C attenuates cardiovascular and microcirculatory dysfunction in acute lung injury and septic shock

Transcatheter aortic valve implantation (TAVI): Valve design and evolution

Respiratory support for infants with bronchiolitis, a narrative review of the literature

In-Vitro Evaluation of Cardiac Energetics and Coronary Flow with Volume Displacement and Rotary Blood Pumps

ECMO as a bridge to non-transplant cardiac surgery

IFI27 transcription is an early predictor for COVID-19 outcomes; a multi-cohort observational study

Plasma selenium status in a group of Australian blood donors and fresh blood components.

A 4-arm randomized controlled pilot trial of innovative solutions for jugular central venous access device securement in 221 cardiac surgical patients

Microvascular dysfunction in septic and dengue shock: Pathophysiology and implications for clinical management