DSpace Community:https://hdl.handle.net/2440/58682024-03-18T16:08:01Z2024-03-18T16:08:01ZLopinavir-ritonavir and hydroxychloroquine for critically ill patients with COVID-19: REMAP-CAP randomized controlled trialArabi, Y.M.Gordon, A.C.Derde, L.P.G.Nichol, A.D.Murthy, S.Beidh, F.A.Annane, D.Swaidan, L.A.Beane, A.Beasley, R.Berry, L.R.Bhimani, Z.Bonten, M.J.M.Bradbury, C.A.Brunkhorst, F.M.Buxton, M.Buzgau, A.Cheng, A.De Jong, M.Detry, M.A.et al.https://hdl.handle.net/2440/1353102023-11-19T19:53:29Z2021-01-01T00:00:00ZTitle: Lopinavir-ritonavir and hydroxychloroquine for critically ill patients with COVID-19: REMAP-CAP randomized controlled trial
Author: Arabi, Y.M.; Gordon, A.C.; Derde, L.P.G.; Nichol, A.D.; Murthy, S.; Beidh, F.A.; Annane, D.; Swaidan, L.A.; Beane, A.; Beasley, R.; Berry, L.R.; Bhimani, Z.; Bonten, M.J.M.; Bradbury, C.A.; Brunkhorst, F.M.; Buxton, M.; Buzgau, A.; Cheng, A.; De Jong, M.; Detry, M.A.; et al.
Abstract: Purpose: To study the efficacy of lopinavir-ritonavir and hydroxychloroquine in critically ill patients with coronavirus disease 2019 (COVID-19). Methods: Critically ill adults with COVID-19 were randomized to receive lopinavir-ritonavir, hydroxychloroquine, combination therapy of lopinavir-ritonavir and hydroxychloroquine or no antiviral therapy (control). The primary endpoint was an ordinal scale of organ support-free days. Analyses used a Bayesian cumulative logistic model and expressed treatment effects as an adjusted odds ratio (OR) where an OR > 1 is favorable. Results: We randomized 694 patients to receive lopinavir-ritonavir (n = 255), hydroxychloroquine (n = 50), combination therapy (n = 27) or control (n = 362). The median organ support-free days among patients in lopinavir-ritonavir, hydroxychloroquine, and combination therapy groups was 4 (– 1 to 15), 0 (– 1 to 9) and—1 (– 1 to 7), respectively, compared to 6 (– 1 to 16) in the control group with in-hospital mortality of 88/249 (35%), 17/49 (35%), 13/26 (50%), respectively, compared to 106/353 (30%) in the control group. The three interventions decreased organ supportfree days compared to control (OR [95% credible interval]: 0.73 [0.55, 0.99], 0.57 [0.35, 0.83] 0.41 [0.24, 0.72]), yielding posterior probabilities that reached the threshold futility (≥ 99.0%), and high probabilities of harm (98.0%, 99.9% and > 99.9%, respectively). The three interventions reduced hospital survival compared with control (OR [95% CrI]: 0.65 [0.45, 0.95], 0.56 [0.30, 0.89], and 0.36 [0.17, 0.73]), yielding high probabilities of harm (98.5% and 99.4% and 99.8%, respectively). Conclusion: Among critically ill patients with COVID-19, lopinavir-ritonavir, hydroxychloroquine, or combination therapy worsened outcomes compared to no antiviral therapy.2021-01-01T00:00:00ZHospital variability of postoperative sepsis and sepsis-related mortality after elective coronary artery bypass grafting surgeryOu, L.Chen, J.Flabouris, A.Hillman, K.Parr, M.Bellomo, R.https://hdl.handle.net/2440/1148832023-11-19T06:21:36Z2018-01-01T00:00:00ZTitle: Hospital variability of postoperative sepsis and sepsis-related mortality after elective coronary artery bypass grafting surgery
Author: Ou, L.; Chen, J.; Flabouris, A.; Hillman, K.; Parr, M.; Bellomo, R.
Abstract: <h4>Purpose</h4>Hospital variability of postoperative sepsis and sepsis-related mortality after elective CABG surgery was not known in Australia.<h4>Material and methods</h4>Population-based analysis of all elective patients who underwent CABG surgery in public and private hospitals between 2007 and 2014 using linked data from the state-wide Admitted Patient Data Collection and the NSW Registry of Births, Deaths, and Marriages.<h4>Results</h4>We identified 18,928 (9464 pairs) matched patients who had elective CABG surgery in public hospitals (n = 9) and private hospitals (n = 13) during the study period. When compared to public hospital patients, private hospital patients had a significantly lower rate of post-CABG sepsis (13.3 vs 20.4 per 1000 admissions, P < 0.001; treatment effects: -7.1, 95%CI: -11.1 to -3.3), a lower in-hospital mortality rate (6.1 vs 9.9 per 1000 admissions, P = 0.006; treatment effects: -3.8, 95%CI: -6.5 to -1.1), and a lower rate of 30-day readmission (11.9% vs 13.9%, P < 0.001; treatment effects: -2.0%, 95%CI: -3.1% to -1.0%). In addition, for both public and private hospital groups, there were significant differences for all outcomes when comparing the worst and best performance quintile hospitals.<h4>Conclusions</h4>Hospital variability of postoperative sepsis, in-hospital mortality and readmission after elective CABG existed between and within public and private hospitals.2018-01-01T00:00:00ZCritical illness is associated with impaired gallbladder emptying as assessed by 3D ultrasoundPlummer, M.Kar, P.Cousins, C.Hausken, T.Lange, K.Chapman, M.Jones, K.Horowitz, M.Deane, A.https://hdl.handle.net/2440/1092532023-11-19T12:26:26Z2016-01-01T00:00:00ZTitle: Critical illness is associated with impaired gallbladder emptying as assessed by 3D ultrasound
Author: Plummer, M.; Kar, P.; Cousins, C.; Hausken, T.; Lange, K.; Chapman, M.; Jones, K.; Horowitz, M.; Deane, A.
Abstract: Objective: To quantify gallbladder dysfunction during critical illness. Design: Prospective observational comparison study of nutrient-stimulated gallbladder emptying in health and critical illness. Setting: Single-centre mixed medical/surgical ICU. Patients: Twenty-four mechanically ventilated critically ill patients suitable to receive enteral nutrition were compared with 12 healthy subjects. Interventions: Participants were studied after an 8-hour fast. Between 0 and 120 minutes, high-fat nutrient (20% intralipid) was infused via a postpyloric catheter into the duodenum at 2 kcal/min. Measurements and Main Results: Three-dimensional images of the gallbladder were acquired at 30-minute intervals from -30 to 180 minutes. Ejection fraction (%) was calculated as changes between 0 and 120 minutes. Blood samples were obtained at 30-minute intervals for plasma cholecystokinin. Data are mean (SD) or median [interquartile range]. In the critically ill, fasting gallbladder volumes (critically ill, 61 mL [36-100 mL] vs healthy, 22 mL [15-25] mL; p < 0.001] and wall thickness (0.45 mm [0.15 mm] vs 0.26 mm [0.08 mm]; p < 0.001] were substantially greater, and sludge was evident in the majority of patients (71% vs 0%). Nutrient-stimulated emptying was incomplete in the critically ill after 120 minutes but was essentially complete in the healthy individuals (22 mL [9-66 mL] vs 4 mL [3-5 mL]; p < 0.01]. In five critically ill patients (21%), there was no change in gallbladder volume in response to nutrient, and overall ejection fraction was reduced in the critically ill (50% [8-83%] vs 77 [72-84%]; p = 0.01]. There were no differences in fasting or incremental cholecystokinin concentrations. Conclusions: Fasted critically ill patients have larger, thicker-walled gallbladders than healthy subjects and nutrient-stimulated gallbladder emptying is impaired with "gallbladder paresis" occurring in approximately 20%.2016-01-01T00:00:00ZThe timing of discharge from the Intensive Care Unit and subsequent mortality: a prospective, multicenter studySantamaria, J.Duke, G.Pilcher, D.Cooper, D.Moran, J.Bellomo, R.https://hdl.handle.net/2440/1065912023-11-19T12:59:25Z2015-01-01T00:00:00ZTitle: The timing of discharge from the Intensive Care Unit and subsequent mortality: a prospective, multicenter study
Author: Santamaria, J.; Duke, G.; Pilcher, D.; Cooper, D.; Moran, J.; Bellomo, R.
Abstract: Rationale: Previous studies suggested an association between after-hours intensive care unit (ICU) discharge and increased hospital mortality. Their retrospective design and lack of correction for patient factors present at the time of discharge make this association problematic. Objectives: To determine factors independently associated with mortality after ICU discharge. Methods: This was a prospective, multicenter, binational observational study involving 40 ICUs in Australia and New Zealand. Participants were consecutive adult patients discharged alive from the ICU between September 2009 and February 2010. Measurements and Main Results: We studied 10,211 patients discharged alive from the ICU. Median age was 63 years (interquartile range, 49-74), 6,224 (61%) were male, 5,707 (56%) required mechanical ventilation, and their median Acute Physiology and Chronic Health Evaluation III risk of death was 9% (interquartile range, 3-25%). A total of 8,539 (83.6%) patients were discharged in-hours (06:00-18:00) and 1,672 (16.4%) after-hours (18:00-06:00). Of these, 408 (4.8%) and 124 (7.4%), respectively, subsequently died in hospital (P < 0.001). After risk adjustment for markers of illness severity at time of ICU discharge including limitations of medical therapy (LOMT) orders, the time of discharge was no longer a significant predictor of mortality. The presence of a LOMT order was the strongest predictor of death (odds ratio, 35.4; 95% confidence interval, 27.5-45.6). CONCLUSIONS: In this large, prospective, multicenter, binational observational study, we found that patient status at ICU discharge, particularly the presence of LOMT orders, was the chief predictor of hospital survival. In contrast to previous studies, the timing of discharge did not have an independent association with mortality.2015-01-01T00:00:00Z