Publications by authors named "David Pilcher"
Purpose: Patients with Cardiogenic shock (CS) admitted to intensive care units (ICUs) have high mortality rates. We aimed to investigate the changes patient characteristics and outcomes over time among patients admitted to the ICU with CS.
Methods: Retrospective study utilizing a large bi-national ICU database from 2003 to 2022.
Background: The incidence of silicosis has increased due to occupational silica exposure from artificial stone, with no treatments proven to halt or reverse the disease. Whole lung lavage (WLL) involves the instillation of fluid into the lungs to wash out silica particles and disease-causing inflammatory cells. This study aimed to determine the feasibility, safety, and possible benefit of WLL in patients with artificial stone silicosis.
View Article and Find Full Text PDFObjectives: Persistent critical illness (PerCI) occurs when the patient's prolonged intensive care unit (ICU) stay results in complications that become the primary drivers of their condition, rather than the initial reason for their admission. Patients with frailty have a higher risk of developing and dying from PerCI. We aimed to investigate the interplay of frailty and PerCI in critically ill patients with COVID-19.
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- * A total of 7189 admissions for severe anaphylaxis were analyzed, showing an increase in the percentage of such cases from 0.25% in 2012 to 0.43% in 2022, with very low mortality rates of 0.4% and 0.8% in ICU and hospital settings, respectively.
- * Factors predicting in-hospital mortality included older age, higher SOFA scores, chronic immunosuppressive conditions, and a respiratory rate above 16
Background: Patients with shock treated by emergency medical services (EMS) have high morbidity and mortality. Knowledge of prehospital factors predicting outcomes in patients with shock remains limited. We aimed to describe the prehospital predictors of mortality in patients with non-traumatic shock transported to hospital by EMS.
View Article and Find Full Text PDFEpidemiology of acute hypoxaemic respiratory failure in Australian and New Zealand intensive care units during 2005-2022. A binational, registry-based study.
Intensive Care Med
November 2024
Article Synopsis
- Acute hypoxaemic respiratory failure (AHRF) is a significant cause for ICU admissions, comprising over 52% of patients, with differing mortality rates based on severity.
- A study from 2005 to 2022 revealed that the survival rate has improved overall in ICUs, with in-hospital mortality decreasing from 13.3% to 8.2%, even amidst the high risks associated with severe AHRF.
- Researchers emphasize the need for better identification of AHRF patients to manage and reduce the risk of deterioration effectively, as the healthcare impact of AHRF may be larger than previously understood.
Article Synopsis
- Organ transplantation in Australia relies heavily on deceased donors, with Indigenous Australians participating in organ donation at two-thirds the rate of non-Indigenous Australians.
- A study focused on the experiences of Indigenous people revealed key barriers to organ donation, including cultural taboos, discomfort in discussions, inadequate education, and distrust in the healthcare system.
- Recommendations include improving cultural competence among clinicians and providing targeted, community-based education about organ donation before individuals face critical health situations.
Article Synopsis
- The study explored the effects of conservative versus liberal oxygen strategies on patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the ICU, aiming to find a balance between avoiding hyperoxia and preventing hypoxia.
- A total of 300 patients were randomly assigned to either conservative (target SaO 92-96%) or liberal oxygen (target SaO 97-100%), but both groups showed similar outcomes in ICU-free days and mortality rates at days 28 and 60.
- The conservative group had significantly more major protocol deviations compared to the liberal group, but overall, the two oxygen strategies did not differ in their impact on patient recovery in the ICU.
Purpose: Perioperative in-hospital cardiac arrests (Perioperative IHCAs) may have better outcomes than IHCAs in the ward (Ward IHCAs), due to enhanced monitoring and faster response. However, quantitative comparisons of their long-term outcomes are lacking, posing challenges for prognostication.
Methods: This retrospective multicentre study included adult intensive care unit (ICU) admissions from theatre/recovery or wards with a diagnosis of cardiac arrest between January 2018 and March 2022.
Over 10 million ED visits occur each year across Australia and Aotearoa New Zealand. Outside basic administrative data focused on time-based targets, there is minimal information about clinical performance, quality of care, patient outcomes, or equity in emergency care. The lack of a timely, accurate or clinically useful data collection represents a missed opportunity to improve the care we deliver each day.
View Article and Find Full Text PDFObjective: This article aims to examine the impact of nursing workforce skill-mix (percentage of critical care registered nurses [CCRN]) in the intensive care unit (ICU) during a patient's stay.
Design: Registry linked cohort study of the Australian and New Zealand Intensive Care Society Adult Patient Database and the Critical Health Resources Information System using real-time nursing workforce data.
Settings: Fifteen public and 5 private hospital ICUs in Victoria, Australia.
Objectives: To compare in-hospital mortality and intensive care unit (ICU) length of stay for people admitted to Australian and New Zealand ICUs during 2022-23 with coronavirus disease 2019 (COVID-19) pneumonitis, incidental or exacerbating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, or without SAR-CoV-2 infections.
Study Design: Retrospective cohort study; analysis of Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database data.
Setting, Participants: Adults (16 years or older) admitted to participating ICUs in Australia or New Zealand, 1 January 2022 - 30 June 2023.
Introduction: Acute kidney injury (AKI) requiring treatment with renal replacement therapy (RRT) is a common complication after admission to an intensive care unit (ICU) and is associated with significant morbidity and mortality. However, the prevalence of RRT use and the associated outcomes in critically patients across the globe are not well described. Therefore, we describe the epidemiology and outcomes of patients receiving RRT for AKI in ICUs across several large health system jurisdictions.
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- Neutropenic sepsis often leads to ICU admissions, and there's a need to understand differences among patients based on their cancer diagnosis.
- A study analyzed ICU admissions over 22 years in Australia and New Zealand, finding distinct differences in age, comorbidities, and outcomes among patients with hematological malignancies, metastatic solid cancers, or no cancer.
- Results showed that patients with hematological malignancies had the lowest mortality and comorbidities, while those without cancer had the highest rates of mechanical ventilation and death, indicating a need for tailored treatment strategies for these groups.
Background: In-hospital cardiac arrest (IHCA) is a serious medical emergency. When IHCA occurs in patients with frailty, short-term survival is poor. However, the impact of frailty on long-term survival is unknown.
View Article and Find Full Text PDFBackground: Sepsis occurs in 12-27% of patients with haematological malignancy within a year of diagnosis. Sepsis mortality has improved in non-cancer patients in the last two decades, but longitudinal trends in patients with haematological malignancy are not well characterised. We aimed to compare outcomes, including temporal changes, in patients with and without a haematological malignancy admitted to ICU with a primary diagnosis of sepsis in Australia and New Zealand over the past two decades.
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- The text indicates that there is a correction to a previously published article.
- The article is identified by its Digital Object Identifier (DOI): 10.1016/j.ccrj.2023.06.001.
- The correction aims to address inaccuracies or mistakes in the original publication.
Article Synopsis
- A study was conducted to explore how frailty affects long-term survival in patients who were admitted to the ICU due to COVID-19, focusing on those discharged alive.
- Researchers analyzed data from 4028 patients across 118 ICUs in New Zealand and Australia, categorizing them based on their frailty levels using the Clinical Frailty Scale (CFS).
- The results indicated that both mildly frail and moderately-to-severely frail patients had significantly higher mortality rates within two years post-discharge compared to those who were not frail, highlighting the importance of recognizing frailty in ICU care.
Objectives: We aimed to assess the healthcare costs and impact on the economy at large arising from emergency medical services (EMS) treated non-traumatic shock.
Design: We conducted a population-based cohort study, where EMS-treated patients were individually linked to hospital-wide and state-wide administrative datasets. Direct healthcare costs (Australian dollars, AUD) were estimated for each element of care using a casemix funding method.