Publications by authors named "Matt P Wise"
Objectives: Randomized clinical trials informing clinical practice (e.g., like large, pragmatic, and late-phase trials) should ideally mostly use harmonized outcomes that are important to patients, family members, clinicians, and researchers.
View Article and Find Full Text PDFPurpose: Hyperoxemia is common in patients resuscitated after out-of-hospital cardiac arrest (OHCA) admitted to the intensive care unit (ICU) and may increase the risk of mortality. However, the effect of hyperoxemia on functional outcome, specifically related to the timing of exposure to hyperoxemia, remains unclear.
Methods: The secondary analysis of the Target Temperature Management 2 (TTM-2) randomized trial.
Background: The aim of this study was to assess whether hypothermia increased survival and improved functional outcome when compared with normothermia in out-of-hospital cardiac arrest (OHCA) patients with similar characteristics than in previous randomized studies showing benefits for hypothermia.
Methods: Post hoc analysis of a pragmatic, multicenter, randomized clinical trial (TTM-2, NCT02908308). In this analysis, the subset of patients included in the trial who had similar characteristics to patients included in one previous randomized trial and randomized to hypothermia at 33 °C or normothermia (i.
Article Synopsis
- Airway management is vital in treating out-of-hospital cardiac arrest (OHCA), focusing on whether tracheal intubation (TI) or supraglottic airway devices (SGA) lead to better patient outcomes.
- A secondary analysis of the TTM2 trial included 1702 adult OHCA patients and found that most (71.6%) received TI, while 28.4% were managed with SGA.
- Results indicated that the type of airway management did not significantly affect outcomes like ventilator-free days, neurological status, or mortality rates after 26 days.
Article Synopsis
- The study aimed to use standardized and automated CT assessments to predict outcomes for patients who suffered out-of-hospital cardiac arrest.
- Involving 140 unconscious patients, results showed that while qualitative assessments and various gray-white-matter ratio (GWR) models achieved 100% specificity in predicting poor outcomes, sensitivity rates varied, with automated GWR proving robust.
- The research concluded that these CT assessment methods could reliably indicate poor functional outcomes, and automated GWR could enhance accessibility for medical centers handling cardiac arrest cases.
Background: Enteral nutrition may affect risks of gastrointestinal bleeding, pneumonia and mortality in critically ill patients and may also modify the effects of pharmacological stress ulcer prophylaxis. We undertook post hoc analyses of the stress ulcer prophylaxis in the intensive care unit trial to assess for any associations and interactions between enteral nutrition and pantoprazole.
Methods: Extended Cox models with time-varying co-variates and competing events were used to assess potential associations, adjusted for baseline severity of illness.
Introduction: An association between deep sedation and adverse short-term outcomes has been demonstrated although this evidence has been inconsistent. The A2B (alpha-2 agonists for sedation in critical care) sedation trial is designed to determine whether the alpha-2 agonists clonidine and dexmedetomidine, compared with usual care, are clinically and cost-effective. The A2B intervention is a complex intervention conducted in 39 intensive care units (ICUs) in the UK.
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- International guidelines suggest keeping body temperature below 37.8 °C for unconscious patients after out-of-hospital cardiac arrest (OHCA), but targeting 33 °C may yield better results for patients with a nonshockable rhythm.
- The study aimed to determine if inducing hypothermia at 33 °C leads to higher survival rates and better functional outcomes compared to maintaining normal body temperature (normothermia).
- Data was gathered from two clinical trials involving unconscious OHCA patients with nonshockable rhythms, comparing those treated with hypothermia versus normothermia for a minimum of 24 hours, analyzing various factors influencing outcomes.*
Introduction: Almost all patients receiving mechanical ventilation (MV) in intensive care units (ICUs) require analgesia and sedation. The most widely used sedative drug is propofol, but there is uncertainty whether alpha2-agonists are superior. The alpha 2 agonists for sedation to produce better outcomes from critical illness (A2B) trial aims to determine whether clonidine or dexmedetomidine (or both) are clinically and cost-effective in MV ICU patients compared with usual care.
View Article and Find Full Text PDFBackground: Invasive pulmonary aspergillosis is a complication of severe COVID-19, with regional variation in reported incidence and mortality. We describe the incidence, risk factors and mortality associated with COVID-19-associated pulmonary aspergillosis (CAPA) in a prospective, multicentre UK cohort.
Methods: From March 2020 to March 2021, 266 mechanically ventilated adults with COVID-19 were enrolled across 5 UK hospital intensive care units (ICUs).
Background And Aims: Several different scoring systems for early risk stratification after out-of-hospital cardiac arrest have been developed, but few have been validated in large datasets. The aim of the present study was to compare the well-validated Out-of-hospital Cardiac Arrest (OHCA) and Cardiac Arrest Hospital Prognosis (CAHP)-scores to the less complex MIRACLE2- and Target Temperature Management (TTM)-scores.
Methods: This was a post-hoc analysis of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial.
Article Synopsis
- The TTM2 trial found no significant difference in mortality or poor functional outcomes between targeted hypothermia and targeted normothermia 6 months after out-of-hospital cardiac arrest (OHCA).
- A detailed analysis aimed to assess brain dysfunction and cognitive function in survivors, focusing on societal participation after OHCA.
- This study involved 1861 comatose adults across 61 hospitals in 14 countries, with follow-up conducted by masked assessors showing no differences in functional outcomes between the two temperature control methods.
Article Synopsis
- Guidelines suggest maintaining normal carbon dioxide levels for adults in a coma resuscitated from cardiac arrest, but mild higher levels may help increase brain blood flow and improve outcomes.
- In a study involving 1,700 patients, participants were randomly assigned to either mild hypercapnia or normocapnia for 24 hours and were assessed 6 months later for neurologic recovery.
- Results showed no significant difference in favorable neurological outcomes or mortality between the two groups, indicating that mild hypercapnia did not improve recovery compared to normal levels.
Article Synopsis
- The study investigates if blood levels of phosphorylated tau (p-tau) and amyloid-β peptides (Aβ) can serve as biomarkers for predicting neurological outcomes in patients who have experienced cardiac arrest.
- Researchers conducted a clinical biobank study involving 717 unconscious cardiac arrest patients, comparing blood biomarker levels taken at different times after the event with neural injury markers.
- Results from this study could help distinguish between patients with good and poor neurological outcomes, potentially aiding in more effective prognostication after cardiac arrest.
Critically ill patients are at risk of gastrointestinal (GI) bleeding. Counter measures to minimise this risk include the use of pharmacological stress ulcer prophylaxis (SUP). The effect of enteral nutrition as SUP on GI bleeding event rates is unknown.
View Article and Find Full Text PDFBackground/aim: Signs of hypoxic ischaemic encephalopathy (HIE) on head computed tomography (CT) predicts poor neurological outcome after cardiac arrest. We explore whether levels of brain injury markers in blood could predict the likelihood of HIE on CT.
Methods: Retrospective analysis of CT performed at 24-168 h post cardiac arrest on clinical indication within the Target Temperature Management after out-of-hospital cardiac arrest-trial.
Article Synopsis
- The study investigates the link between mechanical ventilation indices and pulmonary artery pressures in ARDS patients, recognizing the potential impact of mechanical ventilation on lung injury.
- A post hoc analysis of the FACTT trial was conducted to analyze ARDS patients with pulmonary artery catheters, using various statistical methods to evaluate correlations and associations.
- Findings indicated that most ventilation parameters correlated with mean pulmonary artery pressure, with specific blood gas levels and airway pressure emerging as significant factors influencing these associations.
Article Synopsis
- Targeted temperature management (TTM) after cardiac arrest was studied to see if a lower temperature (33 °C) versus normal temperature (normothermia) leads to better outcomes, particularly based on how quickly the target temperature is reached.
- In a post-hoc analysis of the TTM-2 trial involving 1592 patients, there was no significant difference in mortality or functional outcomes between those who achieved hypothermia fastest and those who remained at normothermia.
- The study concluded that the time taken to reach hypothermia does not significantly affect the effectiveness of TTM of 33 °C compared to maintaining normothermia and treating fever.
BACKGROUND: The evidence for temperature control for comatose survivors of cardiac arrest is inconclusive. Controversy exists as to whether the effects of hypothermia differ per the circumstances of the cardiac arrest or patient characteristics. METHODS: An individual patient data meta-analysis of the Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest (TTM) and Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trials was conducted.
View Article and Find Full Text PDFThe SPICE III (Sedation Practice in Intensive Care Evaluation) trial reported significant heterogeneity in mortality with dexmedetomidine treatment. Supplemental propofol was commonly used to achieve desirable sedation. To quantify the association of different infusion rates of dexmedetomidine and propofol, given in combination, with mortality and to determine if this is modified by age.
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- Survivors of out-of-hospital cardiac arrest (OHCA) often report good overall health but experience significant limitations in physical function six months post-event compared to STEMI controls.
- A study compared physical function in 287 OHCA survivors with 119 matched STEMI controls using a self-reported scale, revealing noticeably lower scores in OHCA survivors.
- Key factors linked to these physical limitations included older age, being female, cognitive issues, and symptoms of anxiety and depression.
Background: Targeted temperature management at 33 °C (TTM33) has been employed in effort to mitigate brain injury in unconscious survivors of out-of-hospital cardiac arrest (OHCA). Current guidelines recommend prevention of fever, not excluding TTM33. The main objective of this study was to investigate if TTM33 is associated with mortality in patients with vasopressor support on admission after OHCA.
View Article and Find Full Text PDFTraumatic brain injury (TBI) is a major cause of mortality and morbidity worldwide. There are currently no early biomarkers for prognosis in routine clinical use. Interleukin-6 (IL-6) is a potential biomarker in the context of the established role of neuroinflammation in TBI recovery.
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- Scientists are studying blood markers that can help doctors understand how serious a brain injury is after someone has a cardiac arrest (when the heart stops).
- They are doing tests to find out which blood marker is the best at predicting how well a person will recover after six months.
- The goal is to set clear rules for doctors to follow so they can use these markers in everyday medical care to help patients better.
Background: SARS-CoV-2 infection can lead to severe acute respiratory distress syndrome needing intensive care admission and may lead to death. As a virus that transmits by respiratory droplets and aerosols, determining the duration of viable virus shedding from the respiratory tract is critical for patient prognosis, and informs infection-control measures both within healthcare settings and the public domain.
Methods: We prospectively examined upper and lower airway respiratory secretions for both viral RNA and infectious virions in mechanically ventilated patients admitted to the intensive care unit (ICU) of the University Hospital of Wales.