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Background: Patients in the intensive care unit (ICU) frequently develop hyperactive delirium, which may be accompanied by behaviour that increases clinical risks to themselves as well as other patients and staff. There is a paucity of evidence to inform the urgent enteral administration of antipsychotic drugs to treat such hyperactive delirium and behavioural disturbances.

Objective: The aim of this study is to test the efficacy and safety of administering enteral olanzapine when compared to quetiapine in critically ill patients with hyperactive delirium.

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Objective: To assess current evidence regarding guanfacine use in hospitalized patients with delirium.

Introduction: Delirium is a common and important complication of critical illness. Central alpha-2 agonists are often used for symptomatic management.

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Objective: Extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes.

Design Setting And Participants: This is a registry-embedded observational cohort study.

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Background: Severe intensive care unit-acquired hypernatraemia (ICU-AH) is a serious complication of critical illness. However, there is no detailed information on how this condition develops.

Objectives: The objective of this study was to study the prevalence, risk factors, trajectory, management, and outcome of severe ICU-AH (≥155 mmol·L).

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Objective: The optimal timing of vasopressin initiation as an adjunctive vasopressor remains unclear. We aimed to study the association between the timing of vasopressin commencement, pre-specified physiological parameters, and hospital mortality.

Design: We conducted a multicentre, retrospective, observational study.

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Objective: Knowledge of intensive care unit (ICU) acquired hypernatremia (ICU-AH) has been hampered by the absence of granular data and confounded by variable definitions and inclusion criteria.

Design: Multicentre retrospective cohort study.

Setting: Twelve ICUs in Queensland (QLD), Australia.

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Background: Panitumumab (pan) plus chemotherapy is a preferred first-line therapy for unresectable RAS and BRAF wild type metastatic colorectal cancer (mCRC). Older patients may not be suitable for combination regimens. We investigated 2 lower intensity pan-containing regimens.

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The Psychometric Properties of the EuroQol 5D Five Level in Survivors of Critical Illness.

Crit Care Med

January 2025

Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

Objectives: The EuroQol 5D five level (EQ-5D-5L) instrument is a standardized measure of health-related quality of life and is routinely used in survivors of critical illness. However, information on its psychometric properties and minimal clinically important difference (MCID) in this patient group is lacking.

Design: Secondary analysis of data from the previously published PREDICT (a registry in critically ill patients to determine predictors of disability-free survival) study, a prospective, multicenter cohort study.

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Systematic review and meta-analysis of the treatment of hypernatremia in adult hospitalized patients: impact on mortality, morbidity, and treatment-related side effects.

J Crit Care

January 2025

Department of Critical Care, School of Medicine, University of Melbourne, Parkville, Victoria, Australia; Department of Intensive Care, Royal Melbourne Hospital, Parkville, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; Data Analytics Research and Evaluation, Austin Hospital, Melbourne, Australia. Electronic address:

Background: Hypernatremia is relatively common in acutely ill patients and associated with mortality. Guidelines recommend a slow rate of correction (≤ 0.5 mmol/L per hour).

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Adenoid cystic carcinoma (AdCC) of the breast is a rare histological subtype of breast cancer, which usually has a low propensity for metastasis and is associated with a good prognosis. AdCC metastasis to the kidney is rare, with only 29 cases reported in the literature. We report a case of a woman in her 60s with multiple right-sided large cystic-solid renal lesions after a recent diagnosis of marginal zone B-cell lymphoma.

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GIM/FP/GP: [Formula: see text] Allerg & Immunol: [Formula: see text] Pulmonology: [Formula: see text].

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Impact of mild hypercapnia on renal function after out-of-hospital cardiac arrest.

Resuscitation

December 2024

Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Heidelberg, Australia; Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia.

Article Synopsis
  • Acute kidney injury (AKI) is a common and serious problem following out-of-hospital cardiac arrest (OHCA), particularly influenced by post-resuscitation cardiogenic shock (CS).
  • A study compared two groups of patients—those receiving targeted mild hypercapnia and those receiving targeted normocapnia—to see if higher carbon dioxide tension impacted AKI rates and other outcomes.
  • Results showed that approximately 72.1% of patients developed AKI regardless of treatment, with CS significantly increasing the likelihood of AKI, but carbon dioxide levels did not alter this relationship.
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Non-adrenergic vasopressors for vasodilatory shock or perioperative vasoplegia: a meta-analysis of randomized controlled trials.

Crit Care

December 2024

Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

Background: Excessive exposure to adrenergic vasopressors may be harmful. Non-adrenergic vasopressors may spare adrenergic agents and potentially improve outcomes. We aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of non-adrenergic vasopressors in adult patients receiving vasopressor therapy for vasodilatory shock or perioperative vasoplegia.

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Article Synopsis
  • This study analyzed the effects of botulinum toxin-A on upper limb issues in chronic stroke survivors, focusing on those with significant spasticity.
  • The research involved 71 stroke survivors and measured changes in various outcomes, including upper limb activity, spasticity, and grip strength, before and three months after treatment.
  • Results showed no significant improvement in any of the measured outcomes, indicating that botulinum toxin-A may not be beneficial for improving upper limb function in this patient group with severe activity limitations.
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Objectification theory posits that self-objectification can lead to disordered eating, with significant positive correlations between self-objectification and eating disorder (ED) psychopathology found in women in both clinical and non-clinical samples. Maladaptive rumination is another process frequently associated with EDs, but its relationship with self-objectification and ED psychopathology needs further investigation. Our aim was to conduct a preliminary test to investigate whether maladaptive rumination mediated the relationship between self-objectification and ED psychopathology in women.

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Objective: We have shown that men aged 50 years+ at high risk of type 2 diabetes treated with testosterone together with a lifestyle program reduced the risk of type 2 diabetes at 2 years by 40% compared to a lifestyle program alone. To develop a personalized approach to treatment, we aimed to explore a prognostic model for incident type 2 diabetes at 2 years and investigate biomarkers predictive of the testosterone effect.

Design: Model development in 783 men with impaired glucose tolerance but not type 2 diabetes from Testosterone for Prevention of Type 2 Diabetes; a multicenter, 2-year trial of Testosterone vs placebo.

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The Perioperative NonaGEnaRIan And cenTenarian suRgICal (GERIATRIC) Risk Stratification Tool.

Ann Surg Open

December 2024

Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, Faculty of Medicine, The University of Melbourne; Melbourne, Australia.

Objective: To develop age-appropriate nonaGEnaRIan And cenTenarian suRgICal (GERIATRIC) risk tool for classifying patients who may or may not develop postoperative complications or die within their index hospital admission.

Background: There are no validated perioperative risk stratification tools for use in nonagenarian and centenarian patients-people aged 90 to 99 years and >100 years.

Methods: In this retrospective observational study, nonagenarians and centenarians undergoing any surgical procedure were profiled.

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Background: Patients receiving intraoperative ventilation during general anesthesia often have low end-tidal CO (etCO). We examined the association of intraoperative etCO levels with the occurrence of postoperative pulmonary complications (PPCs) in a conveniently-sized international, prospective study named 'Local ASsessment of Ventilatory management during General Anesthesia for Surgery' (LAS VEGAS).

Methods: Patients at high risk of PPCs were categorized as 'low etCO' or 'normal to high etCO' patients, using a cut-off of 35 mmHg.

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Background: In the PROTECTION trial, intravenous amino acids (AA) decreased the occurrence of acute kidney injury (AKI) in cardiac surgery patients with cardiopulmonary bypass (CPB). Recruitment of renal functional reserve may be responsible for such protection. However, patients with chronic kidney disease (CKD) have diminished renal functional reserve, and AA may be less protective in such patients.

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Win Ratio approach for the composite outcome of postoperative pulmonary complications: Secondary analysis of a harmonised and pooled database of three randomised clinical trials.

Eur J Anaesthesiol

December 2024

From the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University (ASN), Department of Intensive Care Austin Hospital, Melbourne, Australia (ASN), Department of Critical Care Medicine, Hospital Israelita Albert Einstein (ASN, NSC), Pulmonary Division, Cardio-Pulmonary Department, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidad de de Sao Paulo, Sao Paulo, Brazil (ASN), Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (TB, MgdA), Department of Anaesthesiology The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (SNTH), Department of Anesthesiology Amsterdam University Medical Centers, location 'AMC', Amsterdam, the Netherlands (SNTH), Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Institut D'investigació August Pi i Sunyer, Barcelona (CF), CIBER (Center of Biomedical Research in Respiratory Diseases), Instituto de Salud Carlos III, Madrid (CF), Navarrabiomed-Fundación Miguel Servet, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona (JL), Anesthesia and Critical Care Department, Hospital IMED Valencia, Valencia, Spain (MS), IRCCS San Martino Policlinico Hospital (LB), Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy (LB), Department of Anesthesiology and Pain Medicine, Hospital Universitario y Politécnico la Fe (GM), Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe (GM), Department of Statistics and Operational Research, Universidad de Valencia, Valencia, Spain (GM), Division of Intensive Care and Resuscitation, Outcomes Research Consortium, Division of Cardiothoracic Anesthesia, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, Ohio, USA (MGdA), Department of Intensive Care, Amsterdam University Medical Centers, location 'AMC', Amsterdam, the Netherlands (MS), Mahidol University, Bangkok, Thailand (MS), Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (MS) and Nuffield Department of Medicine, University of Oxford, Oxford, UK (MS).

Background: The win ratio analysis method might provide new insight on the impact of positive end-expiratory pressure (PEEP) on clinical outcomes.

Objective: The aim is to re-analyse the results of the 'Re-evaluation of the effects of high PEEP with recruitment manoeuvres vs. low PEEP without recruitment manoeuvres during general anaesthesia for surgery' (REPEAT) study using the win ratio analysis.

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Furosemide with adjunctive acetazolamide vs furosemide only in critically ill patients: A pilot two-center randomized controlled trial.

J Crit Care

December 2024

Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.

Purpose: Furosemide is the most commonly used diuretic in intensive care units (ICU). We aimed to evaluate the physiological effects of adjunctive acetazolamide with furosemide on diuresis and the prevention of potential furosemide-induced metabolic alkalosis.

Materials And Methods: We performed a two-center, pilot, open-label, randomized trial.

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A four-dimensional phase-contrast magnetic resonance imaging sequence with respiratory-controlled adaptive k-space reordering (ReCAR-4DPC) offers potential benefits of improved scan efficiency and motion robustness. The purpose of this study was to evaluate the reproducibility of flow measurement using this technique and to compare hemodynamic metrics obtained to two-dimensional phase contrast MRI (2DPC)-derived metrics of the thoracic aorta. ReCAR-4DPC was performed with identical scan parameters in 15 healthy volunteers (6M,9F, mean [range] 37 [23-47] years) and 11 patients with thoracic aortic dissection (6M,5F, 56 [31-81] years) and acquisition time was recorded.

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