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1. Assessment of Clinical Sepsis Subtypes and Individualized Treatment Effects in a Multicenter Trial of Early Goal Directed Therapy

Author

Shah, F.A., primary, Talisa, V.B., additional, Kennedy, J.N., additional, Chang, C.-C.H., additional, Triantafyllou, S., additional, Tang, L., additional, Mayr, F.B., additional, Higgins, A.M., additional, Peake, S., additional, Mouncey, P., additional, Harrison, D., additional, Cooper, G.F., additional, Bellomo, R., additional, Rowan, K.M., additional, Yealy, D.M., additional, Angus, D.C., additional, Seymour, C.W., additional, and Yende, S., additional

Published
2024
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4. Long-term (180-day) outcomes in critically ill patients with COVID-19 in the REMAP-CAP randomized clinical trial

Author

Florescu, S, Stanciu, D, Zaharia, M, Kosa, A, Codreanu, D, Kidwai, A, Masood, S, Kaye, C, Coutts, A, MacKay, L, Summers, C, Polgarova, P, Farahi, N, Fox, E, McWilliam, S, Hawcutt, D, Rad, L, O’Malley, L, Whitbread, J, Jones, D, Dore, R, Saunderson, P, Kelsall, O, Cowley, N, Wild, L, Thrush, J, Wood, H, Austin, K, Bélteczki, J, Magyar, I, Fazekas, Á, Kovács, S, Szőke, V, Donnelly, A, Kelly, M, Smyth, N, O’Kane, S, McClintock, D, Warnock, M, Campbell, R, McCallion, E, Azaiz, A, Charron, C, Godement, M, Geri, G, Vieillard-Baron, A, Johnson, P, McKenna, S, Hanley, J, Currie, A, Allen, B, McGoldrick, C, McMaster, M, Mani, A, Mathew, M, Kandeepan, R, Vignesh, C, TV, B, Ramakrishnan, N, James, A, Elvira, E, Jayakumar, D, Pratheema, R, Babu, S, Ebenezer, R, Krishnaoorthy, S, Ranganathan, L, Ganesan, M, Shree, M, Guilder, E, Butler, M, Cowdrey, K-A, Robertson, M, Ali, F, McMahon, E, Duffy, E, Chen, Y, Simmonds, C, McConnochie, R, O’Connor, C, El-Khawas, K, Richardson, A, Hill, D, Commons, R, Abdelkharim, H, Saxena, M, Muteithia, M, Dobell-Brown, K, Jha, R, Kalogirou, M, Ellis, C, Krishnamurthy, V, O’Connor, A, Thurairatnam, S, Mukherjee, D, Kaliappan, A, Vertue, M, Nicholson, A, Riches, J, Maloney, G, Kittridge, L, Solesbury, A, Ramos, A, Collins, D, Brickell, K, Reid, L, Smyth, M, Breen, P, Spain, S, Curley, G, McEvoy, N, Geoghegan, P, Clarke, J, Silversides, J, McGuigan, P, Ward, K, O’Neill, A, Finn, S, Wright, C, Green, J, Collins, É, Knott, C, Smith, J, Boschert, C, Slieker, K, Ewalds, E, Sanders, A, Wittenberg, W, Geurts, H, Poojara, L, Sara, T, Nand, K, Reeve, B, Dechert, W, Phillips, B, Oritz-Ruiz de Gordoa, L, Affleck, J, Shaikh, A, Murray, A, Ramanan, M, Frakking, T, Pinnell, J, Robinson, M, Gledhill, L, Wood, T, Sanghavi, R, Bhonagiri, D, Ford, M, Parikh, HG, Avard, B, Nourse, M, McDonald, B, Edmunds, N, Hoiting, O, Peters, M, Rengers, E, Evers, M, Prinssen, A, Morgan, M, Cole, J, Hill, H, Davies, M, Williams, A, Thomas, E, Davies, R, Wise, M, Grimm, P, Soukup, J, Wetzold, R, Löbel, M, Starke, L, Lellouche, F, Lizotte, P, Declerq, P, Antoine, M, Stephanie, G, Jean-Pierre, E, François, B, Marion, B, Philippe, R, Pourcine, F, Monchi, M, Luis, D, Mercier, R, Sagnier, A, Verrier, N, Caplin, C, Richecoeu, J, Combaux, D, Siami, S, Aparicio, C, Vautier, S, Jeblaoui, A, Lemaire-Brunel, D, D'Aragon, F, Carbonneau, E, Leblond, J, Plantefeve, G, Leparco, C, Contou, D, Fartoukh, M, Courtin, L, Labbe, V, Voiriot, G, Salhi, S, Chassé, M, Carrier, F, Boumahni, D, Benettaib, F, Ghamraoui, A, Sement, A, Gachet, A, Hanisch, A, Haffiane, A, Boivin, A-H, Barreau, A, Guerineau, E, Poupblanc, S, Egreteau, P, Lefevre, M, Bocher, S, Le Loup, G, Le Guen, L, Carn, V, Bertel, M, Antcliffe, D, Templeton, M, Rojo, R, Coghlan, P, Smee, J, Barker, G, Finn, A, Kreb, G, Hoff, U, Hinrichs, C, Nee, J, Mackay, E, Cort, J, Whileman, A, Spencer, T, Spittle, N, Beavis, S, Padmakumar, A, Dale, K, Hawes, J, Moakes, E, Gascoyne, R, Pritchard, K, Stevenson, L, Cooke, J, Nemeth-Roszpopa, K, Gauli, B, Bastola, S, Muller, G, Nay, M-A, Kamel, T, Benzekri, D, Jacquier, S, Runge, I, Mathonnet, A, Barbier, F, Bretagnol, A, Carter, J, Van Der Heyden, K, Mehrtens, J, Morris, A, Morgan, S, Burke, T, Mercier, E, Chartier, D, Salmon, C, Dequin, P-F, Garot, D, Bellemare, D, Cloutier, È, Daher, R, Costerousse, O, Boulanger, M-C, Couillard-Chénard, É, Lauzier, F, Francoeur, C, Francois, B, Gay, A, Anne-Laure, F, Ramali, M, HC, O, Ghosh, A, Osagie, R, Arachchige, M, Hartley, M, Cheung, W, Wong, H, Seigne, P, Eustace, J, O'Callaghan, A-M, O'Brien, F, Bamford, P, Reid, A, Cawley, K, Faulkner, M, Pickering, C, Raj, A, Tsinaslanidis, G, Khade, R, Agha, G, Sekiwala, R, Smith, T, Brewer, C, Gregory, J, Limb, J, Cowton, A, O’Brien, J, Postlethwaite, K, Malakouti, S, Music, E, Ricketts, D, King, A, Clermont, G, Bart, R, Mayr, F, Schoenling, A, Andreae, M, Shetty, V, Brant, E, Malley, B, Donadee, C, Sackrowitz, R, Weissman, A, Yealy, D, Barton, D, Talia, N, Nikitas, N, Wells, C, Lankester, L, McMillan, H, Van den Oever, H, Kruisdijk-Gerritsen, A, Haidar, G, Bain, W, Barbash, I, Fitzpatrick, M, Franz, C, Kitsios, G, Moghbeli, K, Rosborough, B, Shah, F, Suber, T, Pulletz, M, Williams, P, Birch, J, Wiseman, S, Horton, S, Alegria, A, Turki, S, Elsefi, T, Crisp, N, Allen, L, Truman, N, Smith, M, Chukkambotla, S, Goddard, W, Duberley, S, Khan, M, Kazi, A, Simpson, J, Duke, G, Chan, P, Carter, B, Hunter, S, Voigt, I, Schueler, R, Blank, E, Hüning, V, Steffen, M, Goralski, P, Litton, E, Regli, A, Pellicano, S, Palermo, A, Eroglu, E, Bihari, S, Laver, RD, Jin, X, Brown, J, McIntyre, J, French, C, Bates, S, Towns, M, Yang, Y, McGain, F, McCullagh, I, Cairns, T, Hanson, H, Patel, B, Clement, I, Evetts, G, Touma, O, Holland, S, Hodge, C, Taylor, H, Alderman, M, Barnes, N, Da Rocha, J, Smith, C, Brooks, N, Weerasinghe, T, Sinclair, J-A, Abusamra, Y, Doherty, R, Cudlipp, J, Singh, R, Yu, H, Daebis, A, Ng, C, Kendrick, S, Saran, A, Makky, A, Greener, D, Rowe-Leete, L, Edwards, A, Bland, Y, Dolman, R, Foster, T, Laffey, J, McNicholas, B, Scully, M, Casey, S, Kernan, M, Brennan, A, Rangan, R, Tully, R, Corbett, S, McCarthy, A, Duffy, O, Burke, D, Linnett, V, Sanderson, A, Ritzema, J, Wild, H, Lucas, R, Marriott, Y, Andric, Z, Cviljevic, S, Br, R, Zapalac, M, Mirković, G, Khare, D, Pinder, M, Gopinath, A, Kannan, T, Dean, S, Vanmali, P, Depuydt, P, De Waele, J, De Bus, L, Fierens, J, Bracke, S, Vermassen, J, Vermeiren, D, Pugh, R, Lean, R, Qiu, X, Scanlan, J, Evans, A, Davies, G, Lewis, J, Plesnikova, Y, Khoud, A, Coetzee, S, Puxty, K, Cathcart, S, Rimmer, D, Bagot, C, Scott, K, Martin, L, Yusuff, H, Isgro, G, Brightling, C, Bourne, M, Craner, M, Boyles, R, Alexander, B, Roberts, T, Nelli, A, Rosenstein-Sisson, R, Speyer, R, Pech, Y, McCullough, J, Tallott, M, Vazquez-Grande, G, Marten, N, Liu, T, Siddiqui, A, Khanal, S, Amatya, S, Szakmany, T, Cherian, S, Williams, G, James, C, Waters, A, Prout, R, Stedman, R, Davies, L, Pegler, S, Kyeremeh, L, Moorhouse, L, Arbane, G, Marotti, M, Bociek, A, Campos, S, Van Nieuwkoop, K, Ottens, T, Visser, Y, Van den Berg, L, Van der Kraan-Donker, A, Brett, S, Arias, S, Hall, R, Paneru, H, Koirala, S, Paudel, P, Wilson, M, Vaara, S, Pettilä, L, Heinonen, J, Pettilä, V, Jain, S, Gupta, A, Holbrook, C, Antoine, P, Meziani, F, Allam, H, Cattelan, J, Clere-Jehl, R, Helms, J, Kummerlen, C, Merdji, H, Monnier, A, Rahmani, H, Studer, A, Schneider, F, Castelain, V, Morel, G, L’Hotellier, S, Ochin, E, Vanjak, C, Rouge, P, Bendjemar, L, Albert, M, Serri, K, Cavayas, A, Duplaix, M, Williams, V, Catorze, NJTADS, Pereira, TNAL, Ferreira, RMC, Bastos, JMPS, Batista, TMO, Badie, J, Berdaguer, F, Malfroy, S, Mezher, C, Bourgoin, C, Moneger, G, Bouvier, E, Muñoz-Bermúdez, R, Marin-Corral, J, Degracia, A, Gómez, F, López, M, Aceto, R, Aghemo, A, Badalamenti, S, Brunetta, E, Cecconi, M, Ciccarelli, M, Constantini, E, Greco, M, Folci, M, Selmi, C, Voza, A, Henning, J, Bonner, S, Hugill, K, Cirstea, E, Wilkinson, D, Jones, J, Altomy, M, Karlikowski, M, Sutherland, H, Wilhelmsen, E, Woods, J, North, J, Pletz, M, Hagel, S, Ankert, J, Kolanos, S, Bloos, F, Simons, K, Van Zuylen, T, Bouman, A, Kumar, N, Panwar, R, Poulter, A-L, Sunkara, K, Szigligeti, G, Leszkoven, J, Rochwerg, B, Karachi, T, Oczkowski, S, Centofanti, J, Millen, T, Sundaran, D, Hollos, L, Turns, M, Walsh, J, Al Qasim, E, Alswaidan, L, Hegazy, M, Arishi, H, Al Amri, A, AlQahtani, S, Naidu, B, Tlayjeh, H, Hussain, S, Al Enezi, F, Abdukahil, SA, Hopkins, P, Noble, H, O’Reilly, K, Mehta, R, Wong, O, Makanju, E, Rao, D, Sikondari, N, Saha, S, Corcoran, E, Pappa, E, Cockrell, M, Donegan, C, Balaie, M, Nickoleit-Bitzenberger, D, Schaaf, B, Meermeier, W, Prebeg, K, Azzaui, H, Hower, M, Brieger, K-G, Elender, C, Sabelhaus, T, Riepe, A, Akamp, C, Kremling, J, Klein, D, Landsiedel-Mechenbier, E, Laha, S, Verlander, M, Jha, A, Megarbane, B, Voicu, S, Deye, N, Malissin, I, Sutterlin, L, Mrad, A, Lehalleur, A, Naim, G, Nguyen, P, Ekhérian, J-M, Boué, Y, Sidéris, G, Vodovar, D, Guérin, E, Grant, C, Brain, M, Mineall, S, Paramasivam, E, Wilby, E, Ogg, B, Howcroft, C, Aspinwall, A, Charlton, S, Gould, R, Mistry, D, Awan, S, Bedford, C, Carr-Wilkinson, J, Hall, A, Gardiner-Hill, C, Maloney, C, Brunskill, N, Watchorn, O, Hardy, C, Qureshi, H, Flint, N, Nicholson, S, Southin, S, Ghattaoraya, A, Harding, D, O’Halloran, S, Collins, A, Smith, E, Trues, E, Borgatta, B, Turner-Bone, I, Reddy, A, Wilding, L, Wilson, C, Surti, Z, Aneman, A, Miller, J, White, H, Estensen, K, Morrison, L, Sutton, J, Cooper, M, Warnapura, L, Agno, R, Sathianathan, P, Shaw, D, Ijaz, N, Spong, A, Sabaretnam, S, Burns, D, Lang, E, Tate, M, Fischer, R, Biradar, V, Soar, N, Golden, D, Davey, M, Seaman, R, Osborne, A, Bannard-Smith, J, Clark, R, Birchall, K, Henry, J, Pomeroy, F, Quayle, R, Wylie, K, Sukuraman, A, John, M, Sibin, S, Leditschke, A, Finnis, M, Jongebloed, K, Khwaja, K, Campisi, J, Van Vonderen, M, Pietersma, M, Vrolijk, L, Kampschreur, L, Van Gulik, L, Makowski, A, Misztal, B, Haider, S, Liao, A, Squires, R, Oborska, A, Kayani, A, Kalchko-Veyssal, S, Prabakaran, R, Hadebe, B, KalchkoVeyssal, S, Williams, T, Song, R, Morpeth, S, Lai, V, Habraken, H, Stewart, R, Mwaura, E, Mew, L, Wren, L, Willams, F, Sutherland, S-B, Rebello, R, Shehabi, Y, Al-Bassam, W, Hulley, A, Kadam, U, Sathianathan, K, Innes, R, Doble, P, Graham, L, Shovelton, C, Dean, T, Salahuddin, N, Aryal, D, Koirala, K, Rai, N, Luitel, S, Seppelt, I, Whitehead, C, Lowrey, J, Gresham, R, Masters, K, Hamlyn, V, Hawkins, N, Roynon-Reed, A, Cutler, S, Lewis, S, Lazaro, J, Newman, T, Aravindan, L, Asghar, A, Bartholomew, J, Bayne, M, Beddows, S, Birch, C, Brend, M, Byrne, R, Campbell, D, Campbell, H, Chambers, E, Clinton, A, Collins, J, Crawshaw, S, Dawson, LA, Donaldson, K, Drake, C, Dyas, S, Ellis, Y, Gilmour, K, Goodwin, J, Halden, S, Hall, AS, Hanson, J, Harper, H, Harrison, S, Hayes, A, Hodgson, H, Hurford, S-A, Jackson, S, Levett, C, Lock, S, Lockett, T, Logan, M, Lomme, K, Luo, J, Marsh, E, Mguni, N, Monaghan, H, Murphy, S, Muzengi, N, Naz, M, O'Kell, E, Oliver, A, O'Reilly, J, Pearson, K, Porter, D, Potter, A, Rook, C, Rounds, C, Sheffield, J, Shirley, K, Siewersk, C, Skinner, T, Speight, H, Sutu, M, Unsworth, A, Van’t Hoff, W, Walker, S, Williams, H, Williamson, D, Williamson, JD, Duan, E, Tsang, J, Patterson, L, Austin, P, Chapman, S, Cabrelli, L, Fletcher, S, Nortje, J, Fottrell-Gould, D, Randell, G, Stammers, K, Healey, G, Pinto, M, Borrill, Z, Duncan, T, Ustianowski, A, Uriel, A, Eltayeb, A, Alfonso, J, Hey, S, Shaw, J, Fox, C, Lindergard, G, Charles, B, Blackledge, B, Connolly, K, Harris, J, Cuesta, J, Xavier, K, Purohit, D, Elhassan, M, Haldeos, A, Vincent, R, Abdelrazik, M, Jenkins, S, Ganesan, A, Kumar, R, Carter, D, Bakthavatsalam, D, Frater, A, Saleem, M, Everitt, R, Hacking, D, Zaman, M, Elmahi, E, Jones, A, Hall, K, Phillips, M, Terrill, L, Mills, G, Raithatha, A, Bauchmuller, K, Ryalls, K, Harrington, K, Bowler, H, Sall, J, Bourne, R, Gross, J, Massey, N, Adebambo, O, Long, M, Tony, K, Juffermans, N, Koopmans, M, Dujardin, R, Alderink, B, Rowland, M, Hutton, P, Bashyal, A, Davidson, N, Hird, C, Chhablani, M, Phalod, G, Kirkby, A, Archer, S, Netherton, K, Reschreiter, H, Camsooksai, J, Patch, S, Humphrey, C, Flynn, G, Harrington, C, Kruger, P, Walsham, J, Meyer, J, Harward, M, Jones, C, Sathe, S, Roche, L, Davies, E, Skinner, D, Gaylard, J, Newman, J, Pogson, D, Rose, S, Daly, Z, Brimfield, L, Nown, A, Parekh, D, Bergin, C, Bates, M, McGhee, C, Lynch, D, Bhandal, K, Tsakiridou, K, Bamford, A, Cooper, L, Whitehouse, T, Veenith, T, Forster, E, O'Connell, M, Sim, M, Hay, S, Henderson, S, Nygren, M, Valentine, E, Katary, A, Bell, G, Wilcox, L, Mataliotakis, M, Smith, P, Ali, M, Isguzar, A, Phull, M-K, Zaidi, A, Pogreban, T, Rosaroso, L, Harvey, D, Lowe, B, Meredith, M, Ryan, L, Schouten, J, Pickkers, P, Roovers, N, Klop-Riehl, M, Van der Eng, H, Sloots-Cuppen, S, Preijers, L, Van Oosten, N, Moine, P, Heming, N, Maxime, V, Bossard, I, Nicholier, T, Clair, B, Orlikowski, D, Bounab, R, Abdeladim, L, Baker, S, Duroux, M, Ratcliffe, M, Sy, E, Mailman, J, Lee, S, Gupta, C, Kassir, S, López, R, Rodríguez-Gómez, J, Cárcel, S, Carmona, R, De la Fuente, C, Rodriguez, M, Jan Hassing, R, Greven, F, Huijbens, D, Roebers, L, Verheij, H, Miles, H, Attokaran, A, Buehner, U, Williams, E, Chapman, M, O’Connor, S, Glasby, K, Rivett, J, Brown, N, Kutsogiannis, D, Thompson, P, Rooney, K, Rodden, N, Thomson, N, McGlynn, D, Abel, L, Gemmell, L, Sundaram, R, Hornsby, J, Walden, A, Keating, L, Frise, M, Rai, S, Bartley, S, Schuster-Bruce, M, Pitts, S, Miln, R, Purandare, L, Vamplew, L, Dempster, D, Gummadi, M, Dormand, N, Wang, S, Spivey, M, Bean, S, Burt, K, Moore, L, Hammonds, F, Richards, C, Campbell, L, Smyth, K, Day, C, Zitter, L, Benyon, S, Singh, J, Lynch, C, Mikusek, J, Deacon, B, Turner, K, Baker, E, Hickey, J, Champanerkar, S, Aitken, L, LewisProsser, L, Ahmad, N, Wiles, M, Willson, J, Grecu, I, Martin, J, Wrey Brown, C, Arias, A-M, Bevan, E, Westlake, S, Craven, T, Hope, D, Singleton, J, Clark, S, McCulloch, C, Biddie, S, Welters, I, Hamilton, D, Williams, K, Waugh, V, Mulla, S, Waite, A, Roman, J, Martinez, M, Johnston, B, Puthucheary, Z, Martin, T, Santos, F, Uddin, R, Fernandez, M, Seidu, F, Somerville, A, Pakats, M-L, Begum, S, Shahid, T, Presneill, J, Barge, D, Byrne, K, Janin, P, Yarad, E, Bass, F, Hammond, N, Vuylsteke, A, Chan, C, Victor, S, Waterson, S, McNamara, R, Boardman, M, Gattas, D, Buhr, H, Coles, J, Matsa, R, Gellamucho, M, Creagh-Brown, B, Marriot, C, Salberg, A, Zouita, L, Stone, S, Michalak, N, Donlon, S, Mtuwa, S, Mayangao, I, Verula, J, Burda, D, Harris, C, Jones, E, Bradley, P, Tarr, E, Harden, L, Piercy, C, Nolan, J, Kerslake, I, Cook, T, Simpson, T, Dalton, J, Demetriou, C, Mitchard, S, Ramos, L, White, K, Johnson, T, Headdon, W, Spencer, S, White, A, Howie, L, Reay, M, Watts, A, Traverse, E, Jennings, S, Anumakonda, V, Tuckwell, C, Harrow, K, Matthews, J, McGarry, K, Moore, V, Smith, L, Summerfield, A, Dark, P, Harvey, A, Doonan, R, McMorrow, L, Knowles, K, Pendlebury, J, Perez, J, Marsden, T, Taylor, M, Michael, A, Collis, M, Claxton, A, Habeichi, W, Horner, D, Slaughter, M, Thomas, V, Proudfoot, N, Keatley, C, Donnison, P, Casey, R, Irving, B, Matimba-Mupaya, W, Reed, C, Anthony, A, Trim, F, Cambalova, L, Robertson, D, Wilson, A, Hulme, J, Kannan, S, Kinney, F, Senya, H, Ratnam, V, Gill, M, Kirk, J, Shelton, S, Schweikert, S, Wibrow, B, Anstey, M, Rauniyar, R, Khoso, N, Asif, N, Taqdees, H, Frey, C, Scano, R, McKee, M, Murphy, P, Thomas, M, Worner, R, Faulkner, B, Gendall, E, Hayes, K, Blakemore, H, Borislavova, B, Deshpande, K, Van Haren, F, Konecny, P, Inskip, D, Tung, R, Hayes, L, Murphy, L, Neill, A, Reidy, B, O’Dwyer, M, Ryan, D, Ainscough, K, Hamilton-Davies, C, Mfuko, C, Abbass, H, Mandadapu, V, Leaver, S, Patel, K, Farnell-Ward, S, Saluzzio, R, Rawlins, S, Sicat, C, De Keulenaer, B, Ferrier, J, Fysh, E, Davda, A, Mevavala, B, Cook, D, Clarke, F, Banach, D, Fernández de Pinedo Artaraz, Z, Cabreros, L, Latham, V, Kruisselbrink, R, Brochard, L, Burns, K, Sandhu, G, Khalid, I, White, I, Croft, M, Holland, N, Pereira, R, Nair, P, Buscher, H, Reynolds, C, Newman, S, Santamaria, J, Barbazza, L, Homes, J, Smith, R, Zaki, A, Johnson, D, Garrard, H, Juhaz, V, Brown, L, Pemberton, A, Roy, A, Rostron, A, Woods, L, Cornell, S, Fowler, R, Adhikari, N, Kamra, M, Marinoff, N, Garrett, P, Murray, L, Brailsford, J, Fennessy, G, Mulder, J, Morgan, R, Pillai, S, Harford, R, Ivatt, H, Evans, D, Richards, S, Roberts, E, Bowen, J, Ainsworth, J, Kuitunen, A, Karlsson, S, Vahtera, A, Kiiski, H, Ristimäki, S, Albrett, J, Jackson, C, Kirkham, S, Tamme, K, Reinhard, V, Ellervee, A, Põldots, L, Rennit, P, Svitškar, N, Browne, T, Grimwade, K, Goodson, J, Keet, O, Callender, O, Udy, A, McCracken, P, Young, M, Board, J, Martin, E, Kasipandian, V, Patel, A, Allibone, S, Mary-Genetu, R, English, S, Watpool, I, Porteous, R, Miezitis, S, McIntyre, L, Brady, K, Vale, C, Shekar, K, Lavana, J, Parmar, D, Peake, S, Kurenda, C, Hormis, A, Walker, R, Collier, D, Kimpton, S, Oakley, S, Bhagani, S, De Neef, M, Garcia, S, Maharajh, A, Nandani, A, Dobson, J, Fernando, G, Eastgate, C, Gomez, K, Abdi, Z, Tatham, K, Jhanji, S, Black, E, Dela Rosa, A, Howle, R, Baikady, R, Drummond, A, Dearden, J, Philbin, J, Munt, S, Gopal, S, Pooni, J-S, Ganguly, S, Smallwood, A, Metherell, S, Naeem, A, Fagan, L, Ryan, E, Mariappa, V, Foulds, A, Revill, A, Bhattarai, B, De Jonge, E, Wigbers, J, Del Prado, M, Cremer, O, Mulier, J, Peters, A, Romberg, B, Schutgens, R, Troeman, D, Van Opdorp, M, Besten, H, Brakké, K, Barber, R, Hilldrith, A, Kluge, S, Nierhaus, A, Jarczak, D, Roedl, K, Kochanek, M, Rueß-Paterno, G, Mc-Kenzie, J, Eichenauer, D, Shimabukuro-Vornhagen, A, Wilcox, E, Del Sorbo, L, Abdelhady, H, Romagnuolo, T, Simpson, S, Maiden, M, Horton, M, Trickey, J, Krajinovic, V, Kutleša, M, Kotarski, V, Brohi, F, Jagannathan, V, Clark, M, Purvis, S, Wetherill, B, Brajković, A, Babel, J, Sever, H, Dragija, L, Kušan, I, Dushianthan, A, Cusack, R, De Courcy-Golder, K, Salmon, K, Burnish, R, Smith, S, Ruiz, W, Duke, Z, Johns, M, Male, M, Gladas, K, Virdee, S, Swabe, J, Tomlinson, H, Rohde, G, Grünewaldt, A, Bojunga, J, Petros, S, Kunz, K, Schütze, B, Weismann, D, Frey, A, Drayss, M, Goebeler, ME, Flor, T, Fragner, G, Wahl, N, Totzke, J, Sayehli, C, Hakak, S, Altaf, W, O'Sullivan, M, Murphy, A, Walsh, L, Rega La Valle, A, Bewley, J, Sweet, K, Grimmer, L, Johnson, R, Wyatt, R, Morgan, K, Varghese, S, Willis, J, Stratton, E, Kyle, L, Putensen, D, Drury, K, Skorko, A, Bremmer, P, Ward, G, Bassford, C, Sligl, W, Baig, N, Rewa, O, Bagshaw, S, Basile, K, Stavor, D, Burbee, D, McNamara, A, Wunderley, R, Bensen, N, Adams, P, Vita, T, Buhay, M, Scholl, D, Gilliam, M, Winters, J, Doherty, K, Berryman, E, Ghaffari, M, Marroquin, O, Quinn, K, Garrard, W, Kalchthaler, K, Beard, G, Skrtich, A, Bagavathy, K, Drapola, D, Bryan-Morris, K, Arnold, J, Reynolds, B, Hussain, M, Dunsavage, J, Saiyed, S, Hernandez, E, Goldman, J, Brown, C, Comp, S, Raczek, J, Morris, J, Vargas Jr., J, Weiss, D, Hensley, J, Kochert, E, Wnuk, C, Nemeth, C, Mowery, B, Hutchinson, C, Winters, L, McAdams, D, Walker, G, Minnier, T, Wisniewski, M, Mayak, K, McCreary, E, Bariola, R, Viehman, A, Daley, J, Lopus, A, Schmidhofer, M, Ambrosino, R, Keen, S, Toffalo, S, Stambaugh, M, Trimmer, K, Perri, R, Casali, S, Medva, R, Massar, B, Beyerl, A, Burkey, J, Keeler, S, Lowery, M, Oncea, L, Daugherty, J, Sevilla, C, Woelke, A, Dice, J, Weber, L, Roth, J, Ferringer, C, Beer, D, Fesz, J, Carpio, L, Colin, G, Zinzoni, V, Maquigneau, N, Henri-Lagarrigue, M, Pouplet, C, Reill, L, Distler, M, Maselli, A, Martynoga, R, Trask, K, Butler, A, Attwood, B, Parsons, P, Campbell, B, Smith, A, Page, V, Zhao, X, Oza, D, Abrahamson, G, Sheath, B, Young, P, Young, C, Lesona, E, Navarra, L, Cruz, R, Delaney, K, Aguilar-Dano, A, Gojanovic, M, Rhodes, J, Anderson, T, Morris, S, Nayyar, V, Bowen, D, Kong, J, Joy, J, Fuchs, R, Lambert, B, Tai, C, Thomas, A, Keen, A, Tierney, C, Omer, N, Bacon, G, Tridente, A, Shuker, K, Anders, J, Greer, S, Scott, P, Millington, A, Buchanan, P, Binnie, A, Powell, E, McMillan, A, Luk, T, Aref, N, Denmade, C, Sadera, G, Jacob, R, Hughes, D, Sterba, M, Geng, W, Digby, S, Southern, D, Reddy, H, Hulse, S, Campbell, A, Garton, M, Watkins, C, Smuts, S, Quinn, A, Simpson, B, McMillan, C, Finch, C, Hill, C, Cooper, J, Budd, J, Small, C, O’Leary, R, Collins, E, Holland, A, Alexander, P, Felton, T, Ferguson, S, Sellers, K, Ward, L, Yates, D, Birkinshaw, I, Kell, K, Scott, Z, Pearson, H, Hashmi, M, Hassan, N, Panjwani, A, Umrani, Z, Shaikh, M, Ain, Q, Kanwal, D, Van Bree, S, Bouw-Ruiter, M, Osinga, M, Van Zanten, A, McEldrew, R, Rashan, S, Singh, V, Azergui, N, Bari, S, Beltran, M, Brugman, C, Groeneveld, E, Jafarzadeh, M, Keijzer-Timmers, N, Kester, E, Koelink, M, Kwakkenbos-Craanen, M, Okundaye, C, Parker, L, Peters, S, Post, S, Rietveld, I, Scheepstra-Beukers, I, Schreuder, G, Smit, A, Brillinger, N, Markgraf, R, Eichinger, F, Doran, P, Anjum, A, Best-Lane, J, Barton, F, Miller, L, Richards-Belle, A, Saull, M, Sprinckmoller, S, Wiley, D, Darnell, R, Au, C, Lindstrum, K, Cheng, A, Forbes, A, Heritier, S, Trapani, T, Cuthbertson, B, Manoharan, V, Dondrop, A, Tolppa, T, Ehrmann, S, Hullegie, S, Povoa, P, Beasley, R, Daneman, N, McGloughlin, S, Paterson, D, Venkatesh, B, De Jong, M, Uyeki, T, Baillie, K, Netea, M, Orr, K, Patanwala, A, Tong, S, Cooper, N, Galea, J, Leavis, H, Ogungbenro, K, Patawala, A, Rademaker, E, Youngstein, T, Carrier, M, Fergusson, D, Hunt, B, Kumar, A, Laffan, M, Lother, S, Middeldorp, S, Stanworth, S, De Man, A, Masse, M-H, Abraham, J, Arnold, D, Begin, P, Charlewood, R, Chasse, M, Coyne, M, Daly, J, Gosbell, I, Harvala-Simmonds, H, MacLennan, S, McDyer, J, Menon, D, Pridee, N, Roberts, D, Thomas, H, Tinmouth, A, Triulzi, D, Walsh, T, Wood, E, Calfee, C, O’Kane, C, Shyamsundar, M, Sinha, P, Thompson, T, Young, I, Burrell, A, Ferguson, N, Hodgson, C, Orford, N, Phua, J, Baron, R, Epelman, S, Frankfurter, C, Gommans, F, Kim, E, Leaf, D, Vaduganathan, M, Van Kimmenade, R, Sanil, A, Van Beurden, M, Effelaar, E, Schotsman, J, Boyd, C, Harland, C, Shearer, A, Wren, J, Attanayaka, U, Darshana, S, Ishani, P, Udayanga, I, Higgins, AM, Berry, LR, Lorenzi, E, Murthy, S, McQuilten, Z, Mouncey, PR, Al-Beidh, F, Annane, D, Arabi, YM, Beane, A, Van Bentum-Puijk, W, Bhimani, Z, Bonten, MJM, Bradbury, CA, Brunkhorst, FM, Buzgau, A, Buxton, M, Charles, WN, Cove, M, Detry, MA, Estcourt, LJ, Fagbodun, EO, Fitzgerald, M, Girard, TD, Goligher, EC, Goossens, H, Haniffa, R, Hills, T, Horvat, CM, Huang, DT, Ichihara, N, Lamontagne, F, Marshall, JC, McAuley, DF, McGlothlin, A, McGuinness, SP, McVerry, BJ, Neal, MD, Nichol, AD, Parke, RL, Parker, JC, Parry-Billings, K, Peters, SEC, Reyes, LF, Rowan, KM, Saito, H, Santos, MS, Saunders, CT, Serpa-Neto, A, Seymour, CW, Shankar-Hari, M, Stronach, LM, Turgeon, AF, Turner, AM, Van de Veerdonk, FL, Zarychanski, R, Green, C, Lewis, RJ, Angus, DC, McArthur, CJ, Berry, S, Derde, LPG, Gordon, AC, Webb, SA, Lawler, PR, Comm REMAP-CAP Investigators, Apollo - University of Cambridge Repository, Intensive Care Medicine, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Hôpital Raymond Poincaré [Garches], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Pittsburgh Foundation, PF, Amgen, Health Research Board, HRB: CTN 2014-012, Horizon 2020 Framework Programme, H2020: 101003589, Translational Breast Cancer Research Consortium, TBCRC, Canadian Institutes of Health Research, IRSC: 158584, Heart and Stroke Foundation of Canada, HSF, National Institute for Health and Care Research, NIHR, European Commission, EC, National Health and Medical Research Council, NHMRC: 1101719, APP194811, CS-2016-16-011, GNT2008447, RP-2015-06-18, Office of Health and Medical Research, OHMR, Health Research Council of New Zealand, HRC: 16/631, Eisai, Ministère des Affaires Sociales et de la Santé: PHRC-20-0147, Université Pierre et Marie Curie, UPMC, NIHR Imperial Biomedical Research Centre, BRC, Minderoo Foundation, Funding/Support : The Platform for European Preparedness Against (Re-) emerging Epidemics (PREPARE) consortium by the European Union, FP7-HEALTH-2013-INNOVATION-1 (#602525), the Rapid European COVID-19 Emergency Research response (RECOVER) consortium by the European Union’s Horizon 2020 research and innovation programme (#101003589), the Australian National Health and Medical Research Council (#APP1101719), the Australian Medical Research Future Fund (#APP2002132), the Health Research Council of New Zealand (#16/631), the Canadian Institutes of Health Research Strategy for Patient-Oriented Research Innovative Clinical Trials Program Grant (#158584) and the Canadian Institute of Health Research COVID-19 Rapid Research Funding (#447335), the UK National Institute for Health Research (NIHR) and the NIHR Imperial Biomedical Research Centre, the Health Research Board of Ireland (CTN 2014-012), the UPMC Learning While Doing Program, the Translational Breast Cancer Research Consortium, the French Ministry of Health (PHRC-20-0147), the Wellcome Trust Innovations Project (215522), the Minderoo Foundation, the EU Programme Emergency Support Instrument, the NHS Blood and Transplant Research and Development Programme, the Translational Breast Cancer Research Consortium, the NSW Office of Health and Medical Research, Amgen, Eisai, and the Pittsburgh Foundation. Dr Higgins is funded by an NHMRC Emerging Leadership Fellowship (GNT2008447). Dr McQuilten is funded by an NHMRC Emerging Leadership Fellowship (APP194811). Dr Gordon is funded by an NIHR Research Professorship (RP-2015-06-18) and Dr Shankar-Hari by an NIHR Clinician Scientist Fellowship (CS-2016-16-011). Dr Turgeon is the Chairholder of the Canada Research Chair in Critical Care Neurology and Trauma. Dr Lawler is supported by a career award from the Heart and Stroke Foundation of Canada., and European Project: 602525,EC:FP7:HEALTH,FP7-HEALTH-2013-INNOVATION-1,PREPARE(2014)

Subjects
Adult, Male, corticosteroid, [SDV]Life Sciences [q-bio], Critical Illness, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], antiplatelet, Lopinavir, Adaptive platform trial randomized controlled trial intensive care, pneumonia COVID-19 antiplatelet immunoglobulin antiviral corticosteroid immune modulation anticoagulation, All institutes and research themes of the Radboud University Medical Center, Adrenal Cortex Hormones, Humans, anticoagulation, intensive care, pneumonia, COVID-19 Serotherapy, Original Investigation, Medicine(all), immune modulation, Ritonavir, SARS-CoV-2, COVID-19, Anticoagulants, Bayes Theorem, General Medicine, Middle Aged, antiviral, Receptors, Interleukin-6, Adaptive platform trial, randomized controlled trial, Female, Human medicine, immunoglobulin, Follow-Up Studies, Hydroxychloroquine
Abstract

ImportanceThe longer-term effects of therapies for the treatment of critically ill patients with COVID-19 are unknown.ObjectiveTo determine the effect of multiple interventions for critically ill adults with COVID-19 on longer-term outcomes.Design, Setting, and ParticipantsPrespecified secondary analysis of an ongoing adaptive platform trial (REMAP-CAP) testing interventions within multiple therapeutic domains in which 4869 critically ill adult patients with COVID-19 were enrolled between March 9, 2020, and June 22, 2021, from 197 sites in 14 countries. The final 180-day follow-up was completed on March 2, 2022.InterventionsPatients were randomized to receive 1 or more interventions within 6 treatment domains: immune modulators (n = 2274), convalescent plasma (n = 2011), antiplatelet therapy (n = 1557), anticoagulation (n = 1033), antivirals (n = 726), and corticosteroids (n = 401).Main Outcomes and MeasuresThe main outcome was survival through day 180, analyzed using a bayesian piecewise exponential model. A hazard ratio (HR) less than 1 represented improved survival (superiority), while an HR greater than 1 represented worsened survival (harm); futility was represented by a relative improvement less than 20% in outcome, shown by an HR greater than 0.83.ResultsAmong 4869 randomized patients (mean age, 59.3 years; 1537 [32.1%] women), 4107 (84.3%) had known vital status and 2590 (63.1%) were alive at day 180. IL-6 receptor antagonists had a greater than 99.9% probability of improving 6-month survival (adjusted HR, 0.74 [95% credible interval {CrI}, 0.61-0.90]) and antiplatelet agents had a 95% probability of improving 6-month survival (adjusted HR, 0.85 [95% CrI, 0.71-1.03]) compared with the control, while the probability of trial-defined statistical futility (HR >0.83) was high for therapeutic anticoagulation (99.9%; HR, 1.13 [95% CrI, 0.93-1.42]), convalescent plasma (99.2%; HR, 0.99 [95% CrI, 0.86-1.14]), and lopinavir-ritonavir (96.6%; HR, 1.06 [95% CrI, 0.82-1.38]) and the probabilities of harm from hydroxychloroquine (96.9%; HR, 1.51 [95% CrI, 0.98-2.29]) and the combination of lopinavir-ritonavir and hydroxychloroquine (96.8%; HR, 1.61 [95% CrI, 0.97-2.67]) were high. The corticosteroid domain was stopped early prior to reaching a predefined statistical trigger; there was a 57.1% to 61.6% probability of improving 6-month survival across varying hydrocortisone dosing strategies.Conclusions and RelevanceAmong critically ill patients with COVID-19 randomized to receive 1 or more therapeutic interventions, treatment with an IL-6 receptor antagonist had a greater than 99.9% probability of improved 180-day mortality compared with patients randomized to the control, and treatment with an antiplatelet had a 95.0% probability of improved 180-day mortality compared with patients randomized to the control. Overall, when considered with previously reported short-term results, the findings indicate that initial in-hospital treatment effects were consistent for most therapies through 6 months.

Published
2023

7. Designing Capacity-Building in E-Learning Expertise: Challenges and Strategies

Author

Aczel, J. C., Peake, S. R., and Hardy, P.

Abstract

This research study looks at how organizations in developing countries perceive the challenge of building capacity in e-learning expertise. Data was collected on six such organizations, and a range of perceived rationales and constraints were identified. The paper hypothesizes a four-part framework to define the e-learning capacity gaps that these circumstances appear to represent: the "instructional design capacity gap", the "production capacity gap", the "tutorial capacity gap" and the "community building gap". The framework is used to re-examine the data to explore the ways in which the organizations' e-learning activities might constitute strategic responses to the hypothesized capacity gaps.

Published
2008
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8. Protocol describing a systematic review and mixed methods consensus process to define the deteriorated ward patient.

Author

Malycha, J, Andersen, C, Redfern, OC, Peake, S, Subbe, C, Dykes, L, Phillips, A, Ludbrook, G, Young, D, Watkinson, PJ, Flabouris, A, Jones, D, Malycha, J, Andersen, C, Redfern, OC, Peake, S, Subbe, C, Dykes, L, Phillips, A, Ludbrook, G, Young, D, Watkinson, PJ, Flabouris, A, and Jones, D

Abstract

INTRODUCTION: Most patients admitted to hospital recover with treatments that can be administered on the general ward. A small but important group deteriorate however and require augmented organ support in areas with increased nursing to patient ratios. In observational studies evaluating this cohort, proxy outcomes such as unplanned intensive care unit admission, cardiac arrest and death are used. These outcome measures introduce subjectivity and variability, which in turn hinders the development and accuracy of the increasing numbers of electronic medical record (EMR) linked digital tools designed to predict clinical deterioration. Here, we describe a protocol for developing a new outcome measure using mixed methods to address these limitations. METHODS AND ANALYSIS: We will undertake firstly, a systematic literature review to identify existing generic, syndrome-specific and organ-specific definitions for clinically deteriorated, hospitalised adult patients. Secondly, an international modified Delphi study to generate a short list of candidate definitions. Thirdly, a nominal group technique (NGT) (using a trained facilitator) will take a diverse group of stakeholders through a structured process to generate a consensus definition. The NGT process will be informed by the data generated from the first two stages. The definition(s) for the deteriorated ward patient will be readily extractable from the EMR. ETHICS AND DISSEMINATION: This study has ethics approval (reference 16399) from the Central Adelaide Local Health Network Human Research Ethics Committee. Results generated from this study will be disseminated through publication and presentation at national and international scientific meetings.

Published
2022

9. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators

Author

Angus, D. C., Barnato, A. E., Bell, D., Bellomo, R., Chong, C.-R., Coats, T. J., Davies, A., Delaney, A., Harrison, D. A., Holdgate, A., Howe, B., Huang, D. T., Iwashyna, T., Kellum, J. A., Peake, S. L., Pike, F., Reade, M. C., Rowan, K. M., Singer, M., Webb, S. A. R., Weissfeld, L. A., Yealy, D. M., and Young, J. D.

Published
2015
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11. Potential Impact of the 2016 Consensus Definitions of Sepsis and Septic Shock on Future Sepsis Research

Author

Peake, Sandra L., Delaney, Anthony, Bailey, Michael, Bellomo, Rinaldo, Bennett, V., Board, J., McCracken, P., McGloughlin, S., Nanjayya, V., Teo, A., Hill, E., Jones, P., O’Brien, E., Sawtell, F., Schimanski, K., Wilson, D., Bellomo, R., Bolch, S., Eastwood, G., Kerr, F., Peak, L., Young, H., Edington, J., Fletcher, J., Smith, J., Ghelani, D., Nand, K., Sara, T., Cross, A., Flemming, D., Grummisch, M., Purdue, A., Fulton, E., Grove, K., Harney, A., Milburn, K., Millar, R., Mitchell, I., Rodgers, H., Scanlon, S., Coles, T., Connor, H., Dennett, J., Van Berkel, A., Barrington-Onslow, S., Henderson, S., Mehrtens, J., Dryburgh, J., Tankel, A., Braitberg, G., O’Bree, B., Shepherd, K., Vij, S., Allsop, S., Haji, D., Haji, K., Vuat, J., Bone, A., Elderkin, T., Orford, N., Ragg, M., Kelly, S., Stewart, D., Woodward, N., Harjola, V.-P., Okkonen, M., Pettilä, V., Sutinen, S., Wilkman, E., Fratzia, J., Halkhoree, J., Treloar, S., Ryan, K., Sandford, T., Walsham, J., Jenkins, C., Williamson, D., Burrows, J., Hawkins, D., Tang, C., Dimakis, A., Holdgate, A., Micallef, S., Parr, M., White, H., Morrison, L., Sosnowski, K., Ramadoss, R., Soar, N., Wood, J., Franks, M., Williams, A., Hogan, C., Song, R., Tilsley, A., Rainsford, D., Wells, R., Dowling, J., Galt, P., Lamac, T., Lightfoot, D., Walker, C., Braid, K., DeVillecourt, T., Tan, H. S., Seppelt, I., Chang, L. F., Cheung, W. S., Fok, S. K., Lam, P. K., Lam, S. M., So, H. M., Yan, W. W., Altea, A., Lancashire, B., Gomersall, C. D., Graham, C. A., Leung, P., Arora, S., Bass, F., Shehabi, Y., Isoardi, J., Isoardi, K., Powrie, D., Lawrence, S., Ankor, A., Chester, L., Davies, M., O’Connor, S., Poole, A., Soulsby, T., Sundararajan, K., Williams, J., Greenslade, J. H., MacIsaac, C., Gorman, K., Jordan, A., Moore, L., Ankers, S., Bird, S., Delaney, A., Fogg, T., Hickson, E., Jewell, T., Kyneur, K., O’Connor, A., Townsend, J., Yarad, E., Brown, S., Chamberlain, J., Cooper, J., Jenkinson, E., McDonald, E., Webb, S., Buhr, H., Coakley, J., Cowell, J., Hutch, D., Gattas, D., Keir, M., Rajbhandari, D., Rees, C., Baker, S., Roberts, B., Farone, E., Holmes, J., Santamaria, J., Winter, C., Finckh, A., Knowles, S., McCabe, J., Nair, P., Reynolds, C., Ahmed, B., Barton, D., Meaney, E., Nichol, A., Harris, R., Shields, L., Thomas, K., Karlsson, S., Kuitunen, A., Kukkurainen, A., Tenhunen, J., Varila, S., Ryan, N., Trethewy, C., Crosdale, J., Smith, J. C., Vellaichamy, M., Furyk, J., Gordon, G., Jones, L., Senthuran, S., Bates, S., Butler, J., French, C., Tippett, A., Kelly, J., Kwans, J., Murphy, M., O’Flynn, D., Kurenda, C., Otto, T., Peake, S., Raniga, V., Williams, P., Ho, H. F., Leung, A., and Wu, H.

Published
2017
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16. P445 Does The Sequence Matter ? Comparative effectiveness of a second line biologic in patients with Ulcerative Colitis: vedolizumab followed by an anti-TNF versus anti-TNF followed by vedolizumab

Author

Miller, C, primary, Kwok, H, additional, Parisi, I, additional, Harrow, P, additional, McCartney, S, additional, Vega, R, additional, Rahman, F, additional, Seward, E, additional, Mehta, S, additional, Lim, S, additional, Sharma, E, additional, Samaan, M, additional, Bancil, A, additional, Kok, K, additional, Shalabi, A, additional, Johnston, E, additional, Katarey, D, additional, Taherzadeh, N, additional, Murray, C, additional, Sharip, M, additional, Carter, M, additional, Radhakrishnan, S, additional, Peake, S, additional, Khakoo, I, additional, Wahed, M, additional, Povlsen, S, additional, Patel, M, additional, Dubois, P, additional, Finkel, J, additional, Onnie, C, additional, and Bloom, S, additional

Published
2021
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19. Clinical care of pregnant and postpartum women with COVID-19: Living recommendations from the National COVID-19 Clinical Evidence Taskforce.

Author

Burgess P., Morphet J., Nou S., Russo P., Sarson M., Young A., Norris S., Morris-Donovan B., Gurry S., Hudson E., Hurley S., Primmer D., Timms S., Whicker S., Mukherjee S., Booth K., Cameron P., Cooper M., Cheng A., Fowler P., Frydenberg M., McGloughlin S., McPhee E., Mitchell B., O'Donnell C., Parr M., Phillips J., Varndell W., Whyte I., Randall R., Brightwell R., Condon L., Deshpande A., Ehm A., Ferrie M., Muller J., Pullin L., Robinson E., Witt A., Larkins S., Morgan M., Taylor G., Agostino J., Douglas K., Ewald B., Fornasier D., Knight S., Nelson C., Peachey L., Peiris D., Driel M., Walters L., Weaver I., Burr L., Hendel S., Shekar K., Avard B., Cairns K., Glanville A., Gilroy N., Myles P., O'Sullivan R., Robinson O., Sharland C., McCarthy S., Wark P., McGoughlin S., Hodgson C., Ankravs M., Hansen K., Huckson S., Iredell J., Janerka C., Jaspers R., Litton E., Macdonald S., Peake S., Bowen A., McMullan B., Tingay D., Vasilunas N., Anderson L., Best J., Burns P., Erickson S., Fancourt N., Goff Z., Kapuya V., Keyte C., Malyon L., Wurzel D., Agar M., Lindley R., Smallwood N., Callary M., Chapman M., Good P., Jenkin P., Morgan D., Naganathan V., Srikanth V., Tuffin P., Whiting E., William L., Yates P., Barber B., Davies J., Davis J., Gwee A., Leder K., Matthews G., McMahon J., Peel T., Raftery C., Rees M., Roberts J., Seppelt I., Wibrow B., Baker R., Curnow J., Cutts B., Enjeti A., Forbes A., Ho P., Holyoak A., Liley H., McFadyen J., McQuilten Z., Merriman E., Savoia H., Tan C.W., Tran H., Ward C., Williams K., Ballard N., Bendall S., Bhanderi N., Byers L., Craig S., Ellis D., Ewald D., Fairley C., Hoggard B., Cong M.L., Morley P., Nair P., Pearce A., Turner T., Callesen H., Campbell S., Ring J., Wilson A., Henry D., Pearson S., Boyle D., Chidwick K., Chapman W., French C., Pearce C., Snelling T., Bero L., Grundy Q., Lexchin J., Mintzes B., Vogel J.P., Tendal B., Giles M., Whitehead C., Burton W., Chakraborty S., Cheyne S., Downton T., Fraile Navarro D., Gleeson G., Gordon A., Hunt J., Kitschke J., McDonald S., McDonnell N., Middleton P., Millard T., Murano M., Oats J., Tate R., White H., Elliott J., Roach V., Homer C.S.E., McGowan S., Ballenden N., Barrett T.-L., Beavis V., Saunders J.B., Buchanan T., Buchanan-Grey M., Casey D., Cowie M., Doyle J., Gnjidic D., Green S., Greenland R., Griffin K., Groombridge S., Hardy L., Hodak A., Holley A., Jovanovska V., Michaels K., Burgess P., Morphet J., Nou S., Russo P., Sarson M., Young A., Norris S., Morris-Donovan B., Gurry S., Hudson E., Hurley S., Primmer D., Timms S., Whicker S., Mukherjee S., Booth K., Cameron P., Cooper M., Cheng A., Fowler P., Frydenberg M., McGloughlin S., McPhee E., Mitchell B., O'Donnell C., Parr M., Phillips J., Varndell W., Whyte I., Randall R., Brightwell R., Condon L., Deshpande A., Ehm A., Ferrie M., Muller J., Pullin L., Robinson E., Witt A., Larkins S., Morgan M., Taylor G., Agostino J., Douglas K., Ewald B., Fornasier D., Knight S., Nelson C., Peachey L., Peiris D., Driel M., Walters L., Weaver I., Burr L., Hendel S., Shekar K., Avard B., Cairns K., Glanville A., Gilroy N., Myles P., O'Sullivan R., Robinson O., Sharland C., McCarthy S., Wark P., McGoughlin S., Hodgson C., Ankravs M., Hansen K., Huckson S., Iredell J., Janerka C., Jaspers R., Litton E., Macdonald S., Peake S., Bowen A., McMullan B., Tingay D., Vasilunas N., Anderson L., Best J., Burns P., Erickson S., Fancourt N., Goff Z., Kapuya V., Keyte C., Malyon L., Wurzel D., Agar M., Lindley R., Smallwood N., Callary M., Chapman M., Good P., Jenkin P., Morgan D., Naganathan V., Srikanth V., Tuffin P., Whiting E., William L., Yates P., Barber B., Davies J., Davis J., Gwee A., Leder K., Matthews G., McMahon J., Peel T., Raftery C., Rees M., Roberts J., Seppelt I., Wibrow B., Baker R., Curnow J., Cutts B., Enjeti A., Forbes A., Ho P., Holyoak A., Liley H., McFadyen J., McQuilten Z., Merriman E., Savoia H., Tan C.W., Tran H., Ward C., Williams K., Ballard N., Bendall S., Bhanderi N., Byers L., Craig S., Ellis D., Ewald D., Fairley C., Hoggard B., Cong M.L., Morley P., Nair P., Pearce A., Turner T., Callesen H., Campbell S., Ring J., Wilson A., Henry D., Pearson S., Boyle D., Chidwick K., Chapman W., French C., Pearce C., Snelling T., Bero L., Grundy Q., Lexchin J., Mintzes B., Vogel J.P., Tendal B., Giles M., Whitehead C., Burton W., Chakraborty S., Cheyne S., Downton T., Fraile Navarro D., Gleeson G., Gordon A., Hunt J., Kitschke J., McDonald S., McDonnell N., Middleton P., Millard T., Murano M., Oats J., Tate R., White H., Elliott J., Roach V., Homer C.S.E., McGowan S., Ballenden N., Barrett T.-L., Beavis V., Saunders J.B., Buchanan T., Buchanan-Grey M., Casey D., Cowie M., Doyle J., Gnjidic D., Green S., Greenland R., Griffin K., Groombridge S., Hardy L., Hodak A., Holley A., Jovanovska V., and Michaels K.

Abstract

To date, 18 living recommendations for the clinical care of pregnant and postpartum women with COVID-19 have been issued by the National COVID-19 Clinical Evidence Taskforce. This includes recommendations on mode of birth, delayed umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, antenatal corticosteroids, angiotensin-converting enzyme inhibitors, disease-modifying treatments (including dexamethasone, remdesivir and hydroxychloroquine), venous thromboembolism prophylaxis and advanced respiratory support interventions (prone positioning and extracorporeal membrane oxygenation). Through continuous evidence surveillance, these living recommendations are updated in near real-time to ensure clinicians in Australia have reliable, evidence-based guidelines for clinical decision-making. Please visit https://covid19evidence.net.au/ for the latest recommendation updates.Copyright © 2020 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Published
2021

20. The Australasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In Emergency Department Sepsis, a multicentre observational study (ARISE FLUIDS observational study): Rationale, methods and analysis plan.

Author

Keijzers G., Macdonald S.P.J., Udy A.A., Arendts G., Bailey M., Bellomo R., Blecher G.E., Burcham J., Delaney A., Coggins A.R., Fatovich D.M., Fraser J.F., Harley A., Jones P., Kinnear F., May K., Peake S., Taylor D.M., Williams J., Williams P., Keijzers G., Macdonald S.P.J., Udy A.A., Arendts G., Bailey M., Bellomo R., Blecher G.E., Burcham J., Delaney A., Coggins A.R., Fatovich D.M., Fraser J.F., Harley A., Jones P., Kinnear F., May K., Peake S., Taylor D.M., Williams J., and Williams P.

Abstract

Objective: There is uncertainty about the optimal i.v. fluid volume and timing of vasopressor commencement in the resuscitation of patients with sepsis and hypotension. We aim to study current resuscitation practices in EDs in Australia and New Zealand (the Australasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In Emergency Department Sepsis [ARISE FLUIDS] observational study). Method(s): ARISE FLUIDS is a prospective, multicentre observational study in 71 hospitals in Australia and New Zealand. It will include adult patients presenting to the ED during a 30 day period with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation. We will obtain data on baseline demographics, clinical and laboratory variables, all i.v. fluid given in the first 24 h, vasopressor use, time to antimicrobial administration, admission to intensive care, organ failure and in-hospital mortality. We will specifically describe (i) the volume of fluid administered at the following time points: when meeting eligibility criteria, in the first 6 h, at 24 h and prior to vasopressor commencement and (ii) the frequency and timing of vasopressor use in the first 6 h and at 24 h. Screening logs will provide reliable estimates of the proportion of ED patients meeting eligibility criteria for a subsequent randomised controlled trial. Discussion(s): This multicentre, observational study will provide insight into current haemodynamic resuscitation practices in patients with sepsis and hypotension as well as estimates of practice variation and patient outcomes. The results will inform the design and feasibility of a multicentre phase III trial of early haemodynamic resuscitation in patients presenting to ED with sepsis and hypotension.Copyright © 2019 Australasian College for Emergency Medicine

Published
2021

22. The Australasian Resuscitation In Sepsis Evaluation: Fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand.

Author

Tan E., Burcham J., Coggins A.R., Delaney A., Fatovich D.M., Fraser J.F., Harley A., Jones P., Kinnear F.B., May K., Peake S., Williams P., Nguyen K., Foong L.H., Hullick C., McNulty R., Na A., Trethewy C., Lutze L., Zhang M., Cowan T., Middleton P., Avis S., Vidler S., Salter M., Janes S., Harwood T., Oliver M., Jazayeri F., Jones S., Davoren M., Coggins A., Pradhananga B., Newby L., Beck S., Sandleback B., Rabas S., Harger S., Song R., Gutenstein M., Munro A., Connely M., Goodson J., Mclean A., Brabyn C., Mukerji S., Simmonds H., Young P., Sugeng Y., Bird C., McConnell A., Henderson P., Johnson D., Perez S., Mahani A., Orda U., Thom O., Roberts K., Kinnear F., Hazelwood S., Pham H., Eley R., Livesay G., Devlin M., Murdoch I., Wood E., Williams J., Brown N., King A., Sadewasser J., Jones L., Gangathimmaiah V., Manudhane A., Haustead D., Ascencio-Lane J.-C., Taylor D.M., Buntine P., Walker K., Pouryahya P., Crompton D., Sultana R., Campbell T., Dwyer R., Blecher G., Knott J., Mitra B., Luckhoff C., Young R., Rudling N., Mukherjee A., Dyke K.-L., Parker C., Cooper A., Nagree Y., Koay K., Kruger C., Ghedina N., Smedley B., Macdonald S., Hamersley H., Keijzers G., Macdonald S.P.J., Udy A.A., Arendts G., Bailey M., Bellomo R., Blecher G.E., Tan E., Burcham J., Coggins A.R., Delaney A., Fatovich D.M., Fraser J.F., Harley A., Jones P., Kinnear F.B., May K., Peake S., Williams P., Nguyen K., Foong L.H., Hullick C., McNulty R., Na A., Trethewy C., Lutze L., Zhang M., Cowan T., Middleton P., Avis S., Vidler S., Salter M., Janes S., Harwood T., Oliver M., Jazayeri F., Jones S., Davoren M., Coggins A., Pradhananga B., Newby L., Beck S., Sandleback B., Rabas S., Harger S., Song R., Gutenstein M., Munro A., Connely M., Goodson J., Mclean A., Brabyn C., Mukerji S., Simmonds H., Young P., Sugeng Y., Bird C., McConnell A., Henderson P., Johnson D., Perez S., Mahani A., Orda U., Thom O., Roberts K., Kinnear F., Hazelwood S., Pham H., Eley R., Livesay G., Devlin M., Murdoch I., Wood E., Williams J., Brown N., King A., Sadewasser J., Jones L., Gangathimmaiah V., Manudhane A., Haustead D., Ascencio-Lane J.-C., Taylor D.M., Buntine P., Walker K., Pouryahya P., Crompton D., Sultana R., Campbell T., Dwyer R., Blecher G., Knott J., Mitra B., Luckhoff C., Young R., Rudling N., Mukherjee A., Dyke K.-L., Parker C., Cooper A., Nagree Y., Koay K., Kruger C., Ghedina N., Smedley B., Macdonald S., Hamersley H., Keijzers G., Macdonald S.P.J., Udy A.A., Arendts G., Bailey M., Bellomo R., and Blecher G.E.

Abstract

Objectives: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. Method(s): This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. Result(s): A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87-100). Median time to first intravenous antimicrobials was 77 min (42-148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500-3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000-5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4-8.5%). Conclusion(s): Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy.Copyright © 2020 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian

Published
2020

23. The Australasian Resuscitation In Sepsis Evaluation: Fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand

Author

Keijzers, G, Macdonald, SPJ, Udy, AA, Arendts, G, Bailey, M, Bellomo, R, Blecher, GE, Burcham, J, Coggins, AR, Delaney, A, Fatovich, DM, Fraser, JF, Harley, A, Jones, P, Kinnear, FB, May, K, Peake, S, Taylor, DM, Williams, P, Khanh, N, Foong, LH, Hullick, C, McNulty, R, Na, A, Trethewy, C, Lutze, L, Zhang, M, Cowan, T, Middleton, P, Avis, S, Vidler, S, Salter, M, Janes, S, Harwood, T, Oliver, M, Jazayeri, F, Jones, S, Davoren, M, Coggins, A, Pradhananga, B, Newby, L, Beck, S, Sandleback, B, Rabas, S, Harger, S, Tan, E, Song, R, Gutenstein, M, Munro, A, Connely, M, Goodson, J, Mclean, A, Brabyn, C, Mukerji, S, Simmonds, H, Young, P, Sugeng, Y, Bird, C, McConnell, A, Henderson, P, Johnson, D, Perez, S, Mahani, A, Orda, U, Thom, O, Roberts, K, Kinnear, F, Hazelwood, S, Hanh, P, Eley, R, Livesay, G, Devlin, M, Murdoch, I, Wood, E, Williams, J, Brown, N, King, A, Sadewasser, J, Jones, L, Gangathimmaiah, V, Manudhane, A, Haustead, D, Ascencio-Lane, J-C, Buntine, P, Walker, K, Pouryahya, P, Crompton, D, Sultana, R, Campbell, T, Dwyer, R, Blecher, G, Knott, J, Mitra, B, Luckhoff, C, Young, R, Rudling, N, Mukherjee, A, Dyke, K-L, Parker, C, Cooper, A, Nagree, Y, Koay, K, Kruger, C, Ghedina, N, Smedley, B, Macdonald, S, Hamersley, H, Keijzers, G, Macdonald, SPJ, Udy, AA, Arendts, G, Bailey, M, Bellomo, R, Blecher, GE, Burcham, J, Coggins, AR, Delaney, A, Fatovich, DM, Fraser, JF, Harley, A, Jones, P, Kinnear, FB, May, K, Peake, S, Taylor, DM, Williams, P, Khanh, N, Foong, LH, Hullick, C, McNulty, R, Na, A, Trethewy, C, Lutze, L, Zhang, M, Cowan, T, Middleton, P, Avis, S, Vidler, S, Salter, M, Janes, S, Harwood, T, Oliver, M, Jazayeri, F, Jones, S, Davoren, M, Coggins, A, Pradhananga, B, Newby, L, Beck, S, Sandleback, B, Rabas, S, Harger, S, Tan, E, Song, R, Gutenstein, M, Munro, A, Connely, M, Goodson, J, Mclean, A, Brabyn, C, Mukerji, S, Simmonds, H, Young, P, Sugeng, Y, Bird, C, McConnell, A, Henderson, P, Johnson, D, Perez, S, Mahani, A, Orda, U, Thom, O, Roberts, K, Kinnear, F, Hazelwood, S, Hanh, P, Eley, R, Livesay, G, Devlin, M, Murdoch, I, Wood, E, Williams, J, Brown, N, King, A, Sadewasser, J, Jones, L, Gangathimmaiah, V, Manudhane, A, Haustead, D, Ascencio-Lane, J-C, Buntine, P, Walker, K, Pouryahya, P, Crompton, D, Sultana, R, Campbell, T, Dwyer, R, Blecher, G, Knott, J, Mitra, B, Luckhoff, C, Young, R, Rudling, N, Mukherjee, A, Dyke, K-L, Parker, C, Cooper, A, Nagree, Y, Koay, K, Kruger, C, Ghedina, N, Smedley, B, Macdonald, S, and Hamersley, H

Abstract

OBJECTIVES: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. METHODS: This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. RESULTS: A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87-100). Median time to first intravenous antimicrobials was 77 min (42-148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500-3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000-5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4-8.5%). CONCLUSION: Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy.

Published
2020

24. Gender differences in mortality and quality of life after septic shock: A post-hoc analysis of the ARISE study

Author

Luethi, N, Bailey, M, Higgins, A, Howe, B, Peake, S, Delaney, A, Bellomo, R, Bennett, V, Board, J, McCracken, P, McGloughlin, S, Nanjayya, V, Teo, A, Hill, E, O'Brien, PJE, Sawtell, F, Schimanski, K, Wilson, D, Bolch, S, Eastwood, G, Kerr, F, Peak, L, Young, H, Edington, J, Fletcher, J, Smith, J, Ghelani, D, Nand, K, Sara, T, Cross, A, Flemming, D, Grummisch, M, Purdue, A, Fulton, E, Grove, K, Harney, A, Milburn, K, Millar, R, Mitchell, I, Rodgers, H, Scanlon, S, Coles, T, Connor, H, Dennett, J, Van Berkel, A, Barrington-Onslow, S, Henderson, S, Mehrtens, J, Dryburgh, J, Tankel, A, Braitberg, G, O'Bree, B, Shepherd, K, Vij, S, Allsop, S, Haji, D, Haji, K, Vuat, J, Bone, A, Elderkin, T, Orford, N, Ragg, M, Kelly, S, Stewart, D, Woodward, N, Harjola, V-P, Pettila, MO, Sutinen, S, Wilkman, E, Fratzia, J, Halkhoree, J, Treloar, S, Ryan, K, Sandford, T, Walsham, J, Jenkins, C, Williamson, D, Burrows, J, Hawkins, D, Tang, C, Dimakis, A, Holdgate, A, Micallef, S, Parr, M, White, H, Morrison, L, Sosnowski, K, Ramadoss, R, Soar, N, Wood, J, Franks, M, Williams, A, Hogan, C, Song, R, Tilsley, A, Rainsford, D, Wells, R, Dowling, J, Galt, P, Lamac, T, Lightfoot, D, Walker, C, Braid, K, DeVillecourt, T, Tan, HS, Seppelt, I, Chang, LF, Cheung, WS, Fok, SK, Lam, PK, Lam, SM, So, HM, Yan, W, Altea, A, Lancashire, B, Gomersall, CD, Graham, CA, Leung, P, Arora, S, Bass, F, Shehabi, Y, Isoardi, J, Isoardi, K, Powrie, D, Lawrence, S, Ankor, A, Chester, L, Davies, M, O'Connor, S, Poole, A, Soulsby, T, Sundararajan, K, Williams, J, Greenslade, JH, MacIsaac, C, Gorman, K, Jordan, A, Moore, L, Ankers, S, Bird, S, Fogg, T, Hickson, E, Jewell, T, Kyneur, K, O'Connor, A, Townsend, J, Yarad, E, Brown, S, Chamberlain, J, Cooper, J, Jenkinson, E, McDonald, E, Webb, S, Buhr, H, Coakley, J, Cowell, J, Hutch, D, Gattas, D, Keir, M, Rajbhandari, D, Rees, C, Baker, S, Roberts, B, Farone, E, Holmes, J, Santamaria, J, Winter, C, Finckh, A, Knowles, S, McCabe, J, Nair, P, Reynolds, C, Ahmed, B, Barton, D, Meaney, E, Nichol, A, Harris, R, Shields, L, Thomas, K, Karlsson, S, Kuitunen, A, Kukkurainen, A, Tenhunen, J, Varila, S, Ryan, N, Trethewy, C, Crosdale, J, Smith, JC, Vellaichamy, M, Furyk, J, Gordon, G, Jones, L, Senthuran, S, Bates, S, Butler, J, French, C, Tippett, A, Kelly, J, Kwans, J, Murphy, M, O'Flynn, D, Kurenda, C, Otto, T, Raniga, V, Williams, P, Ho, HF, Leung, A, Wu, H, Luethi, N, Bailey, M, Higgins, A, Howe, B, Peake, S, Delaney, A, Bellomo, R, Bennett, V, Board, J, McCracken, P, McGloughlin, S, Nanjayya, V, Teo, A, Hill, E, O'Brien, PJE, Sawtell, F, Schimanski, K, Wilson, D, Bolch, S, Eastwood, G, Kerr, F, Peak, L, Young, H, Edington, J, Fletcher, J, Smith, J, Ghelani, D, Nand, K, Sara, T, Cross, A, Flemming, D, Grummisch, M, Purdue, A, Fulton, E, Grove, K, Harney, A, Milburn, K, Millar, R, Mitchell, I, Rodgers, H, Scanlon, S, Coles, T, Connor, H, Dennett, J, Van Berkel, A, Barrington-Onslow, S, Henderson, S, Mehrtens, J, Dryburgh, J, Tankel, A, Braitberg, G, O'Bree, B, Shepherd, K, Vij, S, Allsop, S, Haji, D, Haji, K, Vuat, J, Bone, A, Elderkin, T, Orford, N, Ragg, M, Kelly, S, Stewart, D, Woodward, N, Harjola, V-P, Pettila, MO, Sutinen, S, Wilkman, E, Fratzia, J, Halkhoree, J, Treloar, S, Ryan, K, Sandford, T, Walsham, J, Jenkins, C, Williamson, D, Burrows, J, Hawkins, D, Tang, C, Dimakis, A, Holdgate, A, Micallef, S, Parr, M, White, H, Morrison, L, Sosnowski, K, Ramadoss, R, Soar, N, Wood, J, Franks, M, Williams, A, Hogan, C, Song, R, Tilsley, A, Rainsford, D, Wells, R, Dowling, J, Galt, P, Lamac, T, Lightfoot, D, Walker, C, Braid, K, DeVillecourt, T, Tan, HS, Seppelt, I, Chang, LF, Cheung, WS, Fok, SK, Lam, PK, Lam, SM, So, HM, Yan, W, Altea, A, Lancashire, B, Gomersall, CD, Graham, CA, Leung, P, Arora, S, Bass, F, Shehabi, Y, Isoardi, J, Isoardi, K, Powrie, D, Lawrence, S, Ankor, A, Chester, L, Davies, M, O'Connor, S, Poole, A, Soulsby, T, Sundararajan, K, Williams, J, Greenslade, JH, MacIsaac, C, Gorman, K, Jordan, A, Moore, L, Ankers, S, Bird, S, Fogg, T, Hickson, E, Jewell, T, Kyneur, K, O'Connor, A, Townsend, J, Yarad, E, Brown, S, Chamberlain, J, Cooper, J, Jenkinson, E, McDonald, E, Webb, S, Buhr, H, Coakley, J, Cowell, J, Hutch, D, Gattas, D, Keir, M, Rajbhandari, D, Rees, C, Baker, S, Roberts, B, Farone, E, Holmes, J, Santamaria, J, Winter, C, Finckh, A, Knowles, S, McCabe, J, Nair, P, Reynolds, C, Ahmed, B, Barton, D, Meaney, E, Nichol, A, Harris, R, Shields, L, Thomas, K, Karlsson, S, Kuitunen, A, Kukkurainen, A, Tenhunen, J, Varila, S, Ryan, N, Trethewy, C, Crosdale, J, Smith, JC, Vellaichamy, M, Furyk, J, Gordon, G, Jones, L, Senthuran, S, Bates, S, Butler, J, French, C, Tippett, A, Kelly, J, Kwans, J, Murphy, M, O'Flynn, D, Kurenda, C, Otto, T, Raniga, V, Williams, P, Ho, HF, Leung, A, and Wu, H

Abstract

PURPOSE: To assess the impact of gender and pre-menopausal state on short- and long-term outcomes in patients with septic shock. MATERIAL AND METHODS: Cohort study of the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial, an international randomized controlled trial comparing early goal-directed therapy (EGDT) to usual care in patients with early septic shock, conducted between October 2008 and April 2014. The primary exposure in this analysis was legal gender and the secondary exposure was pre-menopausal state defined by chronological age (≤ 50 years). RESULTS: 641 (40.3%) of all 1591 ARISE trial participants in the intention-to-treat population were females and overall, 337 (21.2%) (146 females) patients were 50 years of age or younger. After risk-adjustment, we could not identify any survival benefit for female patients at day 90 in the younger (≤50 years) (adjusted Odds Ratio (aOR): 0.91 (0.46-1.89), p = .85) nor in the older (>50 years) age-group (aOR: 1.10 (0.81-1.49), p = .56). Similarly, there was no gender-difference in ICU, hospital, 1-year mortality nor quality of life measures. CONCLUSIONS: This post-hoc analysis of a large multi-center trial in early septic shock has shown no short- or long-term survival effect for women overall as well as in the pre-menopausal age-group.

Published
2020

32. CD32 expressing doublets in HIV-infected gut-associated lymphoid tissue are associated with a T follicular helper cell phenotype

Author

Thornhill, J, Pace, M, Martin, G, Hoare, J, Peake, S, Herrera, C, Phetsouphanh, C, Meyerowitz, J, Hopkins, E, Brown, H, Dunn, P, Olejniczak, N, Willberg, C, Klenerman, P, Goldin, R, Fox, J, Fidler, S, Frater, J, Investigators, Cherub, MRC DCS, British HIV Association (BHIVA), Merck Sharp & Dohme Ltd., Medical Research Council (MRC), and Medical Research Council

Subjects
Adult, Male, 0301 basic medicine, CD32, BLOOD, Gut-associated lymphoid tissue, Immunology, Gene Expression, HIV Infections, Biology, CXCR5, Immunophenotyping, Peyer's Patches, 03 medical and health sciences, 0302 clinical medicine, Antiretroviral Therapy, Highly Active, medicine, Humans, Immunology and Allergy, 11 Medical and Health Sciences, Aged, CHERUB investigators, B-Lymphocytes, Science & Technology, PERSISTENCE, Receptors, IgG, DNA, T-Lymphocytes, Helper-Inducer, Middle Aged, Viral Load, 06 Biological Sciences, Phenotype, CD4 Lymphocyte Count, 030104 developmental biology, Lymphatic system, medicine.anatomical_structure, Tonsil, HIV-1, biology.protein, Female, Life Sciences & Biomedicine, Viral load, Biomarkers, 030215 immunology
Abstract

Gut-associated lymphoid tissue (GALT) is a key location for the HIV reservoir. The observation that B-cell–T-cell doublets are enriched for CD32a (a low-affinity IgG receptor) in peripheral blood raises interesting questions, especially as these cells have been associated with HIV DNA in some studies. We sought to determine if similar doublets were present in GALT, the significance of these doublets, and their implications for the HIV reservoir. Given the importance of GALT as a reservoir for HIV, we looked for expression of CD32 on gut CD4 T cells and for evidence of doublets, and any relationship with HIV DNA in HIV + individuals initiated on antiretroviral therapy (ART) during primary HIV infection (PHI). Tonsil tissue was also available for one individual. As previously shown for blood, CD32high CD4 cells were mainly doublets of CD4 T cells and B cells, with T-cell expression of ICOS in tonsil and gut tissue. CD4 T cells associated with CD32 (compared with ‘CD32−' CD4 cells) had higher expression of follicular markers CXCR5, PD-1, ICOS, and Bcl-6 consistent with a T follicular helper (TFH) phenotype. There was a significant correlation between rectal HIV DNA levels and CD32 expression on TFH cells. Together, these data suggest that CD32high doublets are primarily composed of TFH cells, a subset known to be preferentially infected by HIV.

Published
2019

34. Free Papers

Author

Emmanuel, G., Carranza, S., Vettichira, S., Paradis, M., Lie, T., Kessler, P., Schini-Kerth, V. B., Koh, Y., Hybertson, B. M., Jepson, E. K., Kim, M. J., Lee, I., Lim, C. M., Lee, S. D., Kim, W. S., Kim, D. S., Kim, W. D., Repine, J. E., Takeda, T., Yukioka, T., Matsuda, H., Shimazaki, S., Kammermeier, D., Birkmann, J., Blinzler, L., Gallmeier, W. M., Heuser, D., Jourdain, M., Mangalaboyi, J., Carrette, O., Toumoys, A., Fourrier, F., Mizon, J., Chopin, C., Peake, S. L., Carter, J. K., Russ, R. G., Pierides, J., Leppard, J. P., Porter, K., Galley, H. F., Webster, N. R., Wigmore, S. J., Walsh, T. S., Hopton, P., Lee, A., Ross, J. A., Majcherczyk, P. A., Pugin, J., Glauser, M. P., Heumann, D., Zanetti, G., de Werra, I., Sablotzki, A., Welters, I., Menges, T., Görlach, G., Lehmann, N., Hempelmann, G., Giannitsis, E., Tettenborn, I., Stierle, U., Dalhoff, K., Sheikhzadeh, A., Diederich, K. W., Gant, V., Maciver, C., Treacher, D. F., Lamy, M., Thijs, L. G., Eisele, B., Keinecke, H. -O., Schuster, H. P., Matthias, F. R., Oettinger, W., Hartenauer, U., Fourrier, F., Delvos, U., Stott, S. A., Noble, D. W., Schobersberger, W., Hoffmann, G., Fandrey, J., Bellingan, G. J., Caldwell, H., Dransfield, I., Howie, S. M., Haslett, C., Liaudet, L., Feihl, F., Markert, M., Perret, C., Williams, M. A., Rhoades, C., White, S. A., Miller, J., Withington, S., Newland, A. C., Kelsey, S. M., Froon, A., Bonten, M., Gaillard, C., Greve, J., de Leeuw, P., Drent, M., Stobberingh, E., Buurman, W., Fourcade, O., Simon, M. -F., Leballe, F., Ashraf, R., Sarda, L., Cathala, B., Chap, H., Reper, P., Danckaert, R., Jeunen, R., Bruyns, T., De Hemptinne, J., and Vanderkelen, A.

Published
1996
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36. Initiation of vasopressor infusions via peripheral versus central access in patients with early septic shock: A retrospective cohort study

Author

Delaney, A, Finnis, M, Bellomo, R, Udy, A, Jones, D, Keijzers, G, Macdonald, S, Peake, S, Delaney, A, Finnis, M, Bellomo, R, Udy, A, Jones, D, Keijzers, G, Macdonald, S, and Peake, S

Abstract

OBJECTIVE: To assess whether the initiation of vasopressor infusions via peripheral venous catheters (PVC) compared to central venous catheters (CVC) in ED patients with early septic shock was associated with differences in processes of care and outcomes. METHODS: We conducted a post-hoc analysis of the ARISE trial. We compared participants who had a vasopressor infusion first commenced via a PVC versus a CVC. The primary outcome was 90 day mortality. RESULTS: We studied 937 participants. Of these, 389 (42%) had early vasopressor infusion commenced via a PVC and 548 (58%) via a CVC. Trial participants who received a vasopressor infusion via a PVC were more severely ill, with higher median (interquartile range [IQR]) Acute Physiology And Chronic Health Evaluation (APACHE II) scores (17 [13-23] versus 16 [12-21], P = 0.003), and higher median (IQR) lactate (mmol/L) (3.6 [1.9-5.8] versus 2.5 [1.5-4.5], P < 0.001). After adjusting for baseline covariates, the estimated odds ratio for mortality for PVC-treated patients was 1.26 (95% confidence interval 0.95-1.67, P = 0.11). Trial participants who had vasopressors commenced via PVC had a shorter median (IQR) time to commencement of antimicrobials (55 [32-96] versus 71.5 [39-119] min, P < 0.001) and a shorter median (IQR) time to commencement of vasopressors (2.4 [1.3-3.9] versus 4.9 [3.5-6.6] h, P < 0.001). CONCLUSION: The practice of commencing a vasopressor infusion via a PVC was common in the ARISE trial and more frequent in trial participants with higher severity of illness. Commencement of a vasopressor infusion via a PVC was associated with some improvements in processes of care and, after adjustment, was not associated with an increased risk of death.

Published
2019

37. The Australasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In Emergency Department Sepsis, a multicentre observational study (ARISE FLUIDS observational study): Rationale, methods and analysis plan

Author

Keijzers, G, Macdonald, SPJ, Udy, AA, Arendts, G, Bailey, M, Bellomo, R, Blecher, GE, Burcham, J, Delaney, A, Coggins, AR, Fatovich, DM, Fraser, JF, Harley, A, Jones, P, Kinnear, F, May, K, Peake, S, Taylor, DM, Williams, J, Williams, P, Keijzers, G, Macdonald, SPJ, Udy, AA, Arendts, G, Bailey, M, Bellomo, R, Blecher, GE, Burcham, J, Delaney, A, Coggins, AR, Fatovich, DM, Fraser, JF, Harley, A, Jones, P, Kinnear, F, May, K, Peake, S, Taylor, DM, Williams, J, and Williams, P

Abstract

OBJECTIVE: There is uncertainty about the optimal i.v. fluid volume and timing of vasopressor commencement in the resuscitation of patients with sepsis and hypotension. We aim to study current resuscitation practices in EDs in Australia and New Zealand (the Australasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In Emergency Department Sepsis [ARISE FLUIDS] observational study). METHODS: ARISE FLUIDS is a prospective, multicentre observational study in 71 hospitals in Australia and New Zealand. It will include adult patients presenting to the ED during a 30 day period with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation. We will obtain data on baseline demographics, clinical and laboratory variables, all i.v. fluid given in the first 24 h, vasopressor use, time to antimicrobial administration, admission to intensive care, organ failure and in-hospital mortality. We will specifically describe (i) the volume of fluid administered at the following time points: when meeting eligibility criteria, in the first 6 h, at 24 h and prior to vasopressor commencement and (ii) the frequency and timing of vasopressor use in the first 6 h and at 24 h. Screening logs will provide reliable estimates of the proportion of ED patients meeting eligibility criteria for a subsequent randomised controlled trial. DISCUSSION: This multicentre, observational study will provide insight into current haemodynamic resuscitation practices in patients with sepsis and hypotension as well as estimates of practice variation and patient outcomes. The results will inform the design and feasibility of a multicentre phase III trial of early haemodynamic resuscitation in patients presenting to ED with sepsis and hypotension.

Published
2019

38. Can pre-hospital administration reduce time to initial antibiotic therapy in septic patients?

Author

Cudini, D, Smith, K, Bernard, S, Stephenson, M, Andrew, E, Cameron, P, Lum, M, Udy, A, Peake, S, Delaney, A, Bellomo, R, Cameron, PA, Cooper, DJ, Cross, A, Gomersall, C, Graham, C, Higgins, AM, Holdgate, A, Howe, BD, Jacobs, I, Johanson, S, Jones, P, Kruger, P, McArthur, C, Myburgh, J, Nichol, A, Pettila, V, Rajbhandari, D, Webb, SAR, Williams, A, Williams, J, Williams, P, Cudini, D, Smith, K, Bernard, S, Stephenson, M, Andrew, E, Cameron, P, Lum, M, Udy, A, Peake, S, Delaney, A, Bellomo, R, Cameron, PA, Cooper, DJ, Cross, A, Gomersall, C, Graham, C, Higgins, AM, Holdgate, A, Howe, BD, Jacobs, I, Johanson, S, Jones, P, Kruger, P, McArthur, C, Myburgh, J, Nichol, A, Pettila, V, Rajbhandari, D, Webb, SAR, Williams, A, Williams, J, and Williams, P

Abstract

OBJECTIVE: To quantify the potential time saved with pre-hospital antibiotic therapy in sepsis. METHODS: Study data for adult patients transported by Ambulance Victoria (AV), and enrolled into the Australasian Resuscitation In Sepsis Evaluation (ARISE), were linked with pre-hospital electronic records. RESULTS: An AV record was identified for 240 of 341 ARISE patients. The pre-hospital case notes referred to potential infection in 165 patients. The median time to first antibiotic administration from loading the patient into the ambulance was 107 (74-160) min. CONCLUSIONS: ARISE patients in Victoria were frequently identified pre-hospital. An opportunity exists to study the feasibility of pre-hospital antibiotic therapy.

Published
2019

41. Time to antimicrobial therapy in septic shock patients treated with an early goal‐directed resuscitation protocol: A post‐hoc analysis of the ARISE trial.

Author

Bulle, Esther B, Peake, Sandra L, Finnis, Mark, Bellomo, Rinaldo, Delaney, Anthony, Peake, S., Delaney, A., Bellomo, R., Cameron, P. A., Higgins, A. M., Holdgate, A., Howe, B.D., Webb, S.A.R., Williams, P., Cooper, D. J., Cross, A., Gomersall, C., Graham, C., Higgins, A.M., and Jacobs, I.

Subjects
STATISTICS, HOSPITAL emergency services, CONFIDENCE intervals, DESCRIPTIVE statistics, RESUSCITATION, DATA analysis, ODDS ratio, SEPTIC shock, ANTIBIOTICS
Abstract

Objective: Intravenous antimicrobial therapy within 1 h of the diagnosis of septic shock is recommended in international sepsis guidelines. We aimed to evaluate the association between antimicrobial timing and mortality in patients presenting to the ED with septic shock. Methods: Post‐hoc analysis of 1587 adult participants enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) multicentre trial of early goal‐directed therapy for whom the time of initial antimicrobial therapy was recorded. We compared participants who had initiation of antimicrobials within the first hour (early) or later (delayed) of ED presentation. A propensity score model using inverse probability of treatment weighting was constructed to account for confounding baseline covariates. The primary outcome was 90‐day mortality. Results: The median (interquartile range) time to initiating antimicrobials was 69 (39–112) min with 712 (44.9%) participants receiving the first dose within the first hour of ED presentation. Compared with delayed therapy, early administration was associated with increased baseline illness severity score and greater intensity of resuscitation pre‐randomisation (fluid volumes, vasopressors, invasive ventilation). All‐cause 90‐day mortality was also higher; 22.6% versus 15.5%; unadjusted odds ratio (OR) 1.58 (95% confidence interval [CI] 1.16–2.15), P = 0.004. After inverse probability of treatment weighting, the mortality difference was non‐significant; OR 1.30 (95% CI 0.95–1.76), P = 0.1. Live discharge rates from ICU (OR 0.81, 95% CI 0.72–0.91; P = 0.80) and hospital (OR 0.93, 95% CI 0.82–1.06; P = 0.29) were also not different between groups. Conclusion: In this post‐hoc analysis of the ARISE trial, early antimicrobial therapy was associated with increased illness severity, but 90‐day adjusted mortality was not reduced. [ABSTRACT FROM AUTHOR]

Published
2021
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46. Haemoglobin concentration and volume of intravenous fluids in septic shock in the ARISE trial.

Author

Peake S., Bellomo R., Bailey M., Delaney A., McRae S., Maiden M.J., Finnis M.E., Peake S., Bellomo R., Bailey M., Delaney A., McRae S., Maiden M.J., and Finnis M.E.

Abstract

Background: Intravenous fluids may contribute to lower haemoglobin levels in patients with septic shock. We sought to determine the relationship between the changes in haemoglobin concentration and the volume of intravenous fluids administered during resuscitation from septic shock. Method(s): We performed a retrospective cohort study of patients enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial who were not transfused red blood cells (N = 1275). We determined the relationship between haemoglobin concentration, its change over time and volume of intravenous fluids administered over 6, 24 and 72 h using univariate and multivariate analysis. Result(s): Median (IQR) haemoglobin concentration at baseline was 133 (118-146) g/L and decreased to 115 (102-127) g/L within the first 6 h of resuscitation (P < 0.001), 110 (99-122) g/L after 24 h, and 109 (97-121) g/L after 72 h. At the corresponding time points, the cumulative volume of intravenous fluid administered was 1.3 (0.7-2.2) L, 2.9 (1.8-4.3) L and 4.6 (2.7-7.1) L. Haemoglobin concentration and its change from baseline had an independent but weak association with intravenous fluid volume at each time point (R 2 < 20%, P < 0.001). After adjusting for covariates, each litre of intravenous fluid administered was associated with a change in haemoglobin concentration of - 1.0 g/L (95% CI -1.5 to -0.6, P < 0.001) at 24 h and - 1.3 g/L (-1.6 to - 0.9, P < 0.001) at 72 h. Conclusion(s): Haemoglobin concentration decreases during resuscitation from septic shock, and has a significant but weak association with the volume of intravenous fluids administered.Copyright © 2018 The Author(s).

Published
2018

47. Haemoglobin concentration and volume of intravenous fluids in septic shock in the ARISE trial

Author

Maiden, MJ, Finnis, ME, Peake, S, McRae, S, Delaney, A, Bailey, M, Bellomo, R, Maiden, MJ, Finnis, ME, Peake, S, McRae, S, Delaney, A, Bailey, M, and Bellomo, R

Abstract

BACKGROUND: Intravenous fluids may contribute to lower haemoglobin levels in patients with septic shock. We sought to determine the relationship between the changes in haemoglobin concentration and the volume of intravenous fluids administered during resuscitation from septic shock. METHODS: We performed a retrospective cohort study of patients enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial who were not transfused red blood cells (N = 1275). We determined the relationship between haemoglobin concentration, its change over time and volume of intravenous fluids administered over 6, 24 and 72 h using univariate and multivariate analysis. RESULTS: Median (IQR) haemoglobin concentration at baseline was 133 (118-146) g/L and decreased to 115 (102-127) g/L within the first 6 h of resuscitation (P < 0.001), 110 (99-122) g/L after 24 h, and 109 (97-121) g/L after 72 h. At the corresponding time points, the cumulative volume of intravenous fluid administered was 1.3 (0.7-2.2) L, 2.9 (1.8-4.3) L and 4.6 (2.7-7.1) L. Haemoglobin concentration and its change from baseline had an independent but weak association with intravenous fluid volume at each time point (R2 < 20%, P < 0.001). After adjusting for covariates, each litre of intravenous fluid administered was associated with a change in haemoglobin concentration of - 1.0 g/L (95% CI -1.5 to -0.6, P < 0.001) at 24 h and - 1.3 g/L (- 1.6 to - 0.9, P < 0.001) at 72 h. CONCLUSIONS: Haemoglobin concentration decreases during resuscitation from septic shock, and has a significant but weak association with the volume of intravenous fluids administered.

Published
2018

49. Intensive care discharge delay is associated with increased hospital length of stay: A multicentre prospective observational study.

Author

Eastwood G., Mitchell I., Pilcher D., Rickerby S., Goldsmith D., Tiruvoipati R., Botha J., Fletcher J., Gangopadhyay H., Majumdar M., Vij S., Paul E., French C., McArthur C., Peake S., Parke R., Gattas D., Saxena M., Young P., Cohen J., Deane A., Cooper D., Udy A., Litton E., Erickson S., Eastwood G., Mitchell I., Pilcher D., Rickerby S., Goldsmith D., Tiruvoipati R., Botha J., Fletcher J., Gangopadhyay H., Majumdar M., Vij S., Paul E., French C., McArthur C., Peake S., Parke R., Gattas D., Saxena M., Young P., Cohen J., Deane A., Cooper D., Udy A., Litton E., and Erickson S.

Abstract

Background: Some patients experience a delayed discharge from the intensive care unit (ICU) where the intended and actual discharge times do not coincide. The clinical implications of this remain unclear. Objective(s): To determine the incidence and duration of delayed ICU discharge, identify the reasons for delay and evaluate the clinical consequences. Method(s): Prospective multi-centre observational study involving five ICUs over a 3-month period. Delay in discharge was defined as >6 hours from the planned discharge time. The primary outcome measure was hospital length stay after ICU discharge decision. Secondary outcome measures included ICU discharge after-hours, incidence of delirium, survival to hospital discharge, discharge destination, the incidence of ICU acquired infections, revocation of ICU discharge decision, unplanned readmissions to ICU within 72 hours, review of patients admitting team after ICU discharge decision. Result(s): A total of 955 out of 1118 patients discharged were included in analysis. 49.9% of the patients discharge was delayed. The most common reason (74%) for delay in discharge was non-availability of ward bed. The median duration of the delay was 24 hours. On univariable analysis, the duration of hospital stay from the time of ICU discharge decision was significantly higher in patients who had ICU discharge delay (Median days-5 vs 6; p = 0.003). After-hours discharge was higher in patients whose discharge was delayed (34% Vs 10%; p<0.001). There was no statistically significant difference in the other secondary outcomes analysed. Multivariable analysis adjusting for known confounders revealed delayed ICU discharge was independently associated with increased hospital length of stay. Conclusion(s): Half of all ICU patients experienced a delay in ICU discharge. Delayed discharge was associated with increased hospital length of stay.Copyright © 2017 Tiruvoipati et al. This is an open access article distributed under the terms of the Cre

Published
2017

50. Antibiotic use and impact on outcome from bacteraemic critical illness: the BActeraemia Study in Intensive Care (BASIC)

Author

Corona, A, Bertolini, G, Lipman, J, Wilson, Ap, Singer, M, Rodriguez, A, Cueto, G, Canales, Hs, Acosta Gnass, S, Marinoni, M, Becherucci, A, Baccaro, F, Peake, S, Reece, G, Blythe, D, Mcfayden, B, French, C, Hawker, F, Dobb, G, Seppelt, I, Finfer, S, Skowronski, G, Banerjee, A, Richards, B, Neumark, G, Hiesmayr, M, Rutraert, P, Franck, S, Spapen, H, Ludovic, L, Bruzzi de Carvalho, F, Souza, P, Gasparovic, V, Barsic, B, Chytra, I, Novak, I, Pestel, G, Kaiser, S, Giokas, G, Matamis, D, Yap Hiu Yi, F, Kapadia, F, Iqbal, M, Batoli, T, Costanzo, E, Pistocchini, A, Acquarolo, A, Greco, S, Di Masi, P, Quattrocchi, P, Navarra, M, Rotella, S, Giugiaro, P, Todesco, L, Borromeo, R, Ostando, M, Benassai, C, Pezzi, G, Marchi, M, Luise, C, Di Filippo, A, Mangani, V, Pelagatti, C, Pasetti, G, Salvi, G, Salcuni, R, Marongiu, A, Tavola, M, Rossi, G, Biffali, F, Brunori, E, Piccioni, G, Guadagnucci, A, David, Antonio, Pulici, M, Ughi, F, Sicignano, A, Leggieri, C, Fiore, G, Banfi, G, Lanza, S, Postiglione, M, Bosso, R, Piga, G, Croce, G, Sapuppo, Mf, Giarratano, A, Barbagallo, M, Favetta, P, Gorietti, A, Breschi, C, Andrei, O, Bertolini, R, Bonfà, A, Rossi, S, Asti, A, Rendina, F, Bilotta, F, Azzeri, F, Piacevoli, Q, Hellmann, F, Vaira, C, Avarello, N, Clementi, S, Della Valle, A, Segala, V, Berardino, M, Vaj, M, Sega, P, Bcchi, A, Pizzaballa, Ml, Cohen, J, Sprung, C, Hashimoto, S, Baskiene, R, Mcdonald, J, Sollid, S, Paiva, Ja, Moreno, R, Gloria, C, Yaghi, A, Voga, G, Joo Lee, Y, Zaragoza, R, Valles, J, Gonzalez Diaz, G, Alvarez Lerma, F, Sirvent, Jm, Herve, Z, Romand, Ja, Niblett, D, Laurenson, J, Peters, T, von der Osten, I, and Tomic, V.

Subjects
Adult, Male, Microbiology (medical), medicine.medical_specialty, Pediatrics, Asia, Critical Care, medicine.drug_class, Critical Illness, Antibiotics, Bacteremia, Microbial Sensitivity Tests, Outcome (game theory), Pharmacotherapy, Intensive care, Epidemiology, medicine, Humans, Pharmacology (medical), Prospective Studies, Antibiotic use, Intensive care medicine, bloodstream infections, critically ill patients, prevalence, antibiotic strategy, Aged, Aged, 80 and over, Pharmacology, Australasia, business.industry, Septic shock, Mortality rate, Odds ratio, Middle Aged, South America, medicine.disease, Drug Utilization, Confidence interval, Anti-Bacterial Agents, Europe, Treatment Outcome, Infectious Diseases, Critical illness, Female, business, Fungemia
Abstract

The lack of prospective, randomized, controlled trial data to guide optimal antibiotic use in bacteraemic critically ill patients has led to a wide variety of strategies and major issues with drug resistance. We therefore prospectively investigated the epidemiology of bacteraemia and fungaemia in intensive care units (ICUs); and the impact of timing, type and appropriateness of antibiotic intervention.We conducted a multinational, multicentre, prospective observational study in 132 ICUs from 26 countries with no interventions.1702 patients [European (69.6%), Australasian (12.2%), South American (8.3%) and Asian (9.9%)] developed 1942 bacteraemic episodes over the study period. Mortality rates were similar for those receiving empirical (40.5%), semi-targeted (37.6%) or fully targeted (33.3%) antibiotic therapy (P=0.40), and in those initially receiving broad- (39.3%) or restricted-spectrum (39.1%) therapy (P=0.94). First-line therapy was effective in terms of the antibiogram (where available) in 70.4% of cases. This in vitro susceptibility ranged from 76.3% for broad-spectrum antibiotics to 46.3% for restricted-spectrum antibiotics (P0.0001). However, no antibiotic policy-associated variable, including in vitro susceptibility (odds ratio 0.89, 95% confidence interval 0.61-1.30), was a statistically significant predictor of mortality.We could not show an impact of antibiotics on mortality in critically ill patients, despite in vitro activity and early commencement. Randomized, multicentre trials are urgently needed to establish the appropriate duration, timing and combinations of antibiotics that will both optimally treat infection and minimize development of resistance and other complications.

Published
2010

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