Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine

Publisher: Australasian Academy of Critical Care Medicine, College of Intensive Care Medicine of Australia and New Zealand

Journal description

Current impact factor: 2.15

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 2.154
2012 Impact Factor 1.507
2011 Impact Factor 1.671

Impact factor over time

Impact factor
Year

Additional details

5-year impact 0.00
Cited half-life 4.40
Immediacy index 0.39
Eigenfactor 0.00
Article influence 0.00
Other titles Critical care and resuscitation (Online), Journal of the Australasian Academy of Critical Care Medicine
ISSN 1441-2772
OCLC 223326394
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

College of Intensive Care Medicine of Australia and New Zealand

  • Pre-print
    • Author cannot archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Classification
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Publications in this journal

  • Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):151-2.
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    ABSTRACT: We hypothesise that there exists a substantial and growing group of "persistently critically ill" patients who appear to be intensive care unit-dependent because of a cascade of critical illnesses rather than their original ICU admitting diagnosis. These persistently critically ill patients are those who remain in the ICU because of ongoing complications of care that continue after their reason for admission has been treated and is no longer active. We believe such patients can be distinguished from patients currently labelled as "chronic critical illness" or "prolonged mechanical ventilation". We further believe that their primary problem is not simply failure to wean from mechanical ventilation due to muscle weakness and impaired gas exchange. We outline a program of clinician consultation, epidemiological research, consensus conference and validation to develop a useful definition of persistent critical illness, with the aim of supporting investigations in preventing persistence, and improving the care of patients so affected.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):215-8.
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    ABSTRACT: To identify the characteristics of patients with "persistent critical illness" (PerCI), as perceived by Australian and New Zealand intensive care unit clinicians. Patients with PerCI were defined as those whose reason for being in the ICU was now more related to their ongoing critical illness than their original reason for admission to the ICU. Using a web-based survey, we recruited clinicians affiliated with the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group (CTG) who cared for adults. Clinicians included doctors, nurses, physiotherapists, dietitians, research managers and others. We used the ANZICS-CTG mailing list to email a single request for anonymous participation. A total of 101 eligible clinicians responded to our survey. PerCI was believed to develop after a median of 10 days (IQR, 7-14 days), and to be somewhat uncommon (occurring in 10% of all ICU patients [IQR, 5%-15%], and in 50% of all patients with a prolonged ICU length of stay [IQR, 20%-60%]). Ninety per cent of respondents thought that patients with PerCI required ongoing invasive mechanical ventilation, and the most common problems were thought to be respiratory insufficiency (68%), delirium (59%) and acquired neuromuscular disease (54%). Ten per cent of patients with PerCI were expected to be alive and well and at home 6 months after ICU discharge, with another 15% alive and at home but requiring significant help. The remainder were expected to die within 6 months or to need institutional care. Patients with PerCI appear to be an identifiable group of ICU patients, with definable characteristics, substantial stress associated with their care, and poor perceived long-term outcomes.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):153-8.
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    ABSTRACT: To quantify the time that intensive care unit registrars spend on different work tasks with other health professionals and patients and using information resources, and to compare them with those of clinicians in general wards and the emergency department (ED). A prospective, observational time-and-motion study of two ICUs with a total of 71 beds at two major teaching hospitals in Sydney. Twenty-six registrars were observed between 08:00 and 18:00 on weekdays for a total of 160.52 hours. Proportions of time spent on different tasks, using specific information resources, working with other health professionals and patients, and rates of multitasking and interruptions. A total of 12 043 distinct tasks were observed. Registrars spent 69.2% of time working at patients' bedsides, 49.6% in professional communication and 39.0% accessing information resources. Half of their time (53.8%) was spent with other ICU doctors and 29.2% with nurses. Compared with doctors and nurses on general wards, and doctors in the ED, ICU registrars were more likely to multitask (40.1 times/hour [24.4% of their time]). ICU registrars had a higher interruption rate than ward clinicians, (4.2 times/hour), but a lower rate than ED doctors. Face-to-face communication and information seeking consume a vast proportion of ICU registrars' time. Multitasking and handling frequent interruptions characterise their work, and such behaviours may create an increased risk of task errors. Electronic clinical information systems may be particularly beneficial in this information-rich environment.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):159-66.
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    ABSTRACT: Many critically ill patients require supplemental oxygen. However, the optimal oxygen saturation measured by pulse oximetry (SpO2) in intensive care unit patients is unknown. To evaluate clinical practice in Australia and New Zealand ICUs in relation to SpO2 monitoring, prescription of SpO2 targets by doctors, and upper and lower limits of tolerance of high and low SpO2 levels by ICU bedside nurses. Cross-sectional, observational study conducted on 2 days in 2013 involving adult patients in Australia and New Zealand ICUs. Data from 350 adult ICU patients were included. SpO2 alarms were less likely to be disabled in patients who were invasively ventilated than in patients not receiving supplemental oxygen (4.8% v 15.1%; P = 0.02). In mechanically ventilated patients and non-ventilated patients receiving supplemental oxygen, the lower prescribed SpO2 limit and the ICU bedside nurses' stated limits for action for low SpO2 levels were 92% (interquartile range, 90%-94%). Upper SpO2 limits were less frequently prescribed than lower SpO2 limits (4.9% [95% CI, 3.0%- 7.7%] v 36.6% [95% CI, 31.7%-41.7%]); P < 0.01) and the observed SpO2 exceeded the prescribed upper limit on 10/17 occasions (59%) when an upper limit was prescribed. Our findings suggest a relatively low level of vigilance in relation to prevention of high SpO2 compared with low SpO2 for adult patients in Australian and New Zealand ICUs.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):202-7.
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    ABSTRACT: Variations in blood glucose (BG), hyperglycaemia and hypoglycaemia are associated with adverse clinical outcomes in intensive care unit patients. Continuous glucose monitoring (CGM) offers the potential to improve BG control, leading to improved patient outcomes. In our product development study, we determined the safety and performance of the GluCath Intravascular CGM System for up to 48 hours in 20 patients admitted to the ICU after cardiac surgery. The GluCath system uses a quenched chemical fluorescence mechanism to optically measure glucose in blood. After undergoing elective cardiac surgery, 20 patients had a GluCath sensor inserted through a preexisting radial artery (RA) catheter, and BG was monitored for up to 48 hours. Qualitative measures included effects on patient care, blood pressure monitoring, and ease of blood sampling through the arterial catheter. Safety assessment of the sensor involved ultrasound (US) monitoring for intra-arterial thrombi. Quantitative measures were the accuracy of the sensor in comparison with the reference analyser, and the proportion of paired BG measurements that were compliant with the ISO15197:2003 and CLSI POCT 12-A3 accuracy reference standards. BG was managed according to usual protocols. Twenty sensors were successfully deployed through pre-existing RA catheters and stayed in the RA of the 20 patients for between 6 and 48 hours, with a median time of 45.0 hours (interquartile range, 42.0-47.3 hours). Sixteen of the inserted sensors (80%) remained in situ for more than 40 hours. Three catheters were removed due to clinically significant sampling difficulty or waveform dampening. Two patients had US evidence of a thrombus; in neither patient was the sensor removed early, and there were no significant sequelae or adverse effects detected. For the 758 paired measurements available for performance analysis, reference BG values ranged between 5.3mmol/L and 12.8mmol/L. Of the 758 paired sensor measurements, 735 (97.0%) met the ISO15197:2003 criteria (within 20% of a reference measurement when BG is ≥ 4.2mmol/L [75mg/dL]), and 648 (85.5%) met the CLSI POCT 12-A3 criteria (within 12.5% of a reference measurement when the BG level is ≥ 5.6mmol/L [100mg/dL] and within 0.67mmol/L [12mg/dL] when the BG level is < 5.6mmol/L [100 mg/dL]). The aggregate mean absolute relative difference (MARD) between the sensor and the reference BG was 6.4%, with individual sensor MARDs ranging from 3.6% to 12.4%. The GluCath system, using quenched fluorescence sensing, was safe and showed acceptable accuracy when deployed for up to 48 hours in ICU patients after elective cardiac surgery.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):190-6.
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    ABSTRACT: High-flow nasal cannula (HFNC) therapy is increasingly used in paediatric intensive care unit (PICU) patients, despite a paucity of studies. We describe its use over the 3 years since its implementation in our tertiary intensive care unit. The clinical database was used to identify PICU patients on HFNC therapy from 2011 to 2013. Patients were assessed for risk factors, underlying diagnosis, viral test results and cardiorespiratory parameters before and after HFNC therapy. Fifty-four children were included with a median age of 3.5 months (interquartile range [IQR], 1-10 months) and 59% were females. The commonest diagnosis was bronchiolitis (79%). HFNC therapy was successful in 78% of patients and failed for 12 (seven patients went on to CPAP treatment and five were intubated). The median time to HFNC therapy failure was 5.5 hours (IQR, 3.6-9 hours), with 75% of patients experiencing therapy failure by 8.25 hours. The failure rate was 50% in children with a primary diagnosis of congenital heart disease. There was a statistically significant difference between the mean respiratory rate at 1 hour in the success and failure groups (P = 0.037), despite similar respiratory rates at onset. HFNC therapy failure was associated with a longer PICU LOS (P = 0.04). HFNC therapy was successful in most patients. Most failures occurred within 8.25 hours. Use of HFNC for heart disease was associated with a high therapy failure rate (50%).
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):197-201.
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    ABSTRACT: To describe current nutrition delivery practices and to identify barriers to nutrition in patients receiving venovenous or venoarterial extracorporeal membrane oxygenation (ECMO) in multiple centres in Australia and New Zealand. A prospective, multicentre, observational study, set in eight intensive care units in Australia and New Zealand, of adults treated with ECMO who were expected to receive enteral nutrition (EN) or parenteral nutrition (PN) therapy for > 72 hours. Data were collected from the start of ECMO until 7 days after ECMO cessation. There were 107 patients enrolled, with a median age of 42 years (interquartile range [IQR], 31-56 years), and 54 patients (50%) were men. EN was the most commonly delivered mode of nutrition (on 84% of days) although it was interrupted on 53% of days. The median interruption duration was 8 hours (IQR, 4-5 hours] per episode. The two most common barriers to EN delivery were fasting for a therapeutic or diagnostic procedure and high gastric residual volumes. Median daily calorie and protein deliveries from EN and/or PN were 1680 kcal (IQR, 960-2100 kcal) and 72 g (IQR, 42-98 g) of protein. For patients who received EN and/or PN, median calorie and protein deficits during the study period were -7118 kcal (IQR, -11 614 to -4510 kcal) and -325 g (IQR, - 525 to -188 g) of protein. EN was the most commonly used nutrition-delivery mode during ECMO treatment but was frequently interrupted. Compared with estimated calorie and protein requirements, lesser but reasonably acceptable amounts were delivered, although calorie and protein deficits still existed.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):183-9.
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    ABSTRACT: To assess the prevalence of patients fulfilling clinical review criteria (CRC), to determine activation rates for CRC assessments, to compare baseline characteristics and outcomes of patients who fulfilled CRC with patients who did not, and to identify the documented nursing actions in response to CRC values. A cross-sectional study using a retrospective medical record audit, in a universityaffiliated, tertiary referral hospital with a two-tier rapid response system in Melbourne, Australia. We used a convenience sample of hospital inpatients on general medical, surgical and specialist service wards admitted during a 24-hour period in 2013. Medical emergency team (MET) or code blue activation, unplanned intensive care unit admissions, hospital length of stay and inhospital mortality. For patients who fulfilled CRC or MET criteria during the 24- hour period, the specific criteria fulfilled, escalation treatments and outcomes were collected. Of the sample (N = 422), 81 patients (19%) fulfilled CRC on 109 occasions. From 109 CRC events, 66 patients (81%) had at least one observation fulfilling CRC, and 15 patients (18%) met CRC on multiple occasions. The documented escalation rate was 58 of 109 events (53%). The number of patients who fulfilled CRC and subsequent MET call activation criteria within 24 hours was significantly greater than the number who did not meet CRC (P < 0.001). About one in five patients reached CRC during the study period; these patients were about four times more likely to also fulfil MET call criteria. Contrary to hospital policy, escalation was not documented for about half the patients meeting CRC values. Despite the clarity of escalation procedures on the graphic observation chart, escalation remains an ongoing problem. Further research is needed on the impact on patient outcomes over time and to understand factors influencing staff response.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):167-73.
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    ABSTRACT: A bronchopleural fistula (BPF) is a life-threatening complication of cardiothoracic surgery and acute illness. There is no consensus on how best to treat a BPF. Recently, endobronchial one-way valves, designed for bronchoscopic lung volume reduction in emphysema, have been used to treat BPFs. We describe the use of an endobronchial oneway valve, placed at the bedside via flexible bronchoscopy, to treat a BPF in a patient with hypoxic respiratory failure, supported by extracorporeal membrane oxygenation (ECMO), secondary to pneumonia. We believe that this is the first published description of this technique being used in a patient needing ECMO support.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):219-22.
  • Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):208-10.
  • Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):211-3.
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    ABSTRACT: To describe the self-reported practice of loop diuretic therapy (LDT) administration by intensivists in Australia and New Zealand and to ascertain the anticipated clinical and physiological effects of LDT for several common clinical indications. Structured online questionnaire distributed to intensivists via the Australian and New Zealand Intensive Care Society Clinical Trials Group email contact list. Descriptive statistics were used to analyse the results. Intensivists in Australia and New Zealand. A total of 146 intensivists responded to the survey with most (99 [67.8%]) being Fellows of the College of Intensive Care Medicine or the Joint Faculty of Intensive Care Medicine. Overall, 88 (60.2%) had worked in ICUs for 10 years or more. A positive fluid balance, acute pulmonary oedema (APO) and acute lung injury (ALI) were considered key indications for LDT (> 80.0% positive response), in contrast to an elevated central venous pressure (CVP) (20.3%) and acute kidney injury (AKI) (3.8%), which were not. LDT by bolus therapy was preferred (by 60.0%-89.4%, according to indication) over continuous infusion (3.6%- 11.1%, according to indication). The dominant initial LDT dose was furosemide 40mg as an intravenous (IV) bolus. There was a lack of consensus regarding what would be an adequate response, and for many of the clinical indications, no target was specified. Australian and New Zealand intensivists typically give frusemide as a 40mg IV bolus for a positive fluid balance, ALI and APO, but not for an elevated CVP or AKI. However, such therapy is given without explicit definitions of an adequate response under these different clinical circumstances.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):223-6.
  • Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):144.
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    ABSTRACT: In the past 5 years, there has been a significant rise in the number of trained and fully qualified specialists in intensive care medicine. Recent concerns about saturation of specialist employment opportunities and the prospect of new Fellows unable to find appropriate employment after completion of training has brought intensive care workforce issues to the forefront. The board members of the College of Intensive Care Medicine (CICM) and Australia and New Zealand Intensive Care Society (ANZICS) held the Intensive Care Workforce Summit with presidents of other medical colleges, government officials and legal experts. Current data were presented on College trainee numbers and graduates and compared with similar data from other colleges. Results of workforce surveys of intensive care units and recent CICM graduates were also presented. Projections of future workforce requirements are notoriously uncertain but there was clear agreement among the group that currently, the employment opportunities for new Fellows at consultant level are limited. Recent changes to the selection process for new trainees have had a dramatic impact on the number of new trainees in 2014 but the enduring effect of this is yet to be determined. The group discussed potential growth areas for employment of intensive care consultants, including changes in employment patterns and also the impact of reduced numbers of trainees on unit staffing. CICM and ANZICS have agreed to continue to monitor and discuss the situation on a regular basis.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):73-6.
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    ABSTRACT: Fluid bolus therapy (FBT) is common in critically ill patients. With the exception of use in patients with traumatic brain injury, FBT with human albumin solution (HAS) appears safe and perhaps superior in severe sepsis. To determine the physiological effects of FBT with 4% v 20% HAS. A retrospective observational study of 202 critically ill patients receiving FBT with HAS in a tertiary intensive care unit between April 2012 and March 2013. FBT was instituted with 4% or 20% HAS, according to clinician preference. We compared biochemical and haemodynamic data between groups at baseline and at 1, 2 and 4 hours after FBT. Patients who had received 20% HAS had more liver disease, a greater need for renal replacement therapy and higher Acute Physiology and Chronic Health Evaluation III scores on admission. Patients who had received 4% HAS received a median volume of 500 mL (interquartile range [IQR], 350-500mL), compared with 100mL (IQR, 100- 200mL) in the 20% HAS group (P < 0.0001); a median of 70mmol v 10mmol of sodium (P < 0.0001); and a median of 64mmol v 2mmol of chloride (P < 0.0001). There was a trend toward higher mean arterial pressures in the 20% group after FBT (78.2mmHg v 76.4mmHg, P = 0.03). There were no significant differences in the absolute or percentage change for any haemodynamic parameters. Serum biochemical test results were comparable with a non-significant signal of higher serum chloride and more negative base excess in patients receiving 4% HAS. Haemodynamically, FBT with 100mL of 20% HAS performs in an equivalent way to 500mL of 4% HAS but delivers much less fluid, sodium and chloride.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):122-8.
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    ABSTRACT: Elevation of body temperature is common after traumatic brain injury (TBI). Suppressing fever may be beneficial. In clinical practice, temperature is maintained _37°C. A retrospective, multicentre, cohort study of patients with an intensive care unit admission diagnosis of TBI over a 6-month period. The mean proportion of time per day that temperature _37°C or _38°C (to correct for unequal measurements between patients, imputation was used between consecutive temperature measurements and a linear relationship was assumed); and the proportion of patients on each day with a peak temperature _37°C. 217 patients with TBI were admitted to eight ICUs. The mean Acute Physiology and Chronic Health Evaluation II score of the cohort was 15.7 (SD, 7.7) and intracranial pressure monitoring was done in 29% of patients. The mean proportion of time on each day that temperature was _37°C varied between 56% (SE, 2.6%) on Day 1 and 89% (SE, 3.7%) on Day 14. The mean proportion of time per day that temperature was > 38°C was between a minimum of 11% (SE, 1.5%) on Day 1 and a maximum of 25% (SE, 4.4%) Day 11. The proportion of patients for whom daily peak temperature was > 37°C ranged between a minimum of 73.2% (153/209) on Day 1 and a maximum of 97.4% (26/33) on Day 13. In patients with TBI, a substantial proportion of time is spent with a temperature _37°C. Prospective validation of these data are required.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):129-34.
  • Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):65-6.