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 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: To study agreement between radial and femoral arterial pressure measurements in orthotopic liver transplantation (OLTx) surgery to determine whether arterial cannulation sites are interchangeable. Prospective observational study of 25 patients undergoing OLTx surgery. Radial and femoral arteries were cannulated with standardised arterial line kits. Radial and femoral mean arterial pressure (MAP), systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and pulse pressure (PP) were measured at four time points (30 minutes after induction of anaesthesia, 30 minutes after the start of the anhepatic phase, 30 minutes after liver graft reperfusion and 30 minutes after the start of bile duct anastomosis). The bias, precision and limits of agreement between radial and femoral arterial pressures were calculated in accordance with Bland-Altman statistics. Radial-femoral differences in MAP (mean difference, 4.8mmHg [SD, 4.5mmHg]), limits of agreement (- 13.6 and 8.8, P < 0.001) and DAP showed clinically acceptable agreement between measurement sites across all time points. However, clinically significant differences between radial and femoral SAPs (mean difference, - 14.9mmHg [SD, 24.8mmHg]) and limits of agreement (- 63.5 and 33.7, P < 0.001) occurred overall. This difference started after portal vein clamping and remained significant throughout the remainder of the operation. Radial artery SAP underestimates femoral artery measurements significantly but unpredictably. As femoral measurement is more likely to reflect central arterial pressure, radial SAP measurement is not reliable in adults undergoing OLTx.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):101-7.
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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.
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    ABSTRACT: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Prophylactic hypothermia is effective in laboratory models, but clinical studies to date have been inconclusive, partly because of methodological limitations. Our Prophylactic Hypothermia Trial to Lessen Traumatic Brain Injury (POLAR) randomised controlled trial is currently underway comparing early, sustained hypothermia versus standard care in patients with severe TBI. We describe our study protocol and the challenges in conducting prophylactic hypothermia research in TBI. We aim to randomise 500 patients to either prophylactic 33°C hypothermia initiated within 3 hours of injury and continued for at least 72 hours, or standard normothermic management. Patients will be enrolled by paramedic services in the prehospital setting, or by emergency department staff at participating sites in Australia, New Zealand and Europe. The primary outcome will be the eight-level extended Glasgow outcome scale (GOSE), dichotomised to favourable and unfavourable outcomes at 6 months after injury. Secondary outcomes will include mortality at hospital discharge and at 6 months, ordinal analyses of 6-month GOSE outcomes, quality of life with health economic evaluations and the differential proportion of adverse events. We will predefine subgroup and interaction analyses. After a run-in phase, recruitment for our main study began in December 2010. When the study is completed, we aim to provide evidence on the efficacy of prophylactic hypothermia in TBI to guide clinicians in their management of this devastating condition.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):92-100.
  • Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):144.
  • Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):65-6.
  • Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):63-4.
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    ABSTRACT: The Checklist During Multidisciplinary Visits for Reduction of Mortality in Intensive Care Units (Checklist- ICU) trial is a pragmatic, two-arm, cluster-randomised trial involving 118 intensive care units in Brazil, with the primary objective of determining if a multifaceted qualityimprovement intervention with a daily checklist, definition of daily care goals during multidisciplinary daily rounds and clinician prompts can reduce inhospital mortality. To describe our trial statistical analysis plan (SAP). This is an ongoing trial conducted in two phases. In the preparatory observational phase, we collect three sets of baseline data: ICU characteristics; patient characteristics, processes of care and outcomes; and completed safety attitudes questionnaires (SAQs). In the randomised phase, ICUs are assigned to the experimental or control arms and we collect patient data and repeat the SAQ. Our SAP includes the prespecified model for the primary and secondary outcome analyses, which account for the cluster-randomised design and availability of baseline data. We also detail the multiple mediation models that we will use to assess our secondary hypothesis (that the effect of the intervention on inhospital mortality is mediated not only through care processes targeted by the checklist, but also through changes in safety culture). We describe our approach to sensitivity and subgroup analyses and missing data. We report our SAP before closing our study database and starting analysis. We anticipate that this should prevent analysis bias and enhance the utility of results.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):113-21.
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    ABSTRACT: Low tidal volume ventilation (LTVV) has been shown to reduce mortality of patients with acute lung injury (ALI) but uptake by clinicians has been low. Recent studies have shown that LTVV results in survival benefit at 24 months after discharge and, importantly, benefits patients without ALI. To determine adherence to LTVV in patients on mechanical ventilation (MV). Retrospective analysis of ventilator settings recorded within the clinical information system of a 15-bed general ICU in a tertiary referral hospital, between 1 January 2000 and 31 May 2013. Analysis of mandatory MV with volume or pressure control. Adherence to LTVV (_6.5mL/ kg predicted body weight [PBW]). We studied 4923 patients with a median age of 66 years (interquartile range [IQR], 57-74 years), and a median Acute Physiology and Chronic Health Evaluation II score of 16 (IQR, 13-19). Included were 3486 men (70.8%), and 3386 (66.8%) had undergone cardiac surgery. There were 249 450 ventilator measurements, with a median per patient of 75 measurements (IQR, 17-255 measurements). The median tidal volume was 8.15mL/kg PBW (IQR, 7.15- 9.34mL/kg PBW) for an adherence of 13.4%. Independent factors associated with adherence were sex, high inspiratory pressures, high positive end expiratory pressure and low PaO2/FiO2 ratio. Adherence to LTVV in a general cohort of ICU patients was low, but it was better in patients with more severe lung disease. Overestimation of PBW may have contributed to our findings. Regular auditing of LTVV adherence might be considered a clinical indicator of good MV practice.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):108-12.
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    ABSTRACT: Traumatic brain injury (TBI) can result in cerebral oedema and vascular changes resulting in an increase in intracranial pressure (ICP), which can lead to further secondary damage. Decompressive craniectomy (DC) is a surgical option in the management of ICP. We aimed to investigate outcomes of DC after TBI. We performed a retrospective audit of 57 adult patients (aged > 15 years) who underwent DC after TBI, at the Royal Melbourne Hospital from 1 January 2005 to 30 June 2011. Our functional outcome measure was the Extended Glasgow Outcome Scale (GOSE). Patients had a median age of 30 years (range, 17- 73 years). The hospital mortality rate was 47% (27 patients). A higher postoperative median ICP was the most significant predictor of hospital mortality (OR, 1.1; 95% CI, 1-1.3). There was a mean decrease of 7.7mmHg in ICP between the mean preoperative and postoperative ICP values (95% CI, - 10.5 to - 5.0mmHg). There was a mean decrease of 3.5mmHg in the mean cerebral perfusion pressure (CPP) from preoperative to postoperative CPP values (95% CI, - 6.2 to - 0.8mmHg). At the 6-month follow-up, a poor outcome (GOSE score, 1-4) was seen in 39 patients (68%), while a good outcome (GOSE score, 5- 8) was noted in 15 patients (26%). A high APACHE II score on admission was the most significant predictor of a worse GOSE score at 6 months (OR, 1.3; 95% CI, 1.1-1.5). Analysis of the APACHE II and IMPACT scores as models for predicting mortality at 6 months showed an area under the curve (AUC) of 0.792 and 0.805, respectively, and for predicting poor outcome at 6 months, showed an AUC of 0.862 and 0.883, respectively. DC decreased ICP postoperatively. The IMPACT and APACHE II scores are good models for prediction of death and poor outcome at 6 months.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):67-72.
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    ABSTRACT: The provision of health care has significant direct environmental effects such as energy and water use and waste production, and indirect effects, including manufacturing and transport of drugs and equipment. Recycling of hospital waste is one strategy to reduce waste disposed of as landfill, preserve resources, reduce greenhouse gas emissions, and potentially remain fiscally responsible. We began an intensive care unit recycling program, because a significant proportion of ICU waste was known to be recyclable. To determine the weight and proportion of ICU waste recycled, the proportion of incorrect waste disposal (including infectious waste contamination), the opportunity for further recycling and the financial effects of the recycling program. We weighed all waste and recyclables from an 11-bed ICU in an Australian metropolitan hospital for 7 non-consecutive days. As part of routine care, ICU waste was separated into general, infectious and recycling streams. Recycling streams were paper and cardboard, three plastics streams (polypropylene, mixed plastics and polyvinylchloride [PVC]) and commingled waste (steel, aluminium and some plastics). ICU waste from the waste and recycling bins was sorted into those five recycling streams, general waste and infectious waste. After sorting, the waste was weighed and examined. Recycling was classified as achieved (actual), potential and total. Potential recycling was defined as being acceptable to hospital protocol and local recycling programs. Direct and indirect financial costs, excluding labour, were examined. During the 7-day period, the total ICU waste was 505 kg: general waste, 222 kg (44%); infectious waste, 138 kg (27%); potentially recyclable waste, 145 kg (28%). Of the potentially recyclable waste, 70 kg (49%) was actually recycled (14% of the total ICU waste). In the infectious waste bins, 82% was truly infectious. There was no infectious contamination of the recycling streams. The PVC waste was 37% contaminated (primarily by other plastics), but there was less than 1% contamination of other recycling streams. The estimated cost of the recycling program was about an additional $1000/year. In our 11-bed ICU, we recycled 14% of the total waste produced over 7-days, which was nearly half of the potentially recyclable waste. There was no infectious contamination of recyclables and minimal contamination with other waste streams, except for the PVC plastic. The estimated annual cost of the recycling program was $1000, reflecting the greater cost of disposal of some recyclables (paper and cardboard v most plastic types).
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):135-40.
  • Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2015; 17(2):141-3.
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    ABSTRACT: To investigate the role of coronary driving pressure (CDP) in myocardial microcirculatory blood flow during sepsis. We hypothesised that in septic shock there is an impaired autoregulation of microcirculation, and blood flow is totally dependent on CDP. We analysed the effect of lipopolysaccharide (LPS)-induced shock on myocardial microcirculation, separating subendocardial and epicardial areas. We then studied the effect of CDP increases using noradrenaline (NOR) or metaraminol (Aramine [ARA]) on myocardial microcirculation and function, and we analysed the effect of volume infusion on CDP and myocardial function. Endotoxaemia was induced in male Wistar rats by an intraperitoneal injection of LPS 10 mg/kg. Animals were divided into a control (CT) group, an LPS-injected group, and an LPS-injected group treated with saline fluid, NOR or ARA. Ninety minutes later, a haemodynamic evaluation was performed. NOR or ARA were used to manage the mean arterial pressure (MAP) and CDP, and we inserted a catheter into the left ventricle to measure cardiac parameters. To measure blood flow in the myocardium and other organs, microspheres were introduced into the left ventricle using an infusion pump. After LPS treatment, left ventricular (LV) systolic function (dP/dt max) and diastolic function (dP/dt min) decreased by 34% and 15%, respectively, and load-independent indices (LV contractility in ejection phase and dP/dt max ÷ end-diastolic volume) were reduced. The CDP was also reduced (by 58%) in the endotoxaemic rats. Myocardial blood flow was reduced (by 80%) in animals with an MAP _ 65 mmHg. NOR increased the CDP (LPS, 38 mmHg [SEM, 2 mmHg]; LPS+NOR, 59 mmHg [SEM, 3 mmHg]) and microcirculatory perfusion (LPS, 2 mL/min/g tissue [SEM, 0.6 mL/min/g]; LPS+NOR, 6.2 mL/min/g [SEM, 0.8 mL/min/g]). ARA was also effective in improve microcirculation but saline volume infusion was ineffective in improving CDP or myocardial function. CDP showed a significant correlation with subendocardial blood flow. Myocardial blood flow in the LV subendocardium and the right ventricle decreases in endotoxaemic rats. Increasing CDP improves myocardial blood flow and function. Thus, in endotoxaemia, microcirculatory blood flow is pressure dependent, suggesting that it may be beneficial to treat patients with sepsis using a higher CDP.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 03/2015; 17(1):12-22.
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    ABSTRACT: The physiological changes associated with fluid bolus therapy (FBT) for patients with infectionassociated hypotension in the emergency department (ED) are poorly understood. We describe the physiological outcomes of FBT in the first 6 hours (primary FBT) for patients presenting to the ED with infection-associated hypotension. We studied 101 consecutive ED patients with infection and a systolic blood pressure (SBP) < 100mmHg who underwent FBT in the first 6 hours. We screened 1123 patients with infection and identified 101 eligible patients. The median primary FBT volume given was 1570mL (interquartile range, 1000- 2490mL). The average mean arterial pressure (MAP) did not change from admission to 6 hours in the whole cohort, or in patients who were hypotensive on arrival at the ED. However, the average MAP increased from its lowest value during the first 6 hours (66mmHg [SD, 10mmHg]) to its value at 6 hours (73mmHg [SD, 12mmHg]; P < 0.001). The mean heart rate, body temperature, respiratory rate and plasma creatinine level decreased (P<0.05). In patients who were severely hypotensive (SBP < 90mmHg) on arrival at the ED, the MAP increased from 54mmHg (SD, 8mmHg) to 70mmHg (SD, 14mmHg) (P < 0.001). At 6 hours, however, SBP was still < 100mmHg in 44 patients and < 90mmHg in 17 patients. When noradrenaline was used, in 10 patients, hypotension was corrected in all 10 and the MAP increased from 58mmHg (SD, 9mmHg) to 75mmHg (SD, 13mmHg). Among ED patients admitted to an Australian teaching hospital with infection, hypotension was uncommon. FBT for hypotension was limited in volumes given and failed to achieve a sustained SBP of > 100mmHg in 40% of cases. In contrast, noradrenaline therapy corrected hypotension in all patients who received it.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 03/2015; 17(1):6-11.
  • Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 03/2015; 17(1):55-6.
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    ABSTRACT: Large positive sodium balances, independent of fluid balance, may lead to expanded extracellular fluid volumes and adverse clinical outcomes in the critically ill, including impaired oxygenation. To estimate sodium and fluid balances in critically ill patients needing invasive mechanical ventilation (MV) for more than 48 hours and to evaluate the relationship between fluid balance, sodium balance and respiratory function (PaO2/FiO2 ratio and length of MV). A prospective, observational study of 50 patients on MV in four tertiary intensive care units. Daily sodium and fluid input and output, biochemistry, haemodynamic variables, oxygenation (PaO2/FiO2) and steroid and vasopressor administration were recorded for 3 days after study enrolment. Outcome data included the duration of invasive MV, ICU and hospital mortality and ICU and hospital lengths of stay. Fifty patients (33 men [66%]) with a mean age of 62.8 years (standard deviation, 14.6 years) and a median admission Acute Physiology and Chronic Health Evaluation III score of 82 (interquartile range [IQR], 61-99) were studied. By Day 3 after enrolment, the median cumulative fluid balance was 2668mL (IQR, 875-3507mL) and the cumulative sodium balance was +717mmol (IQR, +422 to +958mmol). Intravenous steroids and the presence of shock led to a lower daily sodium excretion (P=0.004 and P = 0.01, respectively). A positive sodium balance was associated with a reduction in the next day's PaO2/FiO2 ratio (?=-0.36, P = 0.001) and an increased length of MV (linear regression analysis, P< 0.01). The cumulative fluid balance was not associated with either parameter. The cumulative positive sodium balance, not the cumulative positive fluid balance, is associated with respiratory dysfunction and an increased length of MV.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 03/2015; 17(1):23-8.