G Gutteridge

University of Melbourne, Melbourne, Victoria, Australia

Are you G Gutteridge?

Claim your profile

Publications (16)44.74 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: We report on a 64-year-old female presenting with anasarca secondary to volume loading in the setting of chronic liver disease, acute on chronic renal failure, circulatory failure and sepsis. Over 37 days, a net negative fluid balance of 71 L was achieved using continuous hemofiltration, with spontaneous recovery of urine output, vasopressor independence and resolution of coagulopathy. This case report underlines the pathophysiological role of tissue edema in the downward spiral of hepato-renal and cardio-renal dysfunction and illustrates that very large volumes of tissue fluid can be safely and effectively removed with continuous renal replacement therapy, thereby permitting recovery of organ function. To our knowledge, there have been no previous reports of such large volume net fluid removal by progressive ultrafiltration in the intensive care unit.
    The International journal of artificial organs 05/2008; 31(4):367-70. · 1.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the effect of a Medical Emergency Team (MET) service on patient mortality in the 4 years since its introduction into a teaching hospital. Using the hospital electronic database we obtained the number of admissions and in-hospital deaths "before-" (September 1998-August 1999), "during education-" (September 1999-August 2000), the "run-in period-" (September 2000-October 2000), and "after-" (November 2000-December 2004) the introduction of a MET service, intended to review and treat acutely unwell ward patients. There were 42,230 surgical and 112,321 medical admissions over the study period. During the education period for the MET the odds ratio (OR) of death for surgical patients was 0.82 compared to the "before" MET period (95% CI 0.67-1.00; p=0.055). During the 2 month "run-in" period it remained statistically unchanged at 1.01 (95% CI 0.67-1.51; p=0.33). In the 4 years "after" introduction of the MET, the OR of death for surgical patients remained lower than the "before" MET period (multiple chi(2)-test p=0.0174). There were 1252 surgical MET calls, and in December 2004 the ratio of surgical MET calls to surgical deaths was 1.76:1. In contrast, in-hospital deaths for medical patients increased during the "education period", the "run-in" period and into the first year "after" the introduction of the MET (multiple chi(2)-test p<0.0001). There were 1278 medical MET calls, and in December 2004 the ratio of medical MET calls to medical deaths was 1:2.47 (0.41:1). For each 12-month period, the relative risk of death for medical patients as opposed to surgical patients ranged between 1.32 and 2.40. Introduction of an Intensive Care-based MET in a university teaching hospital was associated with a fluctuating reduction in post-operative surgical mortality which was already apparent during the education phase, but a sustained increase in the mortality of medical patients which was similarly already apparent during the education phase. The differential effects on mortality may relate to differences in the degree of disease complexity and reversibility between medical and surgical patients.
    Resuscitation 09/2007; 74(2):235-41. · 4.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Medical Emergency Teams (MET) have been developed to identify, review and manage acutely unwell ward patients. Previous studies have suggested that there may be obstacles to the utilization and activation of the MET. To determine the effect of a detailed education programme on the rate of utilization of the MET system 3.5 years after its introduction in a University teaching hospital. Prospective interventional study involving a detailed programme of education, feedback and decision support for nursing and medical staff given before, during and after implementation of a MET system. We measured the number of MET calls per month for both medical and surgical patients for 109 250 consecutive admissions to the acute care campus of Austin Health from August 2000 to June 2004. Overall activation of the MET increased from 25 calls per month to a peak of 79 calls per month over the study period (average increase of one MET call/month). After standardization for monthly admissions, the increase in MET utilization for surgical patients (increase by 1.13 MET/1000 admissions/month) was 4.9-fold greater than for medical patients (increase by 0.23 MET/1000 admissions/month; P < 0.0001). At the peak level of activity (April 2004), the MET was called to review 8.4% of surgical and 2.7% of medical admissions (P < 0.0001). There was a progressive increase in the utilization of the MET service in the 3.5 years after implementation, with the rate of uptake 4.9 times greater for surgical than for medical patients. Sustained uptake of the MET system is possible, but increased utilization may take several years to develop. Short-term studies testing the efficacy of the MET system are likely to significantly underestimate its effect on reducing adverse events. Intensive care unit resource adjustments will become necessary to meet increased demand.
    Internal Medicine Journal 05/2006; 36(4):231-6. · 1.82 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: It has been suggested that the availability of a high-dependency unit (HDU), to facilitate graded admission to, and discharge from, an intensive care unit (ICU), might decrease post-operative morbidity. We wished to determine whether the addition of a 4-bed HDU to a tertiary 17-bed ICU facility at a University-affiliated hospital would decrease post-operative morbidity and mortality. A prospective controlled before-and-after trial was performed with the opening of a 4-bed HDU. Consecutive patients admitted to hospital for major surgery during a 4-month control (pre-HDU) phase and during a 4-month intervention (HDU) phase were studied for the incidence of serious adverse events (SAEs), mortality after major surgery and mean duration of hospital stay. There were 1319 operations performed in 1125 patients during the pre-HDU period and 1369 operations performed in 1127 patients during the HDU period. During the HDU period there was an excess in unscheduled surgery cases (674 during HDU vs. 531 during the pre-HDU period; p < 0.0001). In the pre-HDU period, there were 414 SAEs in 190 patients compared with 456 SAEs in 209 patients during the HDU period (NS). There were no significant changes in any of the individual SAEs measured except for the incidence of post-operative acute pulmonary edema, which increased from 19 cases to 46 during the HDU period (p = 0.028). This increase was associated with a greater number of patients requiring re-intubation (52 vs. 75 cases; p = 0.044). The introduction of an HDU had no effect on mortality (80 deaths vs. 76; NS) and failed to reduce mean hospital length of stay (21.8 vs. 24 days; NS). The introduction of a 4-bed HDU in a teaching hospital was associated with a marked increase in unscheduled surgery and failed to reduce the incidence of post-operative SAEs, post-operative mortality, and mean duration of hospital stay.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 03/2005; 7(1):16-21. · 1.51 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: It is unknown whether the reported short-term reduction in cardiac arrests associated with the introduction of the medical emergency team (MET) system can be sustained. We conducted a prospective, controlled before-and-after examination of the effect of a MET system on the long-term incidence of cardiac arrests. We included consecutive patients admitted during three study periods: before the introduction of the MET; during the education phase preceding the implementation of the MET; and a period of four years from the implementation of the MET system. Cardiac arrests were identified from a log book of cardiac arrest calls and cross-referenced with case report forms and the intensive care unit admissions database. We measured the number of hospital admissions and MET reviews during each period, performed multivariate logistic regression analysis to identify predictors of mortality following cardiac arrest and studied the correlation between the rate of MET calls with the rate of cardiac arrests. Before the introduction of the MET system there were 66 cardiac arrests and 16,246 admissions (4.06 cardiac arrests per 1,000 admissions). During the education period, the incidence of cardiac arrests decreased to 2.45 per 1,000 admissions (odds ratio (OR) for cardiac arrest 0.60; 95% confidence interval (CI) 0.43-0.86; p = 0.004). After the implementation of the MET system, the incidence of cardiac arrests further decreased to 1.90 per 1,000 admissions (OR for cardiac arrest 0.47; 95% CI 0.35-0.62; p < 0.0001). There was an inverse correlation between the number of MET calls in each calendar year and the number of cardiac arrests for the same year (r2 = 0.84; p = 0.01), with 17 MET calls being associated with one less cardiac arrest. Male gender (OR 2.88; 95% CI 1.34-6.19) and an initial rhythm of either asystole (OR 7.58; 95% CI 3.15-18.25; p < 0.0001) or pulseless electrical activity (OR 4.09; 95% CI 1.59-10.51; p = 0.003) predicted an increased risk of death. Introduction of a MET system into a teaching hospital was associated with a sustained and progressive reduction in cardiac arrests over a four year period. Our findings show sustainability and suggest that, for every 17 MET calls, one cardiac arrest might be prevented.
    Critical care (London, England) 01/2005; 9(6):R808-15. · 4.72 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine whether the introduction of an intensive care unit-based medical emergency team, responding to hospital-wide preset criteria of physiologic instability, would decrease the rate of predefined adverse outcomes in patients having major surgery. Prospective, controlled before-and-after trial. University-affiliated hospital. Consecutive patients admitted to hospital for major surgery during a 4-month control phase and during a 4-month intervention phase. Introduction of a hospital-wide intensive care unit-based medical emergency team to evaluate and treat in-patients deemed at risk of developing an adverse outcome by nursing, paramedical, and/or medical staff. We measured incidence of serious adverse events, mortality after major surgery, and mean duration of hospital stay. There were 1,369 operations in 1,116 patients during the control period and 1,313 in 1,067 patients during the medical emergency team intervention period. In the control period, there were 336 adverse outcomes in 190 patients (301 outcomes/1,000 surgical admissions), which decreased to 136 in 105 patients (127 outcomes/1,000 surgical admissions) during the intervention period (relative risk reduction, 57.8%; p <.0001). These changes were due to significant decreases in the number of cases of respiratory failure (relative risk reduction, 79.1%; p <.0001), stroke (relative risk reduction, 78.2%; p =.0026), severe sepsis (relative risk reduction, 74.3%; p =.0044), and acute renal failure requiring renal replacement therapy (relative risk reduction, 88.5%; p <.0001). Emergency intensive care unit admissions were also reduced (relative risk reduction, 44.4%; p =.001). The introduction of the medical emergency team was also associated with a significant decrease in the number of postoperative deaths (relative risk reduction, 36.6%; p =.0178). Duration of hospital stay after major surgery decreased from a mean of 23.8 days to 19.8 days (p =.0092). The introduction of an intensive care unit-based medical emergency team in a teaching hospital was associated with a reduced incidence of postoperative adverse outcomes, postoperative mortality rate, and mean duration of hospital stay.
    Critical Care Medicine 04/2004; 32(4):916-21. · 6.12 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine the effect on cardiac arrests and overall hospital mortality of an intensive care-based medical emergency team. Prospective before-and-after trial in a tertiary referral hospital. Consecutive patients admitted to hospital during a 4-month "before" period (May-August 1999) (n = 21 090) and a 4-month intervention period (November 2000 -February 2001) (n = 20 921). Number of cardiac arrests, number of patients dying after cardiac arrest, number of postcardiac-arrest bed-days and overall number of in-hospital deaths. There were 63 cardiac arrests in the "before" period and 22 in the intervention period (relative risk reduction, RRR: 65%; P < 0.001). Thirty-seven deaths were attributed to cardiac arrests in the "before" period and 16 in the intervention period (RRR: 56%; P = 0.005). Survivors of cardiac arrest in the "before" period required 163 ICU bed-days versus 33 in the intervention period (RRR: 80%; P < 0.001), and 1353 hospital bed-days versus 159 in the intervention period (RRR: 88%; P < 0.001). There were 302 deaths in the "before" period and 222 in the intervention period (RRR: 26%; P = 0.004). The incidence of in-hospital cardiac arrest and death following cardiac arrest, bed occupancy related to cardiac arrest, and overall in-hospital mortality decreased after introducing an intensive care-based medical emergency team.
    The Medical journal of Australia 10/2003; 179(6):283-7. · 2.85 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the present study is to understand the nature of acid-base disorders in critically ill patients with acute renal failure (ARF) using the biophysical principles described by Stewart and Figge. A retrospective controlled study was carried out in the intensive care unit of a tertiary hospital. Forty patients with ARF, 40 patients matched for Acute Physiology and Chronic Health Evaluation II score (matched control group), and 60 consecutive critically ill patients without ARF (intensive care unit control group) participated. The study involved the retrieval of biochemical data from computerized records, quantitative biophysical analysis using the Stewart-Figge methodology, and statistical comparison between the three groups. We measured serum sodium, potassium, magnesium, chloride, bicarbonate, phosphate, ionized calcium, albumin, lactate and arterial blood gases. Intensive care unit patients with ARF had a mild acidemia (mean pH 7.30 +/- 0.13) secondary to metabolic acidosis with a mean base excess of -7.5 +/- 7.2 mEq/l. However, one-half of these patients had a normal anion gap. Quantitative acid-base assessment (Stewart-Figge methodology) revealed unique multiple metabolic acid-base processes compared with controls, which contributed to the overall acidosis. The processes included the acidifying effect of high levels of unmeasured anions (13.4 +/- 5.5 mEq/l) and hyperphosphatemia (2.08 +/- 0.92 mEq/l), and the alkalinizing effect of hypoalbuminemia (22.6 +/- 6.3 g/l). The typical acid-base picture of ARF of critical illness is metabolic acidosis. This acidosis is the result of the balance between the acidifying effect of increased unmeasured anions and hyperphosphatemia and the lesser alkalinizing effect of hypoalbuminemia.
    Critical Care 09/2003; 7(4):R60. · 4.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clinicians calculate the anion gap (AG) and the strong ion difference (SID) to make acid-base diagnoses. The technology used is assumed to have limited impact. The authors hypothesized that different measurement technologies markedly affect AG and SID values. SID and AG were calculated using values from the point-of-care blood gas and electrolyte analyzer and the central hospital laboratory automated blood biochemistry analyzer. Simultaneously measured plasma sodium, potassium, and chloride concentrations were also compared. Mean values for central laboratory and point-of-care plasma sodium concentration were significantly different (140.4 +/- 5.6 vs. 138.3 +/- 5.9 mm; P < 0.0001), as were those for plasma chloride concentration (102.4 +/- 6.5 vs. 103.4 +/- 6.0 mm; P < 0.0001) but not potassium. Mean AG values calculated with the two different measurement techniques differed significantly (17.6 +/- 6.2 mEq/l for central laboratory vs. 14.5 +/- 6.0 mEq/l for point-of-care blood gas analyzer; P < 0.0001). Using the Stewart-Figge methodology, SID values also differed significantly (43.7 +/- 4.8 vs. 40.7 +/- 5.6 mEq/l; P < 0.0001), with mean difference of 3.1 mEq/l (95% limits of agreement, -3.4, 9.5 mEq/l). For 83 patients (27.6%), differences in AG values were as high as 5 mEq/l or more, and for 46% of patients whose AG value was outside the reference range with one technology, a value within normal limits was recorded with the other. Results with two different measurement technologies differed significantly for plasma sodium and chloride concentrations. These differences significantly affected the calculated AG and SID values and might lead clinicians to different assessments of acid-base and electrolyte status.
    Anesthesiology 05/2003; 98(5):1077-84. · 5.16 Impact Factor
  • 01/2002;
  • The Annals of Thoracic Surgery 01/2002; 73(3). · 3.45 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to test whether early and intensive use of continuous venovenous hemofiltration (CVVH) achieved a better than predicted outcome in patients with severe acute renal failure undergoing cardiac operations, and whether a simple and yet accurate model could be developed to predict their outcome before starting CVVH. Medical record analysis with collection of demographic, clinical, and outcome information was used. Sixty-five consecutive patients were treated with early and intensive CVVH (mean operation to CVVH time, 2.38 days; pump-controlled ultrafiltration rate, 2 L/h) after coronary artery bypass grafting (56.9%), single valve procedure (16.9%), or combined operations (26.2%). In 32.3% of patients, intraaortic balloon counterpulsation was required and 20% of patients were emergencies. Sustained hypotension despite inotropic and vasopressor support occurred in 40% of patients and prolonged mechanical ventilation in 58.5%. Using an outcome prediction score specific for acute renal failure, the predicted risk of death was 66%. Actual mortality was 40% (p = 0.003). Using multivariate logistic regression analysis and neural network analysis, patient outcome could be predicted with good levels of accuracy (receiver operating characteristic 0.89 and 0.9, respectively). Early and aggressive CVVH is associated with better than predicted survival in severe acute renal failure after cardiac operations. Using readily available clinical data, the outcome of such patients can be predicted before the implementation of CVVH.
    The Annals of Thoracic Surgery 04/2001; 71(3):832-7. · 3.45 Impact Factor
  • Australian Critical Care. 01/1996; 9(1):29-29.
  • Australian Critical Care. 01/1996; 9(1):22-22.
  • [Show abstract] [Hide abstract]
    ABSTRACT: We prospectively investigated the role of sympathetic activation in the etiology of atrial fibrillation following coronary artery bypass grafting. Continuous ambulatory monitoring was performed for 80 hours in 131 patients after coronary artery bypass grafting. Right atrial plasma norepinephrine levels were assessed preoperatively and every 4 hours for 48 hours postoperatively. Of the 131 patients, 50% (65) had development of atrial fibrillation and 36% (47) required treatment. Onset of atrial fibrillation was preceded by a significant increase in sinus rate and atrial ectopic activity. On multivariate logistic regression, elevated mean postoperative norepinephrine levels (5.78 +/- 2.83 versus 3.57 +/- 1.31 nmol/L; p < 0.0001), increased age (68.9 +/- 5.7 versus 63.8 +/- 8.7 years; p = 0.02), and decreased postoperative magnesium levels (0.79 +/- 0.09 versus 0.83 +/- 0.10 mmol/L; p = 0.02) were independently associated with the occurrence of atrial fibrillation. Elevated norepinephrine levels suggest that sympathetic activation may be important in the pathogenesis of atrial fibrillation after coronary artery bypass grafting, and this underlines the importance of beta-adrenoceptor blockade as prophylaxis.
    The Annals of Thoracic Surgery 01/1996; 60(6):1709-15. · 3.45 Impact Factor
  • G K Hart, I Baldwin, G Gutteridge, J Ford
    [Show abstract] [Hide abstract]
    ABSTRACT: This prospective, observational, anonymous incident reporting study aimed to identify and correct factors leading to reduced patient safety in intensive care. An incident was any event which caused or had the potential to cause harm to the patient, but included problems in policy or procedure. Reports were discussed at monthly meetings. Of 390 incidents, 106 occasioned "actual" harm and 284 "potential" harm. There was one death, 86 severe complications and 88 complications of minor severity. Most were transient but the effects of 24 lasted up to a week. Most incidents affected cardiovascular and respiratory systems. Incident categories involved drugs, equipment, management or procedures. Incident causes were knowledge-based, rule-based, technical, slip/lapse, no error or unclassifiable. The study has identified some human and equipment performance problems in our intensive care unit. Correction of these should lead to a reduction in the future incidence of those events and hence an increased level of patient safety.
    Anaesthesia and intensive care 11/1994; 22(5):556-61. · 1.40 Impact Factor

Publication Stats

2k Citations
44.74 Total Impact Points

Institutions

  • 2006–2007
    • University of Melbourne
      • Department of Medicine
      Melbourne, Victoria, Australia
  • 2005
    • Alfred Hospital
      Melbourne, Victoria, Australia
  • 2003–2005
    • Austin Health
      • Unit of Intensive Care
      Melbourne, Victoria, Australia