Andrew D Bersten

Flinders University, Tarndarnya, South Australia, Australia

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Publications (125)621.59 Total impact

  • Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 09/2015; 17(3):151-2. · 2.15 Impact Factor
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    ABSTRACT: Rapid intravenous infusion of 0.9% saline alters respiratory mechanics in healthy subjects. However, the relative cardiovascular and respiratory effects of bolus intravenous crystalloid versus colloid are unknown. Six healthy male volunteers were given 30 ml/kg intravenous 0.9% saline, 4% albumin and 5% glucose at a rate of 100 ml/minute on three separate days in a double-blind randomized crossover study. Impulse oscillometry, spirometry, lung volumes, diffusing capacity and blood samples were measured before and after fluid administration. Lung ultrasound B-line score (indicating interstitial pulmonary edema) and Doppler echocardiography indices of cardiac preload were measured before, midway, immediately after and one hour after fluid administration. Infusion of 0.9% saline increased small airway resistance at 5 Hz (P = 0.04) and lung ultrasound B-line score (P = 0.01), without changes in Doppler echocardiography measures of preload. In contrast, 4% albumin increased diffusing capacity, decreased lung volumes, and increased Doppler echocardiopraphy mitral E velocity (P = 0.001) and E to lateral/septal e' ratio, estimated blood volume and NT-proBNP (P = 0.01), but not lung ultrasound B-line score; consistent with increased pulmonary blood volume without interstitial pulmonary edema. There were no significant changes with 5% glucose. Plasma angiopoietin-2 concentration increased only after 0.9% saline (P = 0.001), suggesting an inflammatory mechanism associated with edema formation. In healthy subjects 0.9% saline and 4% albumin have differential pulmonary effects not attributable to passive fluid filtration. This may reflect either different effects of these fluids on active signaling in the pulmonary circulation, or a protective effect of albumin. Copyright © 2015, Journal of Applied Physiology.
    Journal of Applied Physiology 07/2015; DOI:10.1152/japplphysiol.00356.2015 · 3.43 Impact Factor
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    ABSTRACT: To derive and validate a mortality prediction model from information available at ED triage. Multivariable logistic regression of variables from administrative datasets to predict inpatient mortality of patients admitted through an ED. Accuracy of the model was assessed using the receiver operating characteristic area under the curve (ROC-AUC) and calibration using the Hosmer-Lemeshow goodness of fit test. The model was derived, internally validated and externally validated. Derivation and internal validation were in a tertiary referral hospital and external validation was in an urban community hospital. The ROC-AUC for the derivation set was 0.859 (95% CI 0.856-0.865), for the internal validation set was 0.848 (95% CI 0.840-0.856) and for the external validation set was 0.837 (95% CI 0.823-0.851). Calibration assessed by the Hosmer-Lemeshow goodness of fit test was good. The model successfully predicts inpatient mortality from information available at the point of triage in the ED. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
    Emergency medicine Australasia: EMA 07/2015; 27(4). DOI:10.1111/1742-6723.12425 · 1.22 Impact Factor
  • Claire E Baldwin · Andrew D Bersten
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    ABSTRACT: Purpose of review: Survivors of a critical illness may experience poor physical function and quality of life as a result of reduced skeletal muscle mass and strength during their acute illness. Patients diagnosed with sepsis are particularly at risk, and mechanical ventilation may result in diaphragm dysfunction. Interest in the interaction of these conditions is both growing and important to understand for individualised patient care. Recent findings: This review describes developments in the presentation of both diaphragm and limb myopathy in critical illness, as measured from muscle biopsy and at the bedside with various imaging and strength testing modalities. The influence of unloading of the diaphragm with mechanical ventilation and peripheral muscles with immobilisation in septic patients has been recently questioned. Systemic inflammation appears to primarily accelerate and accentuate dysfunction, which may be remedied by early mobilisation and augmented with developing muscle and/or nerve stimulation techniques. Summary: Many acute muscle changes in septic patients are likely to stem from pre-existing impairments, which should provide context for clinical evaluations of strength. During illness, sarcolemmal injury promotes a cascade of intra-cellular abnormalities. As unique characteristics of ICU acquired weakness and differential effects on muscle groups are understood, early diagnosis and management should be facilitated.
    Current Opinion in Clinical Nutrition and Metabolic Care 03/2015; 18(3). DOI:10.1097/MCO.0000000000000165 · 3.97 Impact Factor
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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. · 2.15 Impact Factor
  • Shailesh Bihari · Andrew D Bersten
    Critical Care Medicine 02/2015; 43(2):481-2. DOI:10.1097/CCM.0000000000000728 · 6.15 Impact Factor
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    Heart, Lung and Circulation 01/2015; 24:S212. DOI:10.1016/j.hlc.2015.06.239 · 1.17 Impact Factor
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    ABSTRACT: We hypothesized that the thromboelastometry (ROTEM; Pentapharm GmbH, Munich, Germany) fibrinolysis parameter "maximum lysis" (ML) would have an independent inverse association with the severity of organ failure in sepsis. Selected adult patients with sepsis (n = 77) were recruited within 24 hours of antibiotic commencement. Patients with Sequential Organ Failure Assessment score higher than 1 (n = 57) were followed for 72 hours. Prothrombin fragments 1 + 2, plasminogen activator inhibitor-1 (aPAI-1), ROTEM, and routine coagulation tests were measured daily along with Sequential Organ Failure Assessment scores. The activity of functional aPAI-1 increased with increasing severity of organ failure (P = .01) and was higher as compared with healthy controls (95% confidence interval, -65.4 to -29.9; P < .001). There was a decreasing trend in ML with increased organ failure (P = .001); however, there was no trend in d-dimer. Among all tests, only the lower ML (ß = -0.38, P < .001) and higher international normalized ratio (INR; ß = 0.32, P = .002) values significantly contributed to greater severity of organ failure (R(2) = 0.35, F2,73 = 19.29, P < .001). Despite an increase in INR, the prothrombin fragment remained unchanged (P = .89). Strong correlations were observed between early (24 hours) increase in fibrinolysis and recovery of organ failures for 48 hours (ML: r = 0.679, P = .001; aPAI-1: r = 0.694, P < .001). Lower ML and higher INR values predicted greater severity of organ failure at presentation. Further studies are required, as ROTEM could aid selection of patients and guide interventions aimed at fibrinolysis in severe sepsis. Copyright © 2014 Elsevier Inc. All rights reserved.
    Journal of Critical Care 10/2014; 30(2). DOI:10.1016/j.jcrc.2014.10.014 · 2.19 Impact Factor
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    ABSTRACT: Background Chronic heart failure (CHF) following coronary artery ligation and myocardial infarction in the rat leads to a homeostatic reduction in surface tension with associated alveolar type II cell hyperplasia and increased surfactant content, which functionally compensates for pulmonary collagen deposition and increased tissue stiffness. To differentiate the effects on lung remodelling of the sudden rise in pulmonary microvascular pressure (Pmv) with myocardial infarction from its consequent chronic elevation, we examined a hypertensive model of CHF. Methods Cardiopulmonary outcomes due to chronic pulmonary capillary hypertension were assessed at six and 15 weeks following abdominal aortic banding (AAB) in the rat. Results At six weeks post-surgery, despite significantly elevated left ventricular end-diastolic pressure, myocardial hypertrophy and increased left ventricular internal circumference in AAB rats compared with sham operated controls (p≤0.003), lung weights and tissue composition remained unchanged, and lung compliance was normal. At 15 weeks post-surgery increased lung oedema was evident in AAB rats (p = 0.002) without decreased lung compliance or evidence of tissue remodelling. Conclusion Despite chronically elevated Pmv, comparable to that resulting from past myocardial infarction (LVEDP >19 mmHg), there is no evidence of pulmonary remodelling in the AAB model of CHF.
    Heart, Lung and Circulation 09/2014; 24(2). DOI:10.1016/j.hlc.2014.08.009 · 1.17 Impact Factor
  • Shailesh Bihari · Shivesh Prakash · Andrew D Bersten
    Intensive Care Medicine 07/2014; 40(9). DOI:10.1007/s00134-014-3385-6 · 5.54 Impact Factor
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    Russell D Laver · Ubbo F Wiersema · Andrew D Bersten
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    ABSTRACT: Background Indirect assessment of mean pulmonary arterial pressure (MPAP) may assist management of critically ill patients with pulmonary hypertension and right heart dysfunction. MPAP can be estimated as the sum of echocardiographically derived mean right ventricular to right atrial systolic pressure gradient and right atrial pressure; however, this has not been validated in critically ill patients. Methods This prospective validation study was conducted in patients undergoing pulmonary artery catheterisation during intensive care admission. Pulmonary artery catheter (PAC) measurements of MPAP were contemporaneously compared to MPAP estimated utilising transthoracic echocardiography (TTE)-derived mean right ventricular to right atrial systolic pressure gradient added to invasively measured right atrial pressure. Results Of 53 patients assessed, 23 had estimable MPAP using TTE. The mean difference between TTE- and PAC-derived MPAP was 1.9 mmHg (SD 5.0), with upper and lower limits of agreement of 11.6 and −7.9 mmHg, respectively. The median absolute percentage difference between TTE- and PAC-derived MPAP was 7.5%. Inter-rater reliability assessment was performed for 15 patients, giving an intra-class correlation coefficient of 0.96 (95% confidence intervals, 0.89 to 0.99). Conclusions This echocardiographic method of estimating MPAP in critically ill patients was not equivalent to invasively measured MPAP, based on our predefined clinically acceptable range (±5 mmHg). The accuracy of this method in critically ill patients was similar to the results obtained in ambulatory patients and compared favourably with regard to the accuracy with echocardiographic estimation of systolic pulmonary arterial pressure. The utility of this technique is limited by frequent inability to obtain an adequate tricuspid regurgitant time-velocity integral in critically ill patients.
    Critical ultrasound journal 07/2014; 6(1):9. DOI:10.1186/2036-7902-6-9
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    ABSTRACT: Background: Because increased serum osmolarity may be lung protective, we hypothesized that increased mortality associated with increased serum sodium would be ameliorated in critically ill patients with an acute respiratory diagnosis. Methods: Data collected within the first 24 hours of intensive care unit (ICU) admission were accessed using ANZICS CORE database. From January 2000 to December 2010, 436 209 patients were assessed. Predefined subgroups including patients with acute respiratory diagnoses were examined. The effect of serum sodium on ICU mortality was assessed with analysis adjusted for illness severity and year of admission. Results are presented as odds ratio (95% confidence interval) referenced against a serum sodium range of 135 to 144.9 mmol/L. Results: Overall ICU mortality was increased at each extreme of dysnatremia (U-shaped relationship). A similar trend was found in various subgroups, with the exception of patients with respiratory diagnoses where ICU mortality was not influenced by high serum sodium (odds ratio, 1.3 [0.7-1.2]) and was different from other patient groups (P < .01). Any adverse associations with hypernatremia in respiratory patients were confined to those with arterial pressure of oxygen (PaO2)/fraction of inspired oxygen (FIO2) ratios of greater than 200. Conclusion: High admission serum sodium is associated with increased odds for ICU death, except in respiratory patients.
    Journal of Critical Care 06/2014; 29(6). DOI:10.1016/j.jcrc.2014.06.008 · 2.19 Impact Factor
  • Shailesh Bihari · Susan Taylor · Andrew D Bersten
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    ABSTRACT: Inadvertent sodium (Na(+)) flux may occur during renal replacement therapy (RRT) in ICU. The objective of this study was to estimate sodium flux during RRT. Between September 2011 to December 2012 we studied 60 ICU patients receiving extended daily dialysis (EDD, Fresenius 4008S) or continuous renal replacement technique (CRRT, Aquarius 6.01). CRRT was categorized as dialysis with continuous veno-venous haemofiltration (CVVH) or haemodiafiltration (CVVHDF). Sodium balance was calculated as the difference between affluent and effluent fluid sodium concentration corrected for volume. The duration of study was either the duration of a single EDD session or 24 h of CRRT. Both EDD and CRRT contributed to a positive Na(+) flux. Despite similar demographics, CRRT patients had a greater positive sodium flux (p < 0.001). At multivariate analysis, factors [exp(b) (SE), p] which significantly affected sodium flux in each mode of RRT were: (1) EDD (R(2) = 0.42): gradient between RRT Na(+) and serum Na(+) [20.9 (5.8), p < 0.02], and total litres of exchange [1.5 (0.68), p < 0.04]; (2) CVVH (R(2) = 0.77): gradient between RRT Na(+) and serum Na(+) [21.8 (4.7), p < 0.001], dialysis day [-20.9 (9.8), p < 0.05], and total litres of exchange [5.2 (0.96), p < 0.001]; (3) CVVHDF (R(2) = 0.73): gradient between RRT Na(+) and serum Na(+) [23.8 (3.7), p < 0.001], and total fluid removal [-18.5 (3.26), p < 0.001]. RRT may inadvertently contribute to sodium load in critically ill patients and is affected by multiple factors including gradient between RRT Na(+) and serum Na(+).
    Journal of nephrology 02/2014; 27(4). DOI:10.1007/s40620-014-0041-8 · 2.00 Impact Factor
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    ABSTRACT: Inadvertent sodium administration in excess of recommended daily requirements has been reported during routine care of critically ill patients. Aim: To determine the amount and sources of sodium administered in Australian and New Zealand intensive care units. Prospective, observational, single-day, point prevalence survey conducted in 46 Australian and New Zealand ICUs on 21 September 2011. All patients present in ICU at 10 am and not receiving an oral diet on the study day were evaluated. Demographic data, ICU admission diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score and sources of sodium administration over the study day were recorded. 356 patients (64% male) were enrolled. Mean (SD) age and weight were 58.5 years (18.0 years) and 81.6 kg (24.0 kg), respectively. Mean ICU admission APACHE II score was 20 (SD, 8). Overall median (interquartile range [IQR]) sodium administration was 224.5 mmol (IQR, 144.9-367.6 mmol), or 2.8 mmol/kg (IQR, 1.6-4.7 mmol/kg). Among patients who were on Day 2-10 of their ICU admission on the study day, sodium sources and amounts administered were: i) maintenance or replacement intravenous (IV) infusions, 69.3mmol; 30.9% of all sodium sources; ii) IV fluid boluses, 36.5 mmol; 16.3%; iii) IV drug boluses, 27.6 mmol; 12.3%; iv) enteral nutrition, 26.5 mmol; 11.8%; v) IV drug infusions, 19.3 mmol; 8.6%; vi) IV flushes, 16.6mmol; 7.4%; vii) blood products, 13.5 mmol; 6%; viii) IV antimicrobials, 11.2mmol; 5%; and ix) parenteral nutrition, 4.3 mmol; 1.9%. Factors associated with sodium administration were site (P = 0.04), age (P < 0.001), administered fluid (P = 0.03) and day of ICU stay (P = 0.01) (multiple linear regression). This point prevalence study suggests that sodium administration in excess of recommended daily requirements may be common in Australia and New Zealand ICUs. The main sodium source was IV maintenance fluids, followed by fluid boluses and drug boluses.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 12/2013; 15(4):294-300. · 2.15 Impact Factor
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    Claire E Baldwin · Andrew D Bersten
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    ABSTRACT: Skeletal muscle wasting and weakness is common in intensive care unit (ICU) patients with sepsis, although less is known about deficits in diaphragm and limb muscles when mechanical ventilation is also required. To concurrently investigate relative differences in both thickness and strength of respiratory and peripheral muscles during routine care. Prospective cross-sectional study of sixteen alert patients with sepsis and sixteen healthy controls. Assessment of: diaphragm, upper-arm, forearm and thigh muscle thicknesses with ultrasound; respiratory muscle strength with maximal inspiratory pressure; isometric hand grip, elbow flexion and knee extension forces with portable dynamometry. To describe relative changes, data were also normalised to fat free body mass (FFM) measured by bioelectrical impedance spectroscopy. Patients (nine males, seven females, aged 62(17) years) were assessed after 16(11-29) days of ICU admission. Patients' diaphragm thickness did not differ from healthy controls (p=0.44), even for a given FFM (p=0.16). When normalised to FFM, only the difference in patients' mid-thigh muscle size significantly deviated from controls (p≤0.001). Within the patient sample, all peripheral muscle groups were thinner, as compared to the diaphragm (p≤0.01). Patients were significantly weaker than healthy controls in all muscle groups (p≤0.001), including for a given FFM (p≤0.001). Within the critically ill, limb weakness was greater than already significant respiratory muscle weakness (p≤0.02). Volitional strength tests were applied such that successive measurements from earlier in the course of illness could not be reliably obtained. When measured at the bedside, survivors of sepsis and a period of mechanical ventilation may experience respiratory muscle weakness without remarkable diaphragm wasting. Furthermore, deficits in peripheral muscle strength and size may exceed those in the diaphragm.
    Physical Therapy 09/2013; 94(1). DOI:10.2522/ptj.20130048 · 3.25 Impact Factor
  • Shailesh Bihari · Claire E Baldwin · Andrew D Bersten
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    ABSTRACT: Distribution of total body water (TBW) depends on local and systemic factors including osmolality, relative sodium content and permeability. Although positive fluid balance has been associated with increased morbidity and mortality in critically ill patients, the mechanisms and relative roles of sodium balance and water distribution are uncertain. To track changes in sodium and fluid balance, respiratory function and body composition in patients who required mechanical ventilation for ≥48 hours. Prospective observational study, set in a tertiary intensive care unit, of 10 patients (seven men) with a mean age of 60 years (standard deviation [SD],12 years) and mean admission Acute Physiology and Chronic Health Evaluation (APACHE) III score of 71 (SD, 26). Sodium and fluid balances were estimated daily for up to 5 days, following institution of mechanical ventilation on Day 0. Serum sodium level, oxygenation (PaO2/FIO2), body weight, intracellular and extracellular fluid (ECF) distribution (bioelectrical impedance spectroscopy), and blinded chest x-ray oedema scores were performed daily. After 5 days of mechanical ventilation, the cumulative fluid balance was - 954 mL (SD, 3181 mL) and estimated cumulative sodium balance was 253 mmol (SD, 346 mmol). Serum sodium had increased from 140mmol/L (SD, 4mmol/L) to 147 mmol/L (SD, 5mmol/L). Cumulative sodium balance was weakly correlated with worsening chest x-ray score (r = 0.35, P = 0.004), a reduction in PaO2/ FIO2 ratio (r = - 0.52, P = 0.001) and 24-hour urinary sodium (r = - 0.24, P = 0.02). Between Days 1 and 5, body weight decreased (- 2.7 kg; SD, 1.4 kg) and TBW decreased (- 3.4 L; SD, 1.3 L), despite a rise in ECF distribution (1.4% of TBW; SD, 1.9% of TBW). Fluid balance may not reflect sodium balance in critically ill patients. As sodium balance correlates with respiratory dysfunction and increased extracellular volume, further studies examining sodium balance and morbidity seem warranted.
    Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 06/2013; 15(2):89-96. · 2.15 Impact Factor
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    ABSTRACT: ABSTRACT BACKGROUND: In a recent multicenter randomized trial comparing unfractionated heparin (UFH) with low-molecular-weight heparin (dalteparin) for thromboprophylaxis in 3746 critically-ill patients, 17 (0.5%) patients developed heparin-induced thrombocytopenia (HIT) based on serotonin-release assay-positive (SRA+) status. A trend to lower frequency of HIT with dalteparin vs UFH was observed in the intention-to-treat analysis (5 vs 12 patients; P=0.14), which was statistically significant (3 vs 12 patients; P=0.046) in a prespecified per-protocol analysis which excluded patients with deep-vein thrombosis (DVT) at study entry. We sought to characterize HIT outcomes and to determine how dalteparin thromboprophylaxis might reduce HIT frequency in ICU patients. METHODS: In 17 patients with HIT, we analyzed platelet counts and thrombotic events in relation to study drug and other open-label heparin, to determine whether study drug plausibly explained seroconversion to SRA+ status and/or breakthrough of thrombocytopenia/thrombosis. We also compared antibody frequencies (dalteparin vs UFH) in 409 patients serologically investigated for HIT. RESULTS: HIT-associated thrombosis occurred in 10/17 (58.8%) patients (8:1:1 venous:arterial:both). Dalteparin was associated with fewer study drug-attributable HIT-related events (P=0.020), including less seroconversion (P=0.058) and less breakthrough of thrombocytopenia/thrombosis (P=0.032). Anti-PF4/heparin IgG antibodies by ELISA were less frequent among patients receiving dalteparin vs UFH (13.5% vs 27.3%; P<0.001). One patient with HIT-associated DVT died post-UFH bolus, whereas platelet counts recovered in two others with HIT-associated VTE despite continuation of therapeutic-dose UFH. CONCLUSIONS: The lower risk of HIT in ICU patients receiving dalteparin appears related to both decreased antibody formation and decreased clinical breakthrough of HIT among patients forming antibodies.
    Chest 05/2013; DOI:10.1378/chest.13-0057 · 7.13 Impact Factor
  • Shailesh Bihari · Shivesh Prakash · Andrew D Bersten
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    ABSTRACT: INTRODUCTION: Administration of fluid boluses(FB) beyond initial resuscitation in patients with severe sepsis are common, and may contribute to positive fluid balance. Little is known regarding the efficacy and risk profile of this strategy. OBJECTIVE: To estimate the prevalence and efficacy of FB post initial resuscitation in septic patients. METHODS: In a prospective study, patients with severe sepsis/septic shock were recruited post initial resuscitation and followed for 3 days. Number, types and volumes of FB, resuscitation goals and their perceived success rates were recorded. Data are presented as median (IQR). RESULTS: Over a 1 year period, 50 patients were recruited, 47(94%) of them received FB, with a total of 184 FB [3(2-5) per patient] administered over the 72 hours. On day 1, 2(1-3) FB, totalling 750(500-1720)ml were administered which comprised 52.4%(22.1-124.2) of the fluid balance. Low blood pressure (MAP)(76.0%) and increased vasopressor requirement(60.3%) were the two most common indications for FB. Low filling pressure(70.9%) and clinical signs(79.4%) were perceived as the most successful indications. One hour after these FB, there was a small increase in MAP(p<0.01) and central venous pressure(p<0.01), however, there was also concomitant increase in noradrenaline administered. There was a significant decrease in PaO2/FiO2 ratio, haemoglobin and temperature, while urine output remained unchanged. Factors[Exp(b)(SE)p-value](R=0.296) which affected the increase in MAP were baseline MAP[-0.49(.057)p<0.001] and amount of these FB[-0.05(.01)p=0.001]. Cumulative fluid balance had a weak correlation with delta SOFA score(r=0.32,p=0.001) and lung injury score(r=0.13,p=0.02) and negative correlation with PaO2/FiO2 ratio(r=-0.28,p=0.001). CONCLUSION: Post-resuscitation FB are common in septic patients, meet limited success and may be harmful.
    Shock (Augusta, Ga.) 04/2013; 40(1). DOI:10.1097/SHK.0b013e31829727f1 · 2.73 Impact Factor
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    R Sinha · D Roxby · A Bersten
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    ABSTRACT: A massive transfusion response (MTR) was introduced in 2007 to provide blood and blood products in a timelier manner. Aim of this study was to determine whether implementation of the MTR was associated with a change in clinical practice or mortality. All MTR activations from 2008 to 2011 were included in the study. Patients who had received a massive transfusion (MT ≥ 10 units RBC in 24 h) as part of the MTR (MT-MTR) were compared with a historical group of MT patients (MT-Pre-MTR) from 2004 to 2006. Blood product usage including fresh frozen plasma (FFP) : RBC and platelet : RBC ratios and mortality were compared between the two groups. Out of 169 MTR activations, 13 patients (8%) did not use any blood products, 73 (43%) used <10 units of RBC in a 24-h period and 83 received a MT. The median number of units of FFP and platelets transfused in the MT-MTR group were 10 [interquartile range (IQR) 7-17] vs 6 (5-10) [P < 0·001] and 3 (IQR 2-4) vs 2 (IQR 1-3) [P < 0·001] in the MT-Pre-MTR group of patients, respectively. The MT-MTR group received a higher 24-h FFP : RBC ratio (1 : 1·4 vs 1 : 2·4, P < 0·001). Overall mortality between the MT-MTR and MT-Pre-MTR groups (29% vs 23%, P = 0·43) and 90-day mortality was 25% vs 29% (P = 0·40), respectively. Although there has been a significant change in transfusion practice in MT patients using a MTR, no change in mortality could be documented using such a protocol.
    Transfusion Medicine 04/2013; 23(2):108-13. DOI:10.1111/tme.12022 · 1.31 Impact Factor
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    Dani-Louise Dixon · Andrew D Bersten
    Critical care medicine 01/2013; 41(1):354-5. DOI:10.1097/CCM.0b013e318270e3c6 · 6.15 Impact Factor

Publication Stats

2k Citations
621.59 Total Impact Points


  • 1991–2015
    • Flinders University
      • • Department of Critical Care Medicine
      • • Flinders Medical Centre
      • • School of Medicine
      • • Department of Human Physiology
      Tarndarnya, South Australia, Australia
  • 1990–2015
    • Flinders Medical Centre
      • Department of Cardiology
      Tarndarnya, South Australia, Australia
  • 2011
    • Lyell McEwin Hospital
      • Intensive Care Unit
      Adelaide, South Australia, Australia
  • 2008
    • Catholic University of Louvain
      • School of Medicine
      Louvain-la-Neuve, WAL, Belgium
  • 2004
    • Royal Perth Hospital
      Perth City, Western Australia, Australia
  • 2002–2004
    • The Queen Elizabeth Hospital
      • Intensive Care Unit
      Tarndarnya, South Australia, Australia
  • 1999
    • Northern Inyo Hospital
      Bishop, California, United States