David V Pilcher

David V Pilcher
Alfred Hospital · Intensive Care Unit

MBBS MRCP FRACP FCICM

About

436
Publications
49,179
Reads
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12,137
Citations
Additional affiliations
January 2011 - present
October 2007 - present
Australian And New Zealand Intensive Care Society
Australian And New Zealand Intensive Care Society
Position
  • Chair
January 2006 - present
Monash University (Australia)

Publications

Publications (436)
Article
Full-text available
Background The Clinical Frailty Scale (CFS) is the most commonly used frailty measure in intensive care unit (ICU) patients. The hospital frailty risk score (HFRS) was recently proposed for the quantification of frailty. We aimed to compare the HFRS with the CFS in critically ill patients in predicting long-term survival up to one year following IC...
Article
Full-text available
Purpose: To develop a set of actionable quality indicators for critical care suitable for use in low- or middle-income countries (LMICs). Methods: A list of 84 candidate indicators compiled from a previous literature review and stakeholder recommendations were categorised into three domains (foundation, process, and quality impact). An expert pa...
Article
Background: The presence of treatment limitations in patients with frailty at intensive care unit (ICU) admission is unknown. We aimed to evaluate the presence and predictors of treatment limitations in patients with and without COVID-19 pneumonitis in those admitted to Australian and New Zealand ICUs. Methods: This registry-based multicenter, r...
Preprint
Background It is unclear if the impact of frailty on mortality differs between patients with viral pneumonitis due to COVID-19 or other causes. We aimed to determine if a difference exists between patients with and without COVID-19 pneumonitis. Methods This multicenter, retrospective, cohort study using the Australian and New Zealand Intensive Care...
Article
Objectives: The Australasian Resuscitation in Sepsis Evaluation (ARISE) study researched septic shock treatment within EDs. This study aims to evaluate whether: (i) conduct of the ARISE study was associated with changes in epidemiology and care for adults (≥18 years) admitted from EDs to ICUs with sepsis in Australia and New Zealand; and (ii) such...
Article
OBJECTIVES: To evaluate the epidemiology of rapid response team (RRT) reviews that led to intensive care unit (ICU) admissions, and to evaluate the frequency of in-hospital cardiac arrests (IHCAs) among ICU patients with confirmed coronavirus disease 2019 (COVID-19) in Australia. DESIGN: Multicentre, retrospective cohort study. SETTING: 48 public a...
Article
Purpose Studies examining the association between obesity and mortality in cardiac arrest patients have been conflicting which might either be due to residual confounding, or a reliance on estimating the conditional effects rather than the marginal (causal) effects of obesity. We estimated the conditional and causal effects of obesity on mortality...
Article
Full-text available
Klebsiella pneumoniae is a major cause of opportunistic healthcare-associated infections, which are increasingly complicated by the presence of extended-spectrum beta-lactamases (ESBLs) and carbapenem resistance. We conducted a year-long prospective surveillance study of K. pneumoniae clinical isolates in hospital patients. Whole-genome sequence (W...
Article
Full-text available
Background There are currently no validated globally and freely available tools to estimate the modified frailty index (mFI). The widely available and non-proprietary International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) coding could be used as a surrogate for the mFI. We aimed to establish an app...
Article
Importance: Identification of potential indirect outcomes associated with the COVID-19 pandemic in the pediatric population may be essential for understanding the challenges of the current global public health crisis for children and adolescents. Objective: To investigate whether the SARS-CoV-2 outbreak and subsequent effective public health mea...
Article
Background & aims: Changes in outcomes of cirrhotic patients admitted to intensive care units (ICUs) with infections are poorly understood. We aimed to describe changes over time in outcomes for such patients and to compare them to other ICU admissions. Methods: Analysis of consecutive admissions to 188 ICUs between 2005 and 2017 as recorded in...
Article
The BEAMS (Burns Evaluation And Mortality Study) risk of death score was developed in 2013 as a mortality prediction tool for burns patients admitted to an ICU (Intensive Care Unit) in Australia and New Zealand. While it previously performed well, identifying high risk groups and allowing benchmarking, over time such scores may lose calibration or...
Article
Full-text available
Purpose: Venous thromboembolism (VTE) prophylaxis is effective in reducing VTE events; however, it is underutilized in critically ill patients. We examined trends and risk factors for omission of early thromboprophylaxis within the first 24 h after admission in Australian and New Zealand intensive care units (ICUs) between 2009 and 2020. Methods:...
Article
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Background The focus of much Intensive Care research has been on short-term survival, which has demonstrated clear improvements over time. Less work has investigated long-term survival, and its correlates. This study describes long-term survival and identifies factors associated with time to death, in patients who initially survived an Intensive Ca...
Article
Objectives: To develop and demonstrate the feasibility of a Global Open Source Severity of Illness Score (GOSSIS)-1 for critical care patients, which generalizes across healthcare systems and countries. Design: A merger of several critical care multicenter cohorts derived from registry and electronic health record data. Data were split into trai...
Preprint
Background: The Clinical Frailty Scale (CFS) is the most commonly used frailty measure in intensive care unit (ICU) patients. The hospital frailty risk score (HFRS) was recently proposed for the quantification of frailty. We aimed to compare the HFRS with the CFS in critically ill patients in predicting long-term survival up to one year following I...
Article
Purpose: Hyperoxia has been associated with adverse outcomes in post cardiac arrest (CA) patients. Study-objective was to examine the association between hyperoxia and 30-day mortality in a mixed cohort of two different modes of Cardiopulmonary Resuscitation (CPR): Extracorporeal (ECPR) vs. Conventional (CCPR). Material and methods: In this retr...
Article
Full-text available
Purpose: Acute illness severity predicts mortality in intensive care unit (ICU) patients, however, its predictive value decreases over time in ICU. Typically after 10 days, pre-ICU (antecedent) characteristics become more predictive of mortality, defining the onset of persistent critical illness (PerCI). How patient frailty affects development and...
Article
Five patients, comprising nine treatment courses of sargramostim use in pulmonary alveolar proteinosis are described. The prevailing standard of treatment, whole lung lavage, is highly invasive, resource intensive and carries some procedural risk. Nebulised recombinant human GM‐CSF (sargramostim) offers a pharmacological treatment option, allowing...
Article
Full-text available
Frailty is often used in clinical decision-making for patients with coronavirus disease 2019, yet studies have found a variable influence of frailty on outcomes in those admitted to the ICU. In this individual patient data meta-analysis, we evaluated the characteristics and outcomes across the range of frailty in patients admitted to ICU with coron...
Article
Background Older frail patients are more likely to have timely goals of care (GOC) documentation than non-frail patients. Aims To investigate whether timely documentation of GOC within 72 h differed in the context of the COVID-19 pandemic (2020), compared with the pre-COVID era (2019) for older frail patients. Methods Multi-site retrospective coh...
Preprint
Full-text available
Klebsiella pneumoniae is a major cause of opportunistic healthcare-associated infections, which are increasingly complicated by the presence of extended-spectrum beta-lactamases (ESBLs) and carbapenem resistance. We conducted a year-long prospective surveillance study of K. pneumoniae clinical isolates identified in a hospital microbiological diagn...
Article
PurposeThe impact of intensivist workload on intensive care unit (ICU) outcomes is incompletely described and assessed across healthcare systems and countries. We sought to examine the association of patient-to-intensivist ratio (PIR) with hospital mortality in Australia/New Zealand (ANZ) ICUs.Methods We conducted a retrospective study of adult adm...
Article
Full-text available
Pulmonary alveolar proteinosis (PAP) is a rare respiratory syndrome, which can be challenging to diagnose given its non‐specific presentation and imaging findings. While most primary cases of PAP have an autoimmune basis, the triggers for the disease are uncertain with occupational factors increasingly thought to be important. We report the unusual...
Article
Full-text available
During 2020, Victoria was the Australian state hardest hit by COVID-19, but was successful in controlling its second wave through aggressive policy interventions. We calibrated a detailed compartmental model of Victoria’s second wave to multiple geographically-structured epidemic time-series indicators. We achieved a good fit overall and for indivi...
Article
Objectives: To describe the short term capability of Australian intensive care units (ICUs) to increase capacity in response to heightened demand caused by the COVID-19 pandemic. Design: Survey of ICU directors or delegated senior clinicians (disseminated 30 August 2021), supplemented by Australian and New Zealand Intensive Care Society (ANZICS)...
Preprint
Full-text available
Background There are currently no validated globally and freely available tools to estimate the modified frailty index (mFI). The widely available and non-proprietary International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) coding could be used as a surrogate for the mFI. We aimed to establish an app...
Article
Objectives: Current definitions of acute kidney injury use a urine output threshold of less than 0.5 mL/kg/hr, which have not been validated in the modern era. We aimed to determine the prognostic importance of urine output within the first 24 hours of admission to the ICU and to evaluate for variance between different admission diagnoses. Design...
Preprint
Full-text available
Purpose: Frailty is often used in clinical decision-making for patients with COVID-19, yet studies have found variable influence of frailty on outcomes in those admitted to the intensive care unit (ICU). In this individual patient data meta-analysis, we evaluated the characteristics, and outcomes of frail patients admitted to ICU with COVID-19. Met...
Article
BACKGROUND: The national hospital-acquired complications (HAC) system has been promoted as a method to identify health care errors that may be mitigated by clinical interventions. OBJECTIVES: To quantify the rate of HAC in multiday stay adults admitted to major hospitals. DESIGN: Retrospective observational analysis of 5-year (July 2014 – June 2019...
Article
OBJECTIVES: To validate a real-time Intensive Care Unit (ICU) Activity Index as a marker of ICU strain from daily data available from the Critical Health Resource Information System (CHRIS), and to investigate the association between this Index and the need to transfer critically ill patients during the coronavirus disease 2019 (COVID-19) pandemic...
Article
Introduction: Rehabilitation outcomes in cardiac survivors are largely unknown, with no data comparing out-of-hospital cardiac arrests (OHCA) and in-hospital cardiac arrests (IHCA). This study aimed to describe and compare inpatient rehabilitation outcomes in these patients who were admitted from intensive care units (ICU). Methods: A retrospect...
Preprint
Full-text available
Background Hyperoxia has been associated with adverse outcomes in post cardiac arrest (CA) patients. However, little data are available from mixed cohorts, where extracorporeal membrane oxygenation cardiopulmonary resuscitation (ECPR) and conventional CPR (CCPR) were utilised. The independence of effect of hyperoxia in this setting is not clear. St...
Article
Introduction Postoperative atrial fibrillation (POAF) is common after cardiac surgery and associated with increased hospital length of stay, patient morbidity and mortality. We aimed to identify factors associated with POAF and evaluate the accuracy of available POAF prediction models. Methods We screened articles from Ovid MEDLINE ® and PubMed Ce...
Article
Rationale: Hypercapnia may affect the outcome of sepsis. Very few clinical studies conducted in non-critically ill patients, have investigated the effects of hypercapnia and hypercapnic acidemia in the context of sepsis. The effect of hypercapnia in critically ill patients with sepsis remains inadequately studied. Objective: To investigate the a...
Article
Purpose: ICU strain (low number of available beds) may be associated with a delay and altered threshold for ICU admission and adverse patient outcomes. We aimed to investigate the impact of ICU strain on hospital mortality in critically ill patients admitted from wards across Australia and New Zealand. Materials and methods: Ward patient admitte...
Article
Objective The objective of this study was to describe family visitation policies, facilities, and support in Australia and New Zealand (ANZ) intensive care units (ICUs). Methods A survey was distributed to all Australian and New Zealand ICUs reporting to the Australian and New Zealand Intensive Care Society Centre for Outcomes and Resources Evalua...
Article
Abstract Background and objective Organ donation rates continue to be low in Australia compared with demand. Donation after circulatory death (DCD) has been an important strategy to increase donation rates, facilitated by advances in cardiopulmonary support in intensive care units (ICUs). However, DCD may harbour greater logistical challenges and...
Article
Full-text available
Background Third-generation cephalosporin-resistant Gram-negatives (3GCR-GN) and vancomycin-resistant enterococci (VRE) are common causes of multi-drug resistant healthcare-associated infections, for which gut colonisation is considered a prerequisite. However, there remains a key knowledge gap about colonisation and infection dynamics in high-risk...
Article
Rationale: Frailty in critically ill patients is associated with higher mortality and prolonged length of stay, however little is known about the impact on the duration of mechanical ventilation. Objectives: To identify the relationship between frailty and total duration of mechanical ventilation and the interaction with patients' age. Methods:...
Article
Background Nonurban residential living is associated with adverse outcomes for a number of chronic health conditions. However, it is unclear what effect it has amongst survivors of critical illness. Objectives The purpose of this study is to determine whether patients living greater than 50 km from the treating intensive care unit (ICU) have disab...
Article
Objective To report intensive care unit admission outcomes for head and neck cancer patients. Methods A retrospective, observational cohort analysis of all Australian and New Zealander head and neck cancer patient intensive care unit admissions from January 2000 to June 2016, including data from 192 intensive care units. Results There were 10 721...
Article
There is growing interest in not only intensive care unit (ICU) outcomes but also the resources required to deliver this care and itscost-effectiveness. The most available metric of resource utilisation is ICU length of stay, which is influenced by casemix, illness severity, and institutional characteristics, including delays in discharge. For inst...
Article
Background Frailty is associated with poor outcomes in critical illness. However, it is unclear whether frailty screening on admission to ICU can be routinely conducted at the population level and whether it has prognostic importance. Research Question Can population-scale frailty screening with the Clinical Frailty Scale (CFS) be implemented for...
Article
Background: In Australia, increased organ donation and subsequent lung transplantation (LTx) rates have followed enhanced donor identification, referral and management, as well as the introduction of a donation after circulatory death (DCD) pathway. However, the number of patients waiting for LTx still continues to exceed the number of lung donors...
Article
Full-text available
Background This paper aimed to describe the airway practices of intensive care units (ICUs) in Australia and New Zealand specific to patients presenting with COVID-19 and to inform whether consistent clinical practice was achieved. Specific clinical airway guidelines were endorsed in March 2020 by the Australian and New Zealand Intensive Care Socie...
Article
Objectives: To investigate the association of socioeconomic status as measured by the average socioeconomic status of the area where a person resides on short-term mortality in adults admitted to an ICU in Queensland, Australia. Design: Secondary data analysis using de-identified data from the Australian and New Zealand Intensive Care Society Ce...
Article
Aims: To describe the effect of alcohol policy on the incidence of intensive care unit (ICU) admissions associated with hazardous and harmful alcohol use in the Northern Territory (NT) of Australia DESIGN, SETTING AND PARTICIPANTS: Before and after analysis of admissions to NT ICUs between April 2018 and September 2019, extending on both a descrip...
Preprint
Full-text available
Victoria has been Australia's hardest hit state by the COVID-19 pandemic, but was successful in reversing its second wave of infections through aggressive policy interventions. The clear reversal in the epidemic trajectory combined with information on the timing and geographical scope of policy interventions offers the opportunity to estimate the r...
Article
Purpose Although use of donation-after-circulatory-death (DCD) donors has significantly increased lung transplant (LTx) rates, 25-40% of intended DCD do not convert to actual donors due to non-progression to asystole in the required 90 minute time frame from withdrawal of cardio-respiratory support (WCRS). Predicting which intended DCD patient will...
Article
Background: ICU-specific tables of antimicrobial susceptibility for key microbial species ('antibiograms'), antimicrobial stewardship (AMS) programmes and routine rounds by infectious diseases (ID) physicians are processes aimed at improving patient care. Their impact on patient-centred outcomes in Australian and New Zealand ICUs is uncertain. Ob...
Article
Full-text available
Background: Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. Methods: Using a Delphi process, an international panel of...
Article
Although the use of donation‐after‐circulatory‐death (DCD) donors has increased lung transplant activity, 25‐40% of intended DCD donors do not convert to actual donation due to no progression to asystole in the required timeframe after withdrawal of cardio‐respiratory support (WCRS). No studies have specifically focused on DCD lung donor progressio...
Article
Background There are limited published data on the epidemiology of skin and soft tissue infections (SSTIs) requiring intensive care unit (ICU) admission. This study intended to describe the annual prevalence, characteristics, and outcomes of critically ill adult patients admitted to the ICU for an SSTI. Methods This was a registry-based retrospecti...
Article
Full-text available
Background The COVID-19 pandemic has led to unprecedented demand for ICU, with the need to triage admissions along with the development of ICU triage criteria. However, how these criteria relate to outcomes in patients already admitted to ICU is unknown, as is the incremental ICU capacity that triage of these patients might create given existing ad...
Article
Introduction : Amongst critically ill trauma patients admitted to ICU and still alive and in ICU after 24 hours, it is unclear which trauma scoring system offers the best performance in predicting in-hospital mortality. Methods : The Australia and New Zealand Intensive Care Society Adult Patient Database and Victorian State Trauma Registry were li...
Article
Introduction: Fewer women than men are admitted to intensive care units (ICUs) worldwide. Objectives: To quantify the relative contribution of each major diagnostic category to the overall sex balance in ICU admissions in Australia and New Zealand, and to describe changes in the sex balance over time and with patient age. Methods: Retrospective cro...
Article
Objective: We aimed to measure the incidence, prevalence, characteristics and outcomes of intensive care unit (ICU) patients with early (first 24 hours) metabolic acidosis (MA) according to two different levels of severity with a focus on recent data. Design: We retrospectively applied two diagnostic criteria to our analysis based on literature for...
Article
Full-text available
Background Data from clinical registries may be linked to gain additional insights into disease processes, risk factors and outcomes. Identifying information varies from full names, addresses and unique identification codes to statistical linkage keys to no direct identifying information at all. A number of databases in Australia contain the statis...
Article
Purpose To study the prevalence, characteristic, outcome, and acid-base biomarker predictors of outcome for different acidemia subtypes. Methods We used national intensive care databases from three countries and classified acidemia subtypes as metabolic (standard base excess [SBE] < −2 mEq/L only), respiratory (PaCO2 > 42 mmHg only), and combined...