G Gutteridge

Austin Health, Melbourne, Victoria, Australia

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Publications (11)79.91 Total impact

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    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.
    No preview · Article · May 2008 · The International journal of artificial organs
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    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.
    No preview · Article · May 2006 · Internal Medicine Journal
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    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.
    Full-text · Article · Mar 2005 · Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine
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    ABSTRACT: Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic outcome, but there have been no conclusive studies in humans. In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from out-of-hospital cardiac arrest. The study subjects were 77 patients who were randomly assigned to treatment with hypothermia (with the core body temperature reduced to 33 degrees C within 2 hours after the return of spontaneous circulation and maintained at that temperature for 12 hours) or normothermia. The primary outcome measure was survival to hospital discharge with sufficiently good neurologic function to be discharged to home or to a rehabilitation facility. The demographic characteristics of the patients were similar in the hypothermia and normothermia groups. Twenty-one of the 43 patients treated with hypothermia (49 percent) survived and had a good outcome--that is, they were discharged home or to a rehabilitation facility--as compared with 9 of the 34 treated with normothermia (26 percent, P=0.046). After adjustment for base-line differences in age and time from collapse to the return of spontaneous circulation, the odds ratio for a good outcome with hypothermia as compared with normothermia was 5.25 (95 percent confidence interval, 1.47 to 18.76; P=0.011). Hypothermia was associated with a lower cardiac index, higher systemic vascular resistance, and hyperglycemia. There was no difference in the frequency of adverse events. Our preliminary observations suggest that treatment with moderate hypothermia appears to improve outcomes in patients with coma after resuscitation from out-of-hospital cardiac arrest.
    Full-text · Article · Mar 2002 · New England Journal of Medicine

  • No preview · Article · Jan 2002
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    ABSTRACT: Introduction: Following resuscitation from prehospital ventricular fibrillation, many patients remain comatose due to the anoxic brain injury. Several animal studies and one case-control human study (1) have suggested improved outcome if moderate hypothermia is induced following resuscitation. We conducted a randomized, controlled, multi-centre trial to assess the complications and outcome when moderate hypothermia (33C for 12 hours) was induced in comatose survivors of prehospital cardiac arrest, compared with normothermic controls. Methods: Patients who remained comatose after resuscitation from prehospital ventricular fibrillation were entered into the study. Patients were randomly allocated to moderate hypothermia (HT) or normothermia (NT). Hypothermia (33C) was rapidly induced in the Emergency Department using ice-packs and neuromuscular blockade and maintained in the Intensive Care Unit for 12 hours, followed by rewarming over 6 hours. Results: There were 27 HT patients and 23 NT patients. The groups were well matched for age, "down-time" and admission vital signs and biochemistry. The incidence of complications including cardiac arrhythmias, metabolic acidosis and coagulopathy was similar in both groups. There were 10/27 (37%) HT patients with good outcome (Glascow Outcome Coma Score 1-2 at hospital discharge) compared with 6/23 (26%) NT patients (p=NS). Conclusion: There is a trend towards improved outcome when hypothermia (33C for 12 hours) is induced in comatose survivors of prehospital ventricular fibrillation.
    No preview · Article · Jan 1999 · Critical Care Medicine
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    ABSTRACT: Introduction: Induced hypothermia has been proposed as a treatment for anoxic brain injury. We examined the effect of induced hypothermia on cerebral arterial-venous differences in oxygen saturation and lactate levels in patients with anoxic brain injury. Methods: Patients who were comatose following resuscitation from prehospital cardiac arrest and enrolled in a randomized controlled multicentre trial of induced hypothermia (33C for 12 hours) were studied. Blood was aspirated from a jugular bulb catheter for lactate and blood gas analysis at 6, 12, 18 and 24 hours following admission. Results: There were 23 hypothermic (HT) patients and 15 normothermic (NT) patients with sufficient data for analysis. The results are shown below: Temperature (degrees Celcius) Cerebral A-V O2 sat difference (%) Cerebral A-V lactate difference (mmole/L) All values are means. A-V= arterial-venous. * p<0.05 Conclusion: Induced hypothermia in patients who are comatose following cardiac arrest increases cerebral venous oxygen saturation at 12, 18 and 24 hours. This suggests increased cerebral oxygen supply compared with demand. Lactate is equally metabolised (not generated) in both patient groups until 24 hours post arrest.
    No preview · Article · Jan 1999 · Critical Care Medicine

  • No preview · Article · Mar 1996 · Australian Critical Care

  • No preview · Article · Mar 1996 · Australian Critical Care
  • G K Hart · I Baldwin · G Gutteridge · J Ford
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    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.
    No preview · Article · Nov 1994 · Anaesthesia and intensive care
  • B Jackson · G Liu · R B Perich · D Paxton · L McNicols · G Gutteridge · C I Johnston
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    ABSTRACT: 1. The haemodynamic and hormonal responses of four patients with acute post-surgical oliguria (urine output <0.5 mL/kg perh) were measured in response to the renin inhibitor enalkiren. Enalkiren was infused at 0.01 up to 0.1 mg/kg perh for up to 4h. 2. Enalkiren infusion was associated with a progressive fall in blood pressure, clinically significant in three of the four patients. Systemic vascular resistance fell in proportion to blood pressure fall. Cardiac output and pulse rate remained unchanged. Effective renal plasma flow rose in all four cases (236 ± 19 to 327± 38). There was no change in urine flow rate, or urinary sodium excretion. 3. Plasma renin activity (ng angiotensin I/mL perh) fell from 1.9 ± 0.5 to 0.02 ± 0.01 (P<0.04), plasma angiotensin II (pg/mL) fell from 104 ± 93 to 7.7 ± 1.5, and plasma aldosterone (ng/dL) fell from 32 ± 8 to 21 ± 9 (P= 0.03) at the highest infusion dose. 4. Enalkiren inhibited plasma renin activity with reduced plasma angiotensin II and aldosterone concentrations. This was associated with vasodilation, reduced blood pressure and maintained cardiac output. There was no beneficial effect on renal function in these patients with post-surgical oliguria.
    No preview · Article · Mar 1994 · Clinical and Experimental Pharmacology and Physiology