Crit Care Resusc
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The Crystalloid versus Hydroxyethyl Starch Trial (CHEST) and the Scandinavian Starch in Severe Sepsis/ Septic Shock (6S) trial reported that 6% hydroxyethyl starch (HES) is associated with increased use of renal replacement therapy and death in critically ill patients. Data collection was harmonised between the two trials in order to facilitate a preplanned individual patient data meta-analysis (IPDMA) of patients with severe sepsis. ⋯ We developed a preanalysis SAP to combine data on patients with severe sepsis from the 6S trial and the CHEST. Prepublication of our SAP will reduce the risk of bias in the reporting of the results and improve confidence in the estimates of effects, allowing comparisons with conventional meta-analyses and assisting in the translation of research findings into clinical practice.
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Randomized Controlled Trial
Randomised trial of software algorithm driven regional citrate anticoagulation versus heparin in continuous renal replacement therapy: the Filter Life in Renal Replacement Therapy pilot trial.
The effectiveness of continuous renal replacement therapy (CRRT) increases when unplanned circuit failure is prevented. Adequate anticoagulation is an important component. Although heparin is the predominating anticoagulant, calcium chelation with citrate is an alternative, but systemic calcium monitoring and supplementation increase the complexity of CRRT. We assessed efficacy and safety of citrate delivery via integrated software algorithms against an established regional heparin protocol. ⋯ Although the per-protocol results favoured citrate when it was actually delivered, the significant crossover between treatment arms hampered more definitive conclusions. Until further studies support improved patient outcomes, increased complexity and complications suggest that anticoagulation choice be made using patient-specific indications.
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Multicenter Study
Sodium administration in critically ill paediatric patients in Australia and New Zealand: a multicentre point prevalence study.
Dysnatraemia and a positive fluid balance are associated with poor outcomes in paediatric intensive care units (PICUs). Our objective was to determine sodium intake and the total daily fluid balance in children in the PICU. ⋯ Daily sodium intake in children in the PICU is high. The contributions of maintenance and bolus intravenous fluids (most commonly as 0.9% sodium chloride), drug infusions and boluses, including antibiotics, and enteral feeds, are significant.
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To examine self-reported treatment preferences among Australasian consultant intensivists for intensive care-acquired hypernatraemia (IAH). ⋯ There is a wide variety of treatments in use for IAH. Most clinicians initiate treatment at a level greater than the level that is independently associated with increased mortality in the literature.1 Initial treatment is equally divided between changes in intravenous fluid and changes in enteral nutrition.
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The model currently used in public hospitals in Australia and New Zealand - of closed, mixed medical-surgical ICUs, led by consultant intensivists who remain in charge but collaborate closely across multiple specialties and disciplines and are supported by well trained junior medical staff- is internationally admired and has provided cost-effective care. Careful workforce planning is essential to ensure that intensivists retain their identity and that an efficient model persists into the future.