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Orford NR, Bone A, Kotowicz MA, Bailey M, Pasco JA, Maiden M, Kakho N, Cattigan C, Nichonghaile M, Jones C, Hodgson C, Nair P, Center J, Bellomo R. A pilot feasibility randomised controlled trial of bone antiresorptive agents on bone turnover markers in critically ill women. Sci Rep 2024; 14:2071. [PMID: 38267490 PMCID: PMC10810087 DOI: 10.1038/s41598-024-52607-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/21/2024] [Indexed: 01/26/2024] Open
Abstract
Critical illness is associated with increased bone turnover, loss of bone density, and increased risk of fragility fractures. The impact of bone antiresorptive agents in this population is not established. This trial examined the efficacy, feasibility, and safety of antiresorptive agents administered to critically ill women aged fifty years or greater. Women aged 50 years or greater admitted to an intensive care unit for at least 24 h were randomised to receive an antiresorptive agent (zoledronic acid or denosumab) or placebo, during critical illness and six months later (denosumab only). Bone turnover markers and bone mineral density (BMD) were monitored for 1 year. We studied 18 patients over 35 months before stopping the study due to the COVID-19 pandemic. Antiresorptive medications decreased the bone turnover marker type 1 cross-linked c-telopeptide (CTX) from day 0 to 28 by 43% (± 40%), compared to an increase of 26% (± 55%) observed with placebo (absolute difference - 69%, 95% CI - 127% to - 11%), p = 0.03). Mixed linear modelling revealed differences in the month after trial drug administration between the groups in serum CTX, alkaline phosphatase, parathyroid hormone, and phosphate. Change in BMD between antiresorptive and placebo groups was not statistically analysed due to small numbers. No serious adverse events were recorded. In critically ill women aged 50-years and over, antiresorptive agents suppressed bone resorption markers without serious adverse events. However, recruitment was slow. Further phase 2 trials examining the efficacy of these agents are warranted and should address barriers to enrolment.Trial registration: ACTRN12617000545369, registered 18th April 2017.
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Affiliation(s)
- Neil R Orford
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia.
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine (SPPHPM), Monash University, Melbourne, Australia.
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia.
- Department of Critical Care, University of Melbourne, Melbourne, Australia.
| | - Allison Bone
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine (SPPHPM), Monash University, Melbourne, Australia
| | - Mark A Kotowicz
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine (SPPHPM), Monash University, Melbourne, Australia
| | - Julie A Pasco
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, Australia
| | - Matthew Maiden
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Nima Kakho
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Claire Cattigan
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Martina Nichonghaile
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Claire Jones
- Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine (SPPHPM), Monash University, Melbourne, Australia
| | - Priya Nair
- Intensive Care Unit, St Vincent's Hospital Sydney, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
| | - Jacqueline Center
- Intensive Care Unit, St Vincent's Hospital Sydney, Sydney, Australia
- Garvan Institute of Medical Research, Sydney, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine (SPPHPM), Monash University, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
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Hughes W, McCormack N, Cattigan C, Thomas D, Goldie SJ. Bilateral anterior compartment syndrome secondary to psychogenic polydipsia. Eur J Plast Surg 2022. [DOI: 10.1007/s00238-022-01939-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Compartment syndrome is a surgical emergency requiring urgent release of the muscular compartments to prevent ischaemia and tissue death. Unusual presentation patterns or aetiological factors may be confusing, delaying the diagnosis and prompt management. We report a rare case of bilateral anterior compartment syndrome, secondary to psychogenic polydipsia. Compartment pressures were measured using a manometer. The patient was expedited to theatre for exploration. A literature review was performed to search for similar cases. In our case, a 42-year-old male presented confused and agitated with bilateral lower limb pain unresponsive to opiates. He had a past medical history of schizophrenia with psychogenic polydipsia, consuming 10 L of cola soft drink per day prior to presentation. Blood tests showed sodium of 112 mmol/L and a peak creatinine kinase of 13,417 U/L. On examination, he had tense and swollen bilateral anterior legs; posterior calves were soft. Left and right anterior compartment pressures were measured at 60 mmHg and 90 mmHg respectively (normal limit < 30 mmHg). At operation, bilateral fasciotomies of the anterior compartments were performed and bulging muscles were found. Reported cases similar to this resulted in permanent disability due to delays in recognising the diagnosis. Follow-up of this patient showed return of normal sensation and movement of the muscles of the anterior compartment. Hyponatraemia as a result of psychogenic polydipsia is well recognised, but isolated anterior compartment syndrome is a rare complication of hyponatraemia. This case report highlights the need to consider non-traumatic causes of compartment syndrome.Level of evidence: Level V, Diagnostic study
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Pilcher DV, Duke G, Rosenow M, Coatsworth N, O’Neill G, Tobias TA, McGloughlin S, Holley A, Warrillow S, Cattigan C, Huckson S, Sberna G, McClure J. Assessment of a novel marker of ICU strain, the ICU Activity Index, during the COVID-19 pandemic in Victoria, Australia. CRIT CARE RESUSC 2021; 23:300-307. [PMID: 38046069 PMCID: PMC10692615 DOI: 10.51893/2021.3.oa7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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 in Victoria, Australia. Design: Retrospective observational cohort study. Setting: All 45 hospitals with an ICU in Victoria, Australia. Participants: Patients in all Victorian ICUs and all critically ill patients transferred between Victorian hospitals from 27 June to 6 September 2020. Main outcome measure: Acute interhospital transfer of one or more critically ill patients per day from one site to an ICU in another hospital. Results: 150 patients were transported over 61 days from 29 hospitals (64%). ICU Activity Index scores were higher on days when critical care transfers occurred (median, 1.0 [IQR, 0.4-1.7] v 0.6 [IQR, 0.3-1.2]; P < 0.001). Transfers were more common on days of higher ICU occupancy, higher numbers of ventilated or COVID-19 patients, and when more critical care staff were unavailable. The highest ICU Activity Index scores were observed at hospitals in north-western Melbourne, where the COVID-19 disease burden was greatest. After adjusting for confounding factors, including occupancy and lack of available ICU staff, a rising ICU Activity Index score was associated with an increased risk of a critical care transfer (odds ratio, 4.10; 95% CI, 2.34-7.18; P < 0.001). Conclusions: The ICU Activity Index appeared to be a valid marker of ICU strain during the COVID-19 pandemic. It may be useful as a real-time clinical indicator of ICU activity and predict the need for redistribution of critical ill patients.
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Affiliation(s)
- David V. Pilcher
- Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Melbourne, VIC, Australia
- Department of Intensive Care, Alfred Health, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Graeme Duke
- Intensive Care Service, Eastern Health, Melbourne, VIC, Australia
| | - Melissa Rosenow
- Adult Retrieval Victoria, Ambulance Victoria, Melbourne, VIC, Australia
| | - Nicholas Coatsworth
- Australian Government Department of Health, Canberra, ACT, Australia
- Australian National University Medical School, Canberra, ACT, Australia
| | - Genevieve O’Neill
- Australian Government Department of Health, Canberra, ACT, Australia
| | - Tracey A. Tobias
- Adult Retrieval Victoria, Ambulance Victoria, Melbourne, VIC, Australia
| | - Steven McGloughlin
- Department of Intensive Care, Alfred Health, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anthony Holley
- Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Steven Warrillow
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Claire Cattigan
- Department of Intensive Care, University Hospital Geelong, Geelong, VIC, Australia
| | - Sue Huckson
- Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Melbourne, VIC, Australia
| | - Gian Sberna
- Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Melbourne, VIC, Australia
| | - Jason McClure
- Department of Intensive Care, Alfred Health, Melbourne, VIC, Australia
- Adult Retrieval Victoria, Ambulance Victoria, Melbourne, VIC, Australia
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Orford NR, Bailey M, Bellomo R, Pasco JA, Cattigan C, Elderkin T, Brennan-Olsen SL, Cooper DJ, Kotowicz MA. The association of time and medications with changes in bone mineral density in the 2 years after critical illness. Crit Care 2017; 21:69. [PMID: 28327171 PMCID: PMC5361814 DOI: 10.1186/s13054-017-1657-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/28/2017] [Indexed: 11/30/2022]
Abstract
Background Critical illness is associated with increased risk of fragility fracture and loss of bone mineral density (BMD), although the impact of medication exposures (bone anti-fracture therapy or glucocorticoids) and time remain unexplored. The objective of this study was to describe the association of time after ICU admission, and post-ICU administration of bone anti-fracture therapy or glucocorticoids after critical illness, with change in BMD. Methods In this prospective observational study, conducted in a tertiary hospital ICU, we studied adult patients requiring mechanical ventilation for at least 24 hours and measured BMD annually for 2 years after ICU discharge. We performed mixed linear modelling to describe the association of time, and post-ICU administration of anti-fracture therapy or glucocorticoids, with annualised change in BMD. Results Ninety-two participants with a mean age of 63 (±15) years had at least one BMD assessment after ICU discharge. In women, a greater loss of spine BMD occurred in the first year after critical illness (year 1: -1.1 ± 2.0% vs year 2: 3.0 ± 1.7%, p = 0.02), and anti-fracture therapy use was associated with reduced loss of BMD (femur 3.1 ± 2.4% vs -2.8 ± 1.7%, p = 0.04, spine 5.1 ± 2.5% vs -3.2 ± 1.8%, p = 0.01). In men anti-fracture and glucocorticoid use were not associated with change in BMD, and a greater decrease in BMD occurred in the second year after critical illness (year 1: -0.9 ± 2.1% vs year 2: -2.5 ± 2.1%, p = 0.03). Conclusions In women a greater loss of spine BMD was observed in the first year after critical illness, and anti-fracture therapy use was associated with an increase in BMD. In men BMD loss increased in the second year after critical illness. Anti-fracture therapy may be an effective intervention to prevent bone loss in women after critical illness. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1657-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Neil R Orford
- Barwon Health, Geelong, VIC, Australia. .,Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, VIC, Australia. .,School of Medicine, Deakin University, Geelong, VIC, Australia. .,Intensive Care Unit, University Hospital Geelong, Ryrie St, Geelong, VIC, 3220, Australia.
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, VIC, Australia
| | - Julie A Pasco
- Barwon Health, Geelong, VIC, Australia.,School of Medicine, Deakin University, Geelong, VIC, Australia.,Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, VIC, Australia.,Melbourne Medical School-Western Campus, Department of Medicine, The University of Melbourne, St Albans, VIC, Australia
| | - Claire Cattigan
- Barwon Health, Geelong, VIC, Australia.,School of Medicine, Deakin University, Geelong, VIC, Australia
| | | | - Sharon L Brennan-Olsen
- School of Medicine, Deakin University, Geelong, VIC, Australia.,Melbourne Medical School-Western Campus, Department of Medicine, The University of Melbourne, St Albans, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, Melbourne, VIC, Australia.,Institute for Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia
| | - David J Cooper
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, VIC, Australia
| | - Mark A Kotowicz
- School of Medicine, Deakin University, Geelong, VIC, Australia.,Melbourne Medical School-Western Campus, Department of Medicine, The University of Melbourne, St Albans, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, Melbourne, VIC, Australia
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Orford NR, Lane SE, Bailey M, Pasco JA, Cattigan C, Elderkin T, Brennan-Olsen SL, Bellomo R, Cooper DJ, Kotowicz MA. Changes in Bone Mineral Density in the Year after Critical Illness. Am J Respir Crit Care Med 2016; 193:736-44. [PMID: 26559667 DOI: 10.1164/rccm.201508-1514oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
RATIONALE Critical illness may be associated with increased bone turnover and loss of bone mineral density (BMD). Prospective evidence describing long-term changes in BMD after critical illness is needed to further define this relationship. OBJECTIVES To measure the change in BMD and bone turnover markers (BTMs) in subjects 1 year after critical illness compared with population-based control subjects. METHODS We studied adult patients admitted to a tertiary intensive care unit (ICU) who required mechanical ventilation for at least 24 hours. We measured clinical characteristics, BTMs, and BMD during admission and 1 year after ICU discharge. We compared change in BMD to age- and sex-matched control subjects from the Geelong Osteoporosis Study. MEASUREMENTS AND MAIN RESULTS Sixty-six patients completed BMD testing. BMD decreased significantly in the year after critical illness at both femoral neck and anterior-posterior spine sites. The annual decrease was significantly greater in the ICU cohort compared with matched control subjects (anterior-posterior spine, -1.59%; 95% confidence interval, -2.18 to -1.01; P < 0.001; femoral neck, -1.20%; 95% confidence interval, -1.69 to -0.70; P < 0.001). There was a significant increase in 10-year fracture risk for major fractures (4.85 ± 5.25 vs. 5.50 ± 5.52; P < 0.001) and hip fractures (1.57 ± 2.40 vs. 1.79 ± 2.69; P = 0.001). The pattern of bone resorption markers was consistent with accelerated bone turnover. CONCLUSIONS Critically ill individuals experience a significantly greater decrease in BMD in the year after admission compared with population-based control subjects. Their bone turnover biomarker pattern is consistent with an increased rate of bone loss.
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Affiliation(s)
- Neil R Orford
- 1 Intensive Care Unit, University Hospital Geelong.,3 School of Medicine, Deakin University, and.,2 Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stephen E Lane
- 3 School of Medicine, Deakin University, and.,4 Biostatistics Unit, Barwon Health, Geelong, Australia
| | - Michael Bailey
- 2 Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Julie A Pasco
- 5 Epi-Centre for Healthy Ageing, School of Medicine, Deakin University, Geelong, Australia.,6 Barwon Health, Geelong, Australia.,7 Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Claire Cattigan
- 1 Intensive Care Unit, University Hospital Geelong.,3 School of Medicine, Deakin University, and
| | | | - Sharon L Brennan-Olsen
- 5 Epi-Centre for Healthy Ageing, School of Medicine, Deakin University, Geelong, Australia.,7 Department of Medicine, The University of Melbourne, Melbourne, Australia.,8 Australian Institute for Musculoskeletal Science and Epidemiology Unit for Healthy Ageing, School of Medicine, University of Melbourne, Melbourne, Australia; and.,9 Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia
| | - Rinaldo Bellomo
- 2 Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - David J Cooper
- 2 Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark A Kotowicz
- 5 Epi-Centre for Healthy Ageing, School of Medicine, Deakin University, Geelong, Australia.,6 Barwon Health, Geelong, Australia.,7 Department of Medicine, The University of Melbourne, Melbourne, Australia
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Elderkin T, Orford N, Bailey M, Kaukonen M, Stow P, Cattigan C, Kotowicz M, Bellomo R, Arblaster R. Glycaemic trips (translation of research into practice) – Glycaemic control and long term outcomes following transition from modified Intensive Insulin Therapy to conventional glycaemic control. Aust Crit Care 2015. [DOI: 10.1016/j.aucc.2014.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Orford N, Cattigan C, Brennan SL, Kotowicz M, Pasco J, Cooper DJ. The association between critical illness and changes in bone turnover in adults: a systematic review. Osteoporos Int 2014; 25:2335-46. [PMID: 24803332 DOI: 10.1007/s00198-014-2734-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/22/2014] [Indexed: 01/11/2023]
Abstract
SUMMARY Critical illness may lead to altered bone turnover and associated adverse health outcomes. This systematic review found moderate evidence for a positive association between critical illness and increased bone turnover. Prospective cohort studies that identify the extent and risk factors for critical illness related bone loss are required. INTRODUCTION Intensive care patients face health issues that extend beyond their critical illness and result in significant morbidity and mortality. Critical illness may result in altered bone turnover due to associated immobilisation, inflammation, exposure to medications that effect bone and calcium metabolism, and endocrine dysfunction. The aim of this study was to synthesise the existing evidence for altered bone turnover in adults admitted to intensive care. METHODS A literature search using MEDLINE and EMBASE was performed from 1965 to March 2013. Reviewed studies investigated the relationship between critical illness and evidence of altered bone turnover (bone turnover markers, bone mineral density, or fracture). Studies were rated upon their methodological quality, and a best-evidence synthesis was used to summarise the results. RESULTS Four cohort and seven case-control studies were identified for inclusion, of which five studies were rated as being of higher methodological quality. Ten of the studies measured bone turnover markers, and one study fracture rate. Findings were consistent across studies, and best-evidence analysis resulted in a conclusion that moderate evidence exists for an association between critical illness requiring admission to intensive care and altered bone turnover. CONCLUSION A positive association between critical illness requiring intensive care admission and bone turnover exists, although data are limited, and the risk factors and the nature of the relationship are not yet understood. Prospective cohort studies that identify risk factors and extent of critical illness related bone turnover changes are required.
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Affiliation(s)
- N Orford
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia,
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Orford NR, Bailey M, Kaukonen K, Elderkin T, Stow P, Cattigan C, Kotowicz M, Bellomo R. Glycaemic control and long-term outcomes following transition from modified intensive insulin therapy to conventional glycaemic control. Anaesth Intensive Care 2014; 42:239-47. [PMID: 24580391 DOI: 10.1177/0310057x1404200212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This retrospective observational cohort study compared glycaemic control and long-term outcomes following transition from a modified intensive insulin therapy (mIIT) regimen to conventional glycaemic control (CGC) in adult patients admitted to a tertiary adult general intensive care unit, during two 24-month periods, before and after the publication of the Normoglycemia in Intensive Care Evaluation and Surviving Using Glucose Algorithm Regulation (NICE-SUGAR) trial. The before NICE-SUGAR cohort received mIIT (target glycaemic ranges 4.4 to 7.0 mmol/l), while the after NICE-SUGAR cohort received CGC (target glycaemic range 7.1 to 9.0 mmol/l). A total of 5202 patients were included in the study. With transition from mIIT to CGC, the mean time-weighted glucose increased from 6.94 mmol/l to 8.2 mmol/l (P <0.0001). A similar increase was observed in other glycaemic indices (mean, highest and lowest glucose values, P <0.0001 for all). The adjusted 90-day odds ratio for mortality decreased by 47% with transition from mIIT to CGC (odds ratio 1.47 (95% confidence interval, 1.22 to 1.78) (P <0.0001). The rate of severe and moderate hypoglycaemia also decreased from 1.2 to 0.4% (P=0.004) and from 23.3 to 5.9% (P <0.0001), respectively. mIIT was associated with an increased risk of moderate and severe hypoglycaemia compared to CGC (odds ratio 3.1 (1.51 to 6.39) (P=0.002), 6.29 (5.1 to 7.75) (P <0.0001)). Changes in recommended glycaemic control were translated into practice, with increased glycaemic indices and decreased rates of severe and moderate hypoglycaemia after the introduction of CGC. The associated decrease in 90-day mortality suggests mIIT was not superior to CGC, despite a lower hypoglycaemia rate than in previous IIT trials. Our findings support the continued use of CGC.
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Affiliation(s)
- N R Orford
- Intensive Care Unit, The Geelong Hospital, Barwon Health, Geelong, Victoria
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Bucca K, Spencer R, Orford N, Cattigan C, Athan E, McDonald A. Early diagnosis and treatment of necrotizing fasciitis can improve survival: an observational intensive care unit cohort study. ANZ J Surg 2012; 83:365-70. [PMID: 22989238 DOI: 10.1111/j.1445-2197.2012.06251.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to describe the clinical characteristics, causative pathogens, clinical management and outcomes of patients presenting to a tertiary adult Australian intensive care unit (ICU) with a diagnosis of necrotizing fasciitis (NF). METHODS This retrospective observational study was conducted in a 19-bed, level III, adult ICU in a 450-bed tertiary, regional hospital. Clinical databases were accessed for patients diagnosed with NF and admitted to The Geelong Hospital ICU between 1 February 2000 and 1 June 2011. Information on severity of sepsis, surgical procedures and microbiological results were collected. RESULTS Twenty patients with NF were identified. The median age was 52.5 years and 38% were female. The overall mortality rate was 8.3%. Common co-morbidities were diabetes (21%) and heart failure (17%), although 50% of patients had no co-morbidities. Group A Streptococcus was the identified pathogen in 11 (46%) patients, and Streptococcus milleri group in 5 (21%) patients. Hyperbaric oxygen therapy was not used in the majority of patients. The initial antibiotics administered were active against subsequently cultured bacteria in 83% of patients. Median time to surgical debridement was 20 h. Diagnosis and management was delayed in the nosocomial group. CONCLUSIONS This study reports physiological data, aetiology and therapeutic interventions in NF for an adult tertiary hospital. We demonstrate one of the lowest reported mortality rates, with early surgical debridement being achieved in the majority of patients. The main delay was found to be in the diagnosis of NF.
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Affiliation(s)
- Kelly Bucca
- Department of Anaesthetics, The Geelong Hospital, Geelong, Victoria, Australia.
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Bolsin SNC, Raineri F, Lo SK, Cattigan C, Arblaster R, Colson M. Cardiac complications and mortality rates in diabetic patients following non-cardiac surgery in an Australian teaching hospital. Anaesth Intensive Care 2009; 37:561-7. [PMID: 19681411 DOI: 10.1177/0310057x0903700409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This retrospective study of diabetic patients undergoing non-cardiac surgery has identified that a greater number of patients are at risk of cardiac complications and death in the perioperative period than had previously been suggested. As well as insulin-dependent diabetic patients and patients with elevated creatinine (> 178 micromol/l) as previously found, our study suggests that non-insulin-dependent diabetic patients and patients with creatinine > 120 micromol/l are also at increased risk of cardiac complications and death following non-cardiac surgery. This increases by a factor of six those diabetic patients at risk of perioperative complications from non-cardiac surgery and also increases the number of patients with renal failure similarly at risk. The study confirms similar risks of cardiac complications and death to other recently published data and suggests ongoing comparisons will contribute to quality assurance activities in anaesthesia and surgery.
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Affiliation(s)
- S N C Bolsin
- Department of Perioperative Medicine, Anaesthesia and Pain Management, The Geelong Hospital, Geelong, Victoria, Australia
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