Earlier tracheostomy is associated with an earlier return to walking, talking, and eating
Earlier tracheostomy is associated with an earlier return to walking, talking, and eating
Sutt AL, Tronstad O, Barnett AG, Kitchenman S, Fraser JF. Aust Crit Care. 2020 May;33(3):213-218
The best timing to perform a tracheostomy remains debatable in the literature. This study investigates patient-centric as well clinician-centric outcomes when looking at tracheostomy timing, and finds that patients who receive a tracheostomy earlier are able to start mobilising out of bed, talking again and eating and drinking much earlier than those that receive a tracheostomy late. These are important outcomes for our patients.
Global Effort to Collect Data on Ventilated Patients With COVID-19
Global Effort to Collect Data on Ventilated Patients With COVID-19
Rubin R. JAMA. 2020 May 13. doi:10.1001/jama.2020.8341.
This article recounts the development of the COVID-19 Critical Care Consortium, from a small interest study in early January to a consortium expanding over 300 hospital sites by early May 2020. The article highlights the incredible collaboration that is providing data to support medical professionals through the pandemic, when there are very limited resources available.
Hypothermic Ex Vivo Perfusion: Protecting the Donor Heart and the Recipient
Hypothermic Ex Vivo Perfusion: Protecting the Donor Heart and the Recipient
See Hoe LE, Suen JY, Li Bassi G, McGiffin DC, Fraser JF. ASAIO J. 2020 Apr 17.
This letter to the Editor comments on a study that used normothermic ex vivo perfusion and plasma cross-circulation to preserve donor hearts for 72 hours. The letter highlights that the key component of donor BD was missing form the animal model, which may have influenced outcomes, and draws comparisons betwen hypothermic ex vivo perfusion for donor herat preservation, which has also been shown in large animal models of heart transplantation to improve outcomes post-transplant.
Heart Transplantation From Brain Dead Donors: A Systematic Review of Animal Models
Heart Transplantation From Brain Dead Donors: A Systematic Review of Animal Models
See Hoe LE, Wells MA, Bartnikowski N, Obonyo NG, Millar JE, Khoo A, Ki KK, Shuker T, Ferraioli A, Colombo SM, Chan W, McGiffin DC, Suen JY, Fraser JF. Transplantation. 2020 Mar 5.
This systematic review highlights the paucity of available animal models of heart transplant that incorporate donor brain death, and demonstrates the significant heterogeneity that exists (and details reported) in the few available models, potentially hindering progression of the field.
Antimicrobial therapy during ECMO - customised dosing with therapeutic drug monitoring: The way to go?
Antimicrobial therapy during ECMO - customised dosing with therapeutic drug monitoring: The way to go?
Abdul-Aziz MH, Shekar K, Roberts JA. Anaesth Crit Care Pain Med. 2019 Oct;38(5):451-453
There is a significant body of work that has emerged in last 5 years to guide antimicrobial dosing on ECMO. The article discusses whether antimicrobial dosing, based on principles of drug dosing during critical illness, along with therapeutic drug monitoring will suffice during ECMO.
Low flow rate alters haemostatic parameters in an ex-vivo extracorporeal membrane oxygenation circuit
Low flow rate alters haemostatic parameters in an ex-vivo extracorporeal membrane oxygenation circuit
Ki KK, Passmore MR, Chan CHH, Malfertheiner MV, Fanning JP, Bouquet M, Millar JE, Fraser JF, Suen JY. Intensive Care Med Exp. 2019 Aug 20;7(1):51.
The use of Extracorporeal membrane oxygenation (ECMO) is on the rise, however there are still significant complications including bleeding and thrombosis. In the following study led by Post Doc Katrina Ki, the CCRG team has shown that high vs low flow rates in ECMO differentially alter a number of haemostatic parameters.
Should Patients With Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation Have Ventilatory Support Reduced to the Lowest Tolerable Settings? No
Should Patients With Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation Have Ventilatory Support Reduced to the Lowest Tolerable Settings? No
Shekar K, Brodie D. Crit Care Med. 2019 Aug;47(8):1147-1149.
ECMO support enables clinicians to rest the diseased native lungs while they heal and recover. However optimal mechanical ventilation strategy on ECMO is not tested in clinical studies. While protecting lungs from iatrogenic harm during mechanical ventilation is important, this article argues that excessive lung testing may actually be detrimental to the patient.
ECMO for immunosuppressed patients with acute respiratory distress syndrome: drawing a line in the sand
ECMO for immunosuppressed patients with acute respiratory distress syndrome: drawing a line in the sand
Schmidt M, Combes A, Shekar K. Intensive Care Med. 2019 Aug;45(8):1140-1142.
Patient selection is key for the success of ECMO therapy. There is a growing population of immunosuppressed patients globally. Respiratory failure is a leading cause of death in these patients and this article explores the risk:benefits of applying ECMO in the immunosuppressed
Hurdles to Cardioprotection in the Critically Ill.
Hurdles to Cardioprotection in the Critically Ill.
See Hoe LE, Bartnikowski N, Wells MA, Suen JY, Fraser JF. Int J Mol Sci. 2019 Aug 5;20(15).
While some treatment options for cardiovascular disease are beneficial and essential for patient survival and restoration of cardiac function, their use comes at a physiological cost that can worsen both short- and long-term outcomes. The target cohort of critically ill cardiac patients would significantly benefit from complimentary and effective cardioprotective strategies. However, in the context of relevant surgical interventions (eg. MCS and HTx), important factors inherent to these treatments must be carefully considered to achieve clinical efficacy.
