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Plummer, Mark P.; Rait, Louise, Finnis, Mark E.; French, Craig J.; Bates Ccrn, Samantha, Douglas, James, Bhurani, Mansi, Broadley, Tessa, Trapani, Tony, Deane, Adam M.; Udy, Andrew A.; Burrell, Aidan J. C.; Burrell, Aidan, Cheng, Allen, Udy, Andrew, Palermo, Annamaria, Reddi, Benjamin, Reynolds, Claire, French, Craig, Cooper, D. James, Litton, Edward, Begum, Husna, Campbell, Lewis, Ramanan, Mahesh, Plummer, Mark, McAllister, Richard, Erickson, Simon, Broadley, Tessa, Trapani, Tony, Cheung, Winston, Sprint-Sari Australia Investigators, The, Visser, Adam, Mattke, Adrian, Regli, Adrian, Rashid, Alan, Tabah, Alexis, Walker, Alison, Cheng, Allen, Corley, Amanda, Udy, Andrew, Ramnani, Anil, Eidan, Anthony, DeKeulenaer, Bart, Reddi, Benjamin, Richards, Brent, Knott, Cameron, Moore, Cara, Delzoppo, Carmel, Boschert, Catherine, Tacon, Catherine, French, Craig, Austin, Danielle, Brewster, David, Cooper, David, Crosbie, David, Hawkins, David, Jessen, Edda, Martinez, Eduardo, Fysh, Edward, Litton, Edward, Oberender, Felix, McGain, Forbes, Salt, Gavin, Eastwood, Glenn, Taori, Gopal, White, Hayden, Buscher, Hergen, Seppelt, Ian, Leditschke, Isabel Anne, Young, Janelle, Lavana, Jayshree, Cohen, Jeremy, Lugsdin, Jessica, Botha, John, Santamaria, John, Barrett, Jonathan, Singh, Kasha, Laupland, Kevin, El-Khawas, Khaled, Estensen, Kristine, Deshpande, Kush, White, Kyle, Fitzpatrick, Leigh, Campbell, Lewis, Ramanan, Mahesh, Saxena, Manoj, Kainer, Marion, Kol, Mark, Page, Mark, Plummer, Mark, Sterba, Martin, Anstey, Matthew, Brain, Matthew, Maiden, Matthew, Kilminster, Myrene, Hammond, Naomi, Bhadange, Neeraj, Humphreys, Nicole, Jain, Paras, Azzi, Paul, Secombe, Paul, Lister, Paula, Chan, Peter, McCanny, Peter, Britton, Phillip, Janin, Pierre, Krishnamurthy, Ravi, Sonawane, Ravikiran, Tiruvoipati, Ravindranath, Totaro, Richard, Bellomo, Rinaldo, Sanghavi, Ritesh, Bates, Samantha, Peake, Sandra, Bihari, Shailesh, George, Shane, Erickson, Simon, Webb, Steve, Arora, Subhash, Ganu, Subodh, Rozen, Thomas, McKenna, Toni, Kadam, Umesh, Nayyar, Vineet, Choy, Wei Han, Albassam, Wisam, Data entry at the nested cohort, sites, Morgan, Rebecca, Prasad, Lalita, Carstens, Laloma, Bates, Samantha, Rait, Louise, Bhurani, Mansi.
Australian Critical Care ; 2022.
Article in English | ScienceDirect | ID: covidwho-1866894


Background Internationally, diabetes mellitus is recognized as a risk factor for severe COVID-19. The relationship between diabetes mellitus and severe COVID-19 has not been reported in the Australian population. Objectives To determine the prevalence of, and outcomes for patients with diabetes admitted to Australian intensive care units (ICUs) with COVID-19. Methods A nested cohort study of four ICUs in Melbourne participating in the the Short PeRiod IncideNce sTudy of Severe Acute Respiratory Infection (SPRINT-SARI) Australia project. All adult patients admitted to ICU with COVID-19 from 20 February 2020 to 27 February 2021 were included. Blood glucose and glycated haemoglobin (HbA1c) data were retrospectively collected. Diabetes was diagnosed from medical history or a HbA1c ≥6.5% (48 mmol/mol). Hospital mortality was assessed using logistic regression. Results There were 136 patients with median age 58 years [48-68] and median APACHE II score of 14 [11-19]. 58 patients had diabetes (43%), 46 patients had stress induced hyperglycaemia (34%) and 32 patients had normoglycaemia (23%). Patients with diabetes were older, with higher APACHE II scores, had greater glycaemic variability than patients with normoglycaemia and longer hospital length of stay. Overall hospital mortality was 16% (22/136), including nine patients with diabetes, nine patients with stress induced hyperglycaemia and two patients with normoglycaemia. Conclusion Diabetes is prevalent in patients admitted to Australian ICUs with severe COVID-19 highlighting the need for prevention strategies in this vulnerable population.

N Engl J Med ; 386(9): 815-826, 2022 03 03.
Article in English | MEDLINE | ID: covidwho-1721751


BACKGROUND: Whether the use of balanced multielectrolyte solution (BMES) in preference to 0.9% sodium chloride solution (saline) in critically ill patients reduces the risk of acute kidney injury or death is uncertain. METHODS: In a double-blind, randomized, controlled trial, we assigned critically ill patients to receive BMES (Plasma-Lyte 148) or saline as fluid therapy in the intensive care unit (ICU) for 90 days. The primary outcome was death from any cause within 90 days after randomization. Secondary outcomes were receipt of new renal-replacement therapy and the maximum increase in the creatinine level during ICU stay. RESULTS: A total of 5037 patients were recruited from 53 ICUs in Australia and New Zealand - 2515 patients were assigned to the BMES group and 2522 to the saline group. Death within 90 days after randomization occurred in 530 of 2433 patients (21.8%) in the BMES group and in 530 of 2413 patients (22.0%) in the saline group, for a difference of -0.15 percentage points (95% confidence interval [CI], -3.60 to 3.30; P = 0.90). New renal-replacement therapy was initiated in 306 of 2403 patients (12.7%) in the BMES group and in 310 of 2394 patients (12.9%) in the saline group, for a difference of -0.20 percentage points (95% CI, -2.96 to 2.56). The mean (±SD) maximum increase in serum creatinine level was 0.41±1.06 mg per deciliter (36.6±94.0 µmol per liter) in the BMES group and 0.41±1.02 mg per deciliter (36.1±90.0 µmol per liter) in the saline group, for a difference of 0.01 mg per deciliter (95% CI, -0.05 to 0.06) (0.5 µmol per liter [95% CI, -4.7 to 5.7]). The number of adverse and serious adverse events did not differ meaningfully between the groups. CONCLUSIONS: We found no evidence that the risk of death or acute kidney injury among critically ill adults in the ICU was lower with the use of BMES than with saline. (Funded by the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand; PLUS number, NCT02721654.).

Acute Kidney Injury/prevention & control , Critical Illness/therapy , Saline Solution/therapeutic use , Acute Kidney Injury/etiology , Adult , Aged , Critical Care/methods , Critical Illness/mortality , Double-Blind Method , Female , Fluid Therapy , Gluconates/adverse effects , Gluconates/therapeutic use , Humans , Intensive Care Units , Magnesium Chloride/adverse effects , Magnesium Chloride/therapeutic use , Male , Middle Aged , Potassium Chloride/adverse effects , Potassium Chloride/therapeutic use , Saline Solution/adverse effects , Sodium Acetate/adverse effects , Sodium Acetate/therapeutic use , Sodium Chloride/adverse effects , Sodium Chloride/therapeutic use , Treatment Outcome
N Engl J Med ; 384(24): 2283-2294, 2021 06 17.
Article in English | MEDLINE | ID: covidwho-1275997


BACKGROUND: Targeted temperature management is recommended for patients after cardiac arrest, but the supporting evidence is of low certainty. METHODS: In an open-label trial with blinded assessment of outcomes, we randomly assigned 1900 adults with coma who had had an out-of-hospital cardiac arrest of presumed cardiac or unknown cause to undergo targeted hypothermia at 33°C, followed by controlled rewarming, or targeted normothermia with early treatment of fever (body temperature, ≥37.8°C). The primary outcome was death from any cause at 6 months. Secondary outcomes included functional outcome at 6 months as assessed with the modified Rankin scale. Prespecified subgroups were defined according to sex, age, initial cardiac rhythm, time to return of spontaneous circulation, and presence or absence of shock on admission. Prespecified adverse events were pneumonia, sepsis, bleeding, arrhythmia resulting in hemodynamic compromise, and skin complications related to the temperature management device. RESULTS: A total of 1850 patients were evaluated for the primary outcome. At 6 months, 465 of 925 patients (50%) in the hypothermia group had died, as compared with 446 of 925 (48%) in the normothermia group (relative risk with hypothermia, 1.04; 95% confidence interval [CI], 0.94 to 1.14; P = 0.37). Of the 1747 patients in whom the functional outcome was assessed, 488 of 881 (55%) in the hypothermia group had moderately severe disability or worse (modified Rankin scale score ≥4), as compared with 479 of 866 (55%) in the normothermia group (relative risk with hypothermia, 1.00; 95% CI, 0.92 to 1.09). Outcomes were consistent in the prespecified subgroups. Arrhythmia resulting in hemodynamic compromise was more common in the hypothermia group than in the normothermia group (24% vs. 17%, P<0.001). The incidence of other adverse events did not differ significantly between the two groups. CONCLUSIONS: In patients with coma after out-of-hospital cardiac arrest, targeted hypothermia did not lead to a lower incidence of death by 6 months than targeted normothermia. (Funded by the Swedish Research Council and others; TTM2 number, NCT02908308.).

Fever/therapy , Hypothermia, Induced , Out-of-Hospital Cardiac Arrest/therapy , Aged , Body Temperature , Cardiopulmonary Resuscitation/methods , Coma/etiology , Coma/therapy , Female , Fever/etiology , Humans , Hypothermia, Induced/adverse effects , Kaplan-Meier Estimate , Male , Middle Aged , Out-of-Hospital Cardiac Arrest/complications , Out-of-Hospital Cardiac Arrest/mortality , Single-Blind Method , Treatment Outcome