Consensus on the definition, components, timeframe and grading of composite outcome of postoperative pulmonary complication-protocol for an international mixed-method consensus study (PrECiSIOn).

Introduction: Postoperative pulmonary complications (PPCs) represent a significant cause of postoperative morbidity and even mortality. However, there is a lack of consensus regarding this composite endpoint, the definition of the individual components, classification and optimal outcome measures. This study aims to refine the PPCs composite framework by evaluating its construct validity, assessing the necessity and risks of a composite measure and exploring the feasibility of differentiating severity categories.

Individual and combined effects of chemical and mechanical power on postoperative pulmonary complications: a secondary analysis of the REPEAT study.

Introduction: Intra-operative supplemental oxygen and mechanical ventilation expose the lungs to potentially injurious energy. This can be quantified as 'chemical power' and 'mechanical power', respectively. In this study, we sought to determine if intra-operative chemical and mechanical power, individually and/or in combination, are associated with postoperative pulmonary complications.

Long-Term Outcomes of Persistent Critical Illness.

Rationale: Persistent critical illness (PerCI) describes a growing group of intensive care unit (ICU) patients whose critical illness persist into chronicity. They account for a disproportionate amount of resources, yet long-term functional outcomes are unknown.

Objectives: To compare death or new disability at six months in ICU patients with and without PerCI (defined as ≥10 days ICU stay).

A cluster double-crossover trial of early versus delayed aperient use in mechanically ventilated, enterally fed patients.

Background: Aperient use in enterally fed, intubated, invasively mechanically ventilated intensive care unit (ICU) patients remains controversial and is associated with diarrhoea. The aim of this study was to assess whether the timing of aperient administration impacts the incidence and timing of diarrhoea and related complications in such patients.

Methods: We conducted a cluster, double-crossover, randomised trial in mechanically ventilated, enterally fed adults.

Admission to specialised neurocritical units and association with clinical outcomes.

Background: Globally, managing critically ill adults with acute brain injuries (ABIs) in specialised neurocritical units (NCCUs) is associated with improved survival, but this has not been assessed in Australia. This study aims to determine in adults with an ABI if admission to a general intensive care unit (ICU) or a NCCU was associated with a difference in outcomes.

Methods: Australian ICUs were surveyed regarding NCCU capabilities via the Australian and New Zealand Intensive Care Society (ANZICS).

Effects of dapagliflozin on urinary output, fluid balance, and biochemistry in critically ill patients: a post-hoc secondary analysis of the DEFENDER trial.

Background: Sodium-glucose cotransport-2 inhibitors (SGLT2i) have established benefits in diabetes mellitus, heart failure, and chronic kidney disease, but their physiological effects during critical illness remain unclear. We explored whether dapagliflozin affected urinary output, fluid balance, and other physiological parameters in critically ill patients with acute organ dysfunction.

Methods: This secondary analysis of the DEFENDER trial included 401 critically ill patients with acute organ dysfunction randomized to receive dapagliflozin 10 mg daily or standard care.

Regional Practice Variation in the Management of Renal Replacement Therapy Modalities in the STARRT-AKI Trial.

Introduction: The assess whether, in high-income countries, in the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial, the management of the chosen initial renal replacement therapy modality varied by region and whether such variation was associated with different outcomes.

Methods: Post hoc analysis of the STARRT-AKI trial, including 142 ICUs in 13 countries.

The Impact of Sex on KRT in Acute Kidney Injury: A Secondary Analysis of the STARRT-AKI Trial.

Background: The purpose of this study is to evaluate whether sex modifies the initiation, prescription, or outcome of KRT, or the relationship between KRT initiation strategy and patient outcomes.

Methods: We performed a secondary analysis of STARRT-AKI, a multinational randomized controlled trial comparing accelerated-initiation and standard-initiation of RRT in critically ill adults with acute kidney injury. The primary outcome was all-cause mortality at 90 days.

Brazilian Research in Intensive Care Network (BRICNet): shaping the landscape of critical care research in Brazil and beyond.

Critical illnesses such as sepsis and acute respiratory distress syndrome lead to millions of deaths globally, with a higher burden in low- and middle-income countries. Conducting multicentric clinical studies is essential to help minimize the burden of critical illnesses, particularly in areas where their impact is greater. However, conducting large-scale multicentric studies is challenging, and most large multicentric studies in critical care are from high-income countries, which limits their relevance in other contexts.

Association of plasma biomarkers of lung injury with positive end expiratory pressure and postoperative pulmonary complications in obese surgical patients: A substudy of the PROBESE randomised controlled trial.

Background: The effect of positive end expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in obese patients remains controversial.

Objective: To test, whether intra-operative PEEP or PPCs are associated with plasma levels of biomarkers of lung injury.

Design: A prospective substudy of a multicentre randomised controlled trial (PROBESE).

Protocol summary and statistical analysis plan for the sodium bicarbonate for metabolic acidosis in the intensive care unit (SODa-BIC) trial.

Background: Metabolic acidosis is common in critically ill patients and is associated with increased risk of organ dysfunction, need for renal replacement therapy, and death. Despite its frequency and clinical relevance, the optimal treatment approach remains uncertain. Sodium bicarbonate is often used to correct acidosis, but its risk-benefit profile in this setting is unclear.

Association of longitudinal triglyceride levels with cardiovascular events in multivessel coronary artery disease.

Aims: The impact of longitudinal fluctuations in triglyceride levels on clinical outcomes in stable coronary artery disease (CAD) is yet to be clarified. This study aims to assess the association between increased upward variability in longitudinal fasting triglyceride levels and the incidence of cardiovascular events during long-term follow-up in patients with multivessel CAD.

Methods And Results: This cohort study included 1020 patients with multivessel CAD in the Medicine, Angioplasty, or Surgery Study Registry of the Heart Institute, University of São Paulo, from June 1995 to March 2010.

The Cost-Effectiveness of Early Active Mobilization During Mechanical Ventilation in the ICU: An Economic Evaluation Alongside the Treatment of Mechanically Ventilated Adults With Early Activity and Mobilization (TEAM) Trial.

Objectives: Early mobilization is recommended by the Society of Critical Care Medicine ICU Liberation Bundle. The Treatment of Mechanically Ventilated Adults With Early Activity and Mobilization (TEAM) randomized controlled trial (RCT) compared early active mobilization to usual care mobilization and found no difference in the primary outcome of days alive and out of hospital to day 180; however, it did find an increase in adverse events in the intervention group. To date, no RCT of early mobilization has reported costs or cost-effectiveness.

Association of preoperative smoking with the occurrence of postoperative pulmonary complications: A post hoc analysis of an observational study in 29 countries.

Introduction: While smoking has been consistently identified as a significant contributor to postoperative complications, the existing literature on its association with postoperative pulmonary complications remains conflicting.

Aim: We examined the association of preoperative smoking with the occurrence of postoperative pulmonary complications (PPCs).

Methods: Post hoc analysis of an observational study in 146 hospitals across 29 countries.

Perioperative management of adult patients undergoing coronary artery bypass grafting and valve surgery: a literature review.

Purpose Of Review: Coronary artery bypass grafting, revascularization by percutaneous coronary intervention, and heart valve surgery are crucial therapeutic interventions for patients with various cardiovascular diseases. The objective of this literature review was to present the main evidence and practical aspects of the perioperative management of patients undergoing coronary artery bypass grafting and heart valve surgery.

Recent Findings: Despite advancements in surgical and anesthetic techniques, coronary artery bypass grafting and heart valve surgery present significant risks for perioperative complications and death.

Association of low-dose ketamine with hallucinations in critically ill patients: a target trial emulation.

Purpose: Ketamine use is a potentially modifiable risk factor for hallucinations. We aimed to use target trial emulation to investigate the association between low-dose ketamine and development of hallucinations in critically ill patients in the intensive care unit (ICU).

Methods: Retrospective study using data from a university affiliated ICU in Melbourne, Australia.

Defining and subphenotyping ARDS: insights from an international Delphi expert panel.

Although the definition of acute respiratory distress syndrome (ARDS) has undergone numerous revisions aimed at enhancing its diagnostic accuracy and clinical practicality, the usefulness and precision of these definitions remain matters of ongoing discussion. In this Position Paper, we report on a Delphi study to reach a consensus on the conceptual model of ARDS, specifically identifying its defining components within clinical, research, and educational contexts as well as exploring the potential role of subphenotyping. We did a four-round Delphi study, involving experts in ARDS research and management from a diverse range of geoeconomic regions and professional backgrounds.

Long-Term Functional Outcomes in the First 12 Months After VA-ECMO in Adult Patients: A Prospective, Multicenter Study.

Background: Long-term outcomes and quality of life have been identified as core patient-centered outcomes for venoarterial extracorporeal membrane oxygenation (VA-ECMO) research. The aim of this study is to investigate the incidence of death or new disability at 12 months after the initiation of VA-ECMO.

Methods: Prospective, multicenter, registry-embedded cohort study in 26 hospitals in Australia and New Zealand from February 2019 through April 2023.

The relationship between administratively recorded ethnicity and outcomes for people admitted to Australian intensive care units with COVID-19.

Background: The relationship between ethnicity and mortality of patients critically ill with COVID-19 in Australia has not been described. Defining those communities at the highest risk of severe COVID-19 may assist with formulating effective public health policy and may improve the equitable delivery of health care in Australia.

Objective: The aim of this study was to describe the baseline characteristics, treatments, and outcomes of administratively recorded ethnic groups admitted to Australian intensive care units with confirmed COVID-19 infection.

Evidence-based personalised medicine in critical care: a framework for quantifying and applying individualised treatment effects in patients who are critically ill.

Clinicians aim to provide treatments that will result in the best outcome for each patient. Ideally, treatment decisions are based on evidence from randomised clinical trials. Randomised trials conventionally report an aggregated difference in outcomes between patients in each group, known as an average treatment effect.