Search

Purpose: To describe the prevalence of perceptions of patients receiving a mismatch in treatment intensity, as perceived by intensive care unit (ICU) healthcare providers, and to assess the congruence of perceptions between providers.Methods: In this cross-sectional, observational study conducted in 21 ICUs in Australia and New Zealand, patient prevalence data was linked to an ICU staff survey to describe the extent to which patient treatment intensity was matched to the perceived prognosis and patient wishes.Results: Of the 307 study patients, 62 (20.2%) were reported to be receiving a mismatch in treatment intensity by at least one ICU healthcare professional. For reported mismatch, there was consensus amongst staff members for 52/62 (84%) of patients. Patients were significantly more likely to receive mismatched treatments if they were more severely unwell (APACHE II score > 20 vs. ≤ 20), odds ratio OR 2.35, 95% confidence interval (CI) 1.63-3.37, p < 0.0001, if they were an emergency admission (OR 3.05, CI 1.18-7.89, p = 0.0212) or if they had an advance care directive (OR 3.68, 95% CI 1.66-8.16, p = 0.0013).Conclusions: Being more severely unwell, being an emergency admission or having an advance care directive made patients more likely to be perceived as having a mismatch between the intensity of treatments provided and either the achievable goals of care, expected prognosis or patient's wishes. [ABSTRACT FROM AUTHOR]

Objective: To document current management of blood glucose in Australian and New Zealand intensive care units (ICUs) and to investigate the association between insulin administration, blood glucose concentration and hospital outcome.Design and Setting: Practice survey and inception cohort study in closed multi-disciplinary ICUs in Australia and New Zealand.Patients: Twenty-nine ICU directors and 939 consecutive admissions to 29 ICUs during a 2-week period.Measurement and Results: Data collected included unit approaches to blood glucose management, patient characteristics, blood glucose concentrations, insulin administration and patient outcomes. Ten percent of the ICU directors reported using an intensive insulin regimen in all their patients. In 861 patients (91.7%) blood glucose concentration was greater than 6.1[Symbol: see text]mmol/l, 287 (31.1%) received insulin, and the median blood glucose concentration triggering insulin administration was 11.5 (IQR 9.4-14) mmol/l. Univariate analysis demonstrated that non-survivors had a higher maximum daily blood glucose concentration (12 mmol/l, 9.4-14.8, vs. 9.5, 7.6-12.2) and were more likely to receive insulin (47% vs. 28%). Multiple logistic regression analysis showed age (OR per 5-year decrease 0.93, 95% CI 0.87-1.00) and APACHE II (OR per point decrease 0.87, 95% CI 0.84-0.90) to be independently associated with hospital mortality. After controlling for age and APACHE II both daily highest blood glucose (OR 0.95, 95% CI 0.90-1.00) and administration of insulin (OR 0.62, 95% CI 0.39-1.00) were independently associated when added to the model alone; neither was independently associated when they were simultaneously included in the model.Conclusion: Few Australian and New Zealand ICUs have adopted intensive insulin therapy. In this study, insulin administration and highest daily blood glucose concentration could not be separated in their association with hospital mortality. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To characterize and compare trends in ICU admission, hospital outcomes, and resource utilization for critically ill very elderly patients (≥ 80 yr old) compared with the younger cohort (16-79 yr old). DESIGN: A retrospective multicenter cohort study. SETTING: One-hundred ninety-four ICUs contributing data to the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database between January 2006 and December 2018. PATIENTS: Adult (≥ 16 yr) patients admitted to Australian and New Zealand ICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Very elderly patients with a mean ± sd age of 84.8 ± 3.7 years accounted for 14.8% (232,582/1,568,959) of all adult ICU admissions. They had higher comorbid disease burden and illness severity scores compared with the younger cohort. Hospital (15.4% vs 7.8%, p < 0.001) and ICU mortality (8.5% vs 5.2%, p < 0.001) were higher in the very elderly. They stayed fewer days in ICU, but longer in hospital and had more ICU readmissions. Among survivors, a lower proportion of very elderly was discharged home (65.2% vs 82.4%, p < 0.001), and a higher proportion was discharged to chronic care/nursing home facilities (20.1% vs 7.8%, p < 0.001). Although there was no change in the proportion of very elderly ICU admissions over the study period, they showed a greater decline in risk-adjusted mortality (6.3% [95% CI, 5.9%-6.7%] vs 4.0% [95% CI, 3.7%-4.2%] relative reduction per year, p < 0.001) compared with the younger cohort. The mortality of very elderly unplanned ICU admissions improved faster than the younger cohort (p < 0.001), whereas improvements in mortality among elective surgical ICU admissions were similar in both groups (p = 0.45). CONCLUSIONS: The proportion of ICU admissions greater than or equal to 80 years old did not change over the 13-year study period. Although their mortality was higher, they showed improved survivorship over time, especially in the unplanned ICU admission subgroup. A higher proportion of survivors were discharged to chronic care facilities. [ABSTRACT FROM AUTHOR]

Background: Despite increasing female enrolment into medical schools, persistent gender gaps exist in the physician workforce. There are limited published data on female representation in the critical care medicine workforce., Methods: To obtain a global perspective, societies (n = 84; 79,834 members (40,363 physicians, 39,471 non-physicians)) registered with the World Federation of Societies of Intensive and Critical Care Medicine were surveyed. Longitudinal data on female trainee and specialist positions between 2006-2017 were obtained from Australia and New Zealand. Data regarding leadership and academic faculty representation were also collected from national training bodies and other organisations of critical care medicine., Results: Of the 84 societies, 23 had a registered membership of greater than 500 members. Responses were received from 27 societies (n = 55,996), mainly high-income countries, covering 70.1% of the membership. Amongst the physician workforce, the gender distribution was available from six (22%) participating societies-mean proportion of females 37 ± 11% (range 26-50%). Longitudinal data from Australia and New Zealand between 2006 and 2017 demonstrate rising proportions of female trainees and specialists. Female trainee and specialist numbers increased from 26 to 37% and from 13 to 22% respectively. Globally, female representation in leadership positions was presidencies of critical care organisations (0-41%), representation on critical care medicine boards and councils (8-50%) and faculty representation at symposia (7-34%). Significant gaps in knowledge exist: data from low and middle-income countries, the age distribution and the time taken to enter and complete training., Conclusions: Despite limited information globally, available data suggest that females are under-represented in training programmes, specialist positions, academic faculty and leadership roles in intensive care. There are significant gaps in data on female participation in the critical care workforce. Further data from intensive care organisations worldwide are required to understand the demographics, challenges and barriers to their professional progress.