161 results on '"Anthony S. McLean"'
Search Results
2. The Sequential Organ Failure Assessment (SOFA) Score: has the time come for an update?
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Rui Moreno, Andrew Rhodes, Lise Piquilloud, Glenn Hernandez, Jukka Takala, Hayley B. Gershengorn, Miguel Tavares, Craig M. Coopersmith, Sheila N. Myatra, Mervyn Singer, Ederlon Rezende, Hallie C. Prescott, Márcio Soares, Jean-François Timsit, Dylan W. de Lange, Christian Jung, Jan J. De Waele, Greg S. Martin, Charlotte Summers, Elie Azoulay, Tomoko Fujii, Anthony S. McLean, and Jean-Louis Vincent
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Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract The Sequential Organ Failure Assessment (SOFA) score was developed more than 25 years ago to provide a simple method of assessing and monitoring organ dysfunction in critically ill patients. Changes in clinical practice over the last few decades, with new interventions and a greater focus on non-invasive monitoring systems, mean it is time to update the SOFA score. As a first step in this process, we propose some possible new variables that could be included in a SOFA 2.0. By so doing, we hope to stimulate debate and discussion to move toward a new, properly validated score that will be fit for modern practice.
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- 2023
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3. Blood transcriptome analysis of patients with uncomplicated bacterial infection and sepsis
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Velma Herwanto, Benjamin Tang, Ya Wang, Maryam Shojaei, Marek Nalos, Amith Shetty, Kevin Lai, Anthony S. McLean, and Klaus Schughart
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Sepsis ,Uncomplicated infection ,Whole blood transcriptome ,Medicine ,Biology (General) ,QH301-705.5 ,Science (General) ,Q1-390 - Abstract
Abstract Objectives Hospitalized patients who presented within the last 24 h with a bacterial infection were recruited. Participants were assigned into sepsis and uncomplicated infection groups. In addition, healthy volunteers were recruited as controls. RNA was prepared from whole blood, depleted from beta-globin mRNA and sequenced. This dataset represents a highly valuable resource to better understand the biology of sepsis and to identify biomarkers for severe sepsis in humans. Data description The data presented here consists of raw and processed transcriptome data obtained by next generation RNA sequencing from 105 peripheral blood samples from patients with uncomplicated infections, patients who developed sepsis, septic shock patients, and healthy controls. It is provided as raw sequenced reads and as normalized log2 transformed relative expression levels. This data will allow performing detailed analyses of gene expression changes between uncomplicated infections and sepsis patients, such as identification of differentially expressed genes, co-regulated modules as well as pathway activation studies.
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- 2021
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4. Calibrated cardiac output monitoring versus standard care for fluid management in the shocked ICU patient: a pilot randomised controlled trial
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Timothy G. Scully, Robert Grealy, Anthony S. McLean, and Sam R. Orde
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Fluid responsiveness ,Cardiac output monitoring ,Minimally invasive ,Shock ,Sepsis and fluid administration ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Despite the evidence for calibrated cardiac monitored devices to determine fluid responsiveness, there is minimal evidence that the use of cardiac output monitor devices leads to an overall change in IV fluid use. We sought to investigate the feasibility of performing a randomised controlled study using calibrated cardiac output monitoring devices in shocked ICU patients and whether the use of these devices led to a difference in total volume of IV fluid administered. Methods We performed a single-centre non-blinded randomised controlled study which included patients who met the clinical criteria for shock on admission to ICU. Patients were divided into two groups (cardiac output monitors or standard) by block randomisation. Patients allocated to the cardiac output monitor all received EV1000 with Volume View sets. Daily intravenous fluid administration and cumulative fluid balance was recorded for 3 days. The primary outcome assessed was the difference in daily intravenous fluid administration and cumulative fluid balance at 72 h between the two groups. We also assessed how often the clinicians used the cardiac monitor to guide fluid therapy and the different reasoning for initiating further intravenous fluids. Results Eighty patients were randomised and 37 received calibrated cardiac output monitors. We found no adverse outcomes in the use of calibrated cardiac output monitoring devices and that was feasible to perform a randomised controlled trial. There was no significant difference between the standard care group vs the cardiac monitoring group for cumulative fluid balance (2503 ± 3764 ml vs 2458 ± 3560 ml, p = 0.96). There was no significant difference between the groups for daily intravenous fluid administration on days 1, 2 or 3. In the cardiac monitored group, only 43% of the time was the EV1000 output incorporated into the decision to give further intravenous fluids. Conclusion It is feasible to perform a randomised controlled trial using calibrated cardiac output monitoring devices. In addition, there was no trend to suggest that the use of a cardiac monitors leads to lower IV fluid use in the shocked patient. Further trials will require study designs to optimise the use of a cardiac output monitor to determine the utility of these devices in the shocked patient. Trial registration ANZCTR, ACTRN12618001373268. Registered 15 August 2018—retrospectively registered.
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- 2019
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5. A novel sampling method to detect airborne influenza and other respiratory viruses in mechanically ventilated patients: a feasibility study
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Alicia B. Mitchell, Benjamin Tang, Maryam Shojaei, Lachlan S. Barnes, Marek Nalos, Brian G. Oliver, and Anthony S. McLean
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Virus ,Intensive care unit ,Airborne ,Influenza ,Ventilator ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Respiratory viruses circulate constantly in the ambient air. The risk of opportunistic infection from these viruses can be increased in mechanically ventilated patients. The present study evaluates the feasibility of detecting airborne respiratory viruses in mechanically ventilated patients using a novel sample collection method involving ventilator filters. Methods We collected inspiratory and expiratory filters from the ventilator circuits of mechanically ventilated patients in an intensive care unit over a 14-month period. To evaluate whether we could detect respiratory viruses collected in these filters, we performed a reverse transcription polymerase chain reaction on the extracted filter membrane with primers specific for rhinovirus, respiratory syncytial virus, influenza virus A and B, parainfluenza virus (type 1, 2 and 3) and human metapneumovirus. For each patient, we also performed a full virology screen (virus particles, antibody titres and virus-induced biomarkers) on respiratory samples (nasopharyngeal swab, tracheal aspirate or bronchoalveolar fluid) and blood samples. Results Respiratory viruses were detected in the ventilator filters of nearly half the patients in the study cohort (n = 33/70). The most common virus detected was influenza A virus (n = 29). There were more viruses detected in the inspiratory filters (n = 18) than in the expiratory filters (n = 15). A third of the patients with a positive virus detection in the ventilator filters had a hospital laboratory confirmed viral infection. In the remaining cases, the detected viruses were different from viruses already identified in the same patient, suggesting that these additional viruses come from the ambient air or from cross-contamination (staff or visitors). In patients in whom new viruses were detected in the ventilator filters, there was no evidence of clinical signs of an active viral infection. Additionally, the levels of virus-induced biomarker in these patients were not statistically different from those of non-infected patients (p = 0.33). Conclusions Respiratory viruses were present within the ventilator circuits of patients receiving mechanical ventilation. Although no adverse clinical effect was evident in these patients, further studies are warranted, given the small sample size of the study and the recognition that ventilated patients are potentially susceptible to opportunistic infection from airborne respiratory viruses.
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- 2018
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6. Application of updated guidelines on diastolic dysfunction in patients with severe sepsis and septic shock
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David J. Clancy, Timothy Scully, Michel Slama, Stephen Huang, Anthony S. McLean, and Sam R. Orde
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Sepsis ,Diastolic function ,Systolic function ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Left ventricular diastolic dysfunction is suggested to be associated with higher mortality in severe sepsis and septic shock, yet the methods of diagnosis described in the literature are often inconsistent. The recently published 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging (ASE/EACVI) guidelines offer the opportunity to apply a simple pragmatic diagnostic algorithm for the detection of diastolic dysfunction; however, it has not been tested in this cohort. Aims We sought to assess the applicability in septic patients of recently published 2016 ASE/EACVI guidelines on diastolic dysfunction compared with the 2009 ASE guidelines. Our hypothesis was that there would be poor agreement in classifying patients. Methods Prospective observational study includes patients identified as having severe sepsis and septic shock. Patients underwent transthoracic echocardiography on day 1 and day 3 of their ICU admission. Patients with normal and abnormal (ejection fraction
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- 2017
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7. Longitudinal wall fractional shortening: an M-mode index based on mitral annular plane systolic excursion (MAPSE) that correlates and predicts left ventricular longitudinal strain (LVLS) in intensive care patients
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Stephen J. Huang, Iris Ting, Andrea M. Huang, Michel Slama, and Anthony S. McLean
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Left ventricular function ,MAPSE ,M-mode ,Longitudinal strain ,Speckle tracking ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Left ventricular longitudinal strain (LVLS) is a modern measurement for LV function. However, strain measurement is often difficult in critically ill patients. We sought to show LVLS can be estimated using M-mode-derived longitudinal wall fractional shortening (LWFS), which is less dependent on image quality and is easier to perform in critically ill patients. Methods Transthoracic echocardiographic records were retrospectively screened and 80 studies suitable for strain and M-mode measurements in the apical 4-chamber view were selected. Longitudinal wall fractional shortening was derived from conventional M-mode (LWFS) and curved anatomical M-mode (CAMMFS). The relationships between LVLS and mitral annular plane systolic excusion (MAPSE) and M-mode-derived fractional shortening were examined using univariate generalized linear model in a training set (n = 50) and was validated in a separate validation set (n = 30). Results MAPSE, CAMMFS, and LWFS demonstrated very good correlations with LVLS (r = 0.852, 0.875 and 0.909, respectively). LWFS was the best unbiased predictor for LVLS (LVLS = 1.180 x LWFS - 0.737, P
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- 2017
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8. Detecting impaired myocardial relaxation in sepsis with a novel tissue Doppler parameter (septal e′/s′)
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David J. Clancy, Michel Slama, Stephen Huang, Timothy Scully, Anthony S. McLean, and Sam R. Orde
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Sepsis ,Diastolic function ,Myocardial relaxation ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Left ventricular diastolic dysfunction is associated with mortality outcomes in severe sepsis and septic shock. There are ongoing issues with diagnosing diastolic dysfunction in this cohort, partly owing to the poor applicability of traditional parameters in the hyperdynamic circulation. In this feasibility study, we sought to assess the utility of a novel parameter (septal e′/s′) to identify diastolic dysfunction in patients with severe sepsis and septic shock who had normal systolic function against the 2016 American Society Echocardiography and European Association of Cardiovascular Imaging (ASE/EACI) guidelines on diastolic dysfunction. Methods In this prospective observational pilot study, patients identified as having severe sepsis and septic shock underwent transthoracic echocardiography on day 1 and day 3 of their intensive care unit admission. In patients with normal systolic function, septal e′/s′ was calculated using the peak modal velocity of the s′ compared with the e′ from the septal annulus tissue Doppler imaging and compared with their diastolic grade according to the 2016 ASE/EACI guidelines on diastolic dysfunction. Results On day 1 of admission, 44 of 62 patients with severe sepsis and septic shock had normal systolic function. There was a strong association of those with diastolic dysfunction having a reduced septal e′/s′ compared with patients with normal diastolic function (AUC 0.91). A similar relationship was seen with patients who had indeterminate diastolic dysfunction. On day 3, 37 patients had normal systolic function. Again, there was a strong association of those with diastolic dysfunction and a reduced septal e′/s′ (AUC 0.95). Conclusions A reduction in septal e′/s′ may indicate diastolic dysfunction in patients with severe sepsis and septic shock who have normal systolic function. As opposed to limited traditional measures of diastolic dysfunction, it is applicable in those with hyperdynamic systolic function.
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- 2017
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9. Appreciating the Strengths and Weaknesses of Transthoracic Echocardiography in Hemodynamic Assessments
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Stephen J. Huang and Anthony S. McLean
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Transthoracic echocardiography (TTE) is becoming the choice of hemodynamic assessment tool in many intensive care units. With an ever increasing number of training programs available worldwide, learning the skills to perform TTE is no longer a limiting factor. Instead, the future emphasis will be shifted to teach the users how to recognize measurement errors and artefacts (internal validity), to realize the limitations of TTE in various applications, and finally how to apply the information to the patient in question (external validity). This paper aims to achieve these objectives in a common area of TTE application—hemodynamic assessments. We explore the strengths and weaknesses of TTE in such assessments in this paper. Various methods of hemodynamic assessments, such as cardiac output measurements, estimation of preload, and assessment of fluid responsiveness, will be discussed.
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- 2012
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10. Association Between Premorbid Beta-Blocker Exposure and Sepsis Outcomes—The Beta-Blockers in European and Australian/American Septic Patients (BEAST) Study
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Marek Nalos, Andrew Simpson, Christina Whitehead, Kristy P. Robledo, Gunawan Gunawan, Yi Chern Tan, Anthony S. McLean, Martin Harazim, Kaiquan Tan, and Benjamin Tang
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Adrenergic beta-Antagonists ,Critical Care and Intensive Care Medicine ,Sepsis ,Internal medicine ,Outcome Assessment, Health Care ,Odds Ratio ,medicine ,Humans ,Beta blocker ,APACHE ,Aged ,Czech Republic ,Proportional Hazards Models ,Retrospective Studies ,Proportional hazards model ,business.industry ,Organ dysfunction ,Hazard ratio ,Retrospective cohort study ,Odds ratio ,Middle Aged ,medicine.disease ,United States ,Female ,Observational study ,New South Wales ,medicine.symptom ,business - Abstract
Objectives To examine the effect of premorbid β-blocker exposure on mortality and organ dysfunction in sepsis. Design Retrospective observational study. Setting ICUs in Australia, the Czech Republic, and the United States. Patients Total of 4,086 critical care patients above 18 years old with sepsis between January 2014 and December 2018. Intervention Premorbid beta-blocker exposure. Measurements and main results One thousand five hundred fifty-six patients (38%) with premorbid β-blocker exposure were identified. Overall ICU mortality rate was 15.1%. In adjusted models, premorbid β-blocker exposure was associated with decreased ICU (adjusted odds ratio, 0.80; 95% CI, 0.66-0.97; p = 0.025) and hospital (adjusted odds ratio, 0.83; 95% CI, 0.71-0.99; p = 0.033) mortality. The risk reduction in ICU mortality of 16% was significant (hazard ratio, 0.84, 95% CI, 0.71-0.99; p = 0.037). In particular, exposure to noncardioselective β-blocker before septic episode was associated with decreased mortality. Sequential Organ Failure Assessment score analysis showed that premorbid β-blocker exposure had potential benefits in reducing respiratory and neurologic dysfunction. Conclusions This study suggests that β-blocker exposure prior to sepsis, especially to noncardioselective β blockers, may be associated with better outcome. The findings suggest prospective evaluation of β-blocker use in the management of sepsis.
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- 2021
11. Transcriptomics in the intensive care unit
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Anthony S McLean and Maryam Shojaei
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Pulmonary and Respiratory Medicine ,Intensive Care Units ,Humans ,Transcriptome - Published
- 2022
12. Redefining critical illness
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David M. Maslove, Benjamin Tang, Manu Shankar-Hari, Patrick R. Lawler, Derek C. Angus, J. Kenneth Baillie, Rebecca M. Baron, Michael Bauer, Timothy G. Buchman, Carolyn S. Calfee, Claudia C. dos Santos, Evangelos J. Giamarellos-Bourboulis, Anthony C. Gordon, John A. Kellum, Julian C. Knight, Aleksandra Leligdowicz, Daniel F. McAuley, Anthony S. McLean, David K. Menon, Nuala J. Meyer, Lyle L. Moldawer, Kiran Reddy, John P. Reilly, James A. Russell, Jonathan E. Sevransky, Christopher W. Seymour, Nathan I. Shapiro, Mervyn Singer, Charlotte Summers, Timothy E. Sweeney, B. Taylor Thompson, Tom van der Poll, Balasubramanian Venkatesh, Keith R. Walley, Timothy S. Walsh, Lorraine B. Ware, Hector R. Wong, Zsolt E. Zador, John C. Marshall, Maslove, David M [0000-0002-0765-7158], Tang, Benjamin [0000-0002-1469-9540], Shankar-Hari, Manu [0000-0002-5338-2538], Baillie, J Kenneth [0000-0001-5258-793X], Bauer, Michael [0000-0002-1521-3514], Buchman, Timothy G [0000-0001-7350-5921], Giamarellos-Bourboulis, Evangelos J [0000-0003-4713-3911], Gordon, Anthony C [0000-0002-0419-547X], Kellum, John A [0000-0003-1995-2653], Leligdowicz, Aleksandra [0000-0001-6055-4644], McAuley, Daniel F [0000-0002-3283-1947], Menon, David K [0000-0002-3228-9692], Meyer, Nuala J [0000-0003-4597-5584], Reddy, Kiran [0000-0002-1621-1481], Reilly, John P [0000-0003-3937-5320], Singer, Mervyn [0000-0002-1042-6350], Summers, Charlotte [0000-0002-7269-2873], van der Poll, Tom [0000-0002-9199-5079], Wong, Hector R [0000-0001-7989-1173], Apollo - University of Cambridge Repository, NIHR, Center of Experimental and Molecular Medicine, and Infectious diseases
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Critical Care ,SARS-CoV-2 ,Critical Illness ,Immunology ,COVID-19 ,Humans ,General Medicine ,Syndrome ,11 Medical and Health Sciences ,General Biochemistry, Genetics and Molecular Biology - Abstract
Both research and practice in critical care medicine have long been defined by syndromes. Though clinically recognizable entities, these are in fact loose amalgams of heterogeneous states, within which responses to therapy may vary. Mounting translational evidence suggests the current syndrome-based framework of critical illness should be reconsidered. Moreover, research done during the COVID-19 pandemic illustrates how the study of a more biologically homogeneous condition – respiratory failure due to SARS-CoV-2 infection – can increase the efficiency with which actionable results are generated. We discuss recent findings from basic science and clinical research in critical care, and explore how these might inform a new conceptual model of critical illness. De-emphasizing syndromes, we focus instead on the underlying biological changes that underpin critical illness states, and that may be amenable to treatment. We hypothesize that such an approach will accelerate translational critical care research, leading to a richer understanding of the pathobiology of critical illness, and of the proximate determinants of ICU outcomes. The specificity and granularity gained will support the design of more effective clinical trials, and inform a more precise, effective practice at the bedside.
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- 2022
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13. The Role of Mitochondria in the Immune Response in Critical Illness
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Ya Wang and Anthony S. McLean
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Critical Care ,Critical Illness ,Emergency Medicine ,Immunity ,Humans ,Review ,Critical Care and Intensive Care Medicine ,Mitochondria - Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2022. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2022 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 .
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- 2022
14. Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study)
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Stephen, Huang, Philippe, Vignon, Armand, Mekontso-Dessap, Ségolène, Tran, Gwenael, Prat, Michelle, Chew, Martin, Balik, Filippo, Sanfilippo, Gisele, Banauch, Fernando, Clau-Terre, Andrea, Morelli, Daniel, De Backer, Bernard, Cholley, Michel, Slama, Cyril, Charron, Marine, Goudelin, Francois, Bagate, Pierre, Bailly, Patrick-Johansson, Blixt, Paul, Masi, Bruno, Evrard, Sam, Orde, Paul, Mayo, Anthony S, McLean, Antoine, Vieillard-Baron, and Thomas, Daix
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Heart Failure ,Male ,Intensive Care Units ,Ventricular Dysfunction, Left ,Echocardiography ,Hypertension, Pulmonary ,Ventricular Dysfunction, Right ,COVID-19 ,Humans ,Female ,Pulmonary Embolism ,Aged ,Retrospective Studies - Abstract
Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU).Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap).Six hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR 4), pulmonary embolism (OR 5) and increased PaCOAlmost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.
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- 2022
15. Evaluating the influence of data collector training for predictive risk of death models: an observational study
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Latesh Poojara, Debbie Odlum, Ashwin Subramaniam, Anders Aneman, Jinghang Luo, Anthony S. McLean, Michele Thomson, Stephen Huang, Adam Howard, Arvind Rajamani, Ramanathan Lakshmanan, Gordon Flynn, Thodur Vinodh Madapusi, Andrew Simpson, J. J. Gatward, and Raju Pusapati
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medicine.medical_specialty ,Data collection ,business.industry ,Health Policy ,Multilevel model ,Australia ,Bayes Theorem ,Training effect ,01 natural sciences ,Intensive Care Units ,010104 statistics & probability ,03 medical and health sciences ,Survey methodology ,0302 clinical medicine ,030228 respiratory system ,Surveys and Questionnaires ,Intensive care ,medicine ,Humans ,Medical physics ,Observational study ,0101 mathematics ,Raw data ,business ,Quality assurance - Abstract
BackgroundSeverity-of-illness scoring systems are widely used for quality assurance and research. Although validated by trained data collectors, there is little data on the accuracy of real-world data collection practices.ObjectiveTo evaluate the influence of formal data collection training on the accuracy of scoring system data in intensive care units (ICUs).Study design and methodsQuality assurance audit conducted using survey methodology principles. Between June and December 2018, an electronic document with details of three fictitious ICU patients was emailed to staff from 19 Australian ICUs who voluntarily submitted data on a web-based data entry form. Their entries were used to generate severity-of-illness scores and risks of death (RoDs) for four scoring systems. The primary outcome was the variation of severity-of-illness scores and RoDs from a reference standard.Results50/83 staff (60.3%) submitted data. Using Bayesian multilevel analysis, severity-of-illness scores and RoDs were found to be significantly higher for untrained staff. The mean (95% high-density interval) overestimation in RoD due to training effect for patients 1, 2 and 3, respectively, were 0.24 (0.16, 0.31), 0.19 (0.09, 0.29) and 0.24 (0.1, 0.38) respectively (Bayesian factor >300, decisive evidence). Both groups (trained and untrained) had wide coefficients of variation up to 38.1%, indicating wide variability. Untrained staff made more errors in interpreting scoring system definitions.InterpretationIn a fictitious patient dataset, data collection staff without formal training significantly overestimated the severity-of-illness scores and RoDs compared with trained staff. Both groups exhibited wide variability. Strategies to improve practice may include providing adequate training for all data collection staff, refresher training for previously trained staff and auditing the raw data submitted by individual ICUs. The results of this simulated study need revalidation on real patients.
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- 2020
16. The effects of static and dynamic measurements using transpulmonary thermodilution devices on fluid therapy in septic shock: A systematic review
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Timothy Scully, Anthony S. McLean, Sam Orde, Stephen Huang, and Yifan Huang
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medicine.medical_specialty ,business.industry ,Septic shock ,Haemodynamic monitoring ,Thermodilution ,Fluid responsiveness ,030208 emergency & critical care medicine ,Critical Care and Intensive Care Medicine ,medicine.disease ,Shock, Septic ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,030228 respiratory system ,Fluid therapy ,Internal medicine ,Cardiac output monitoring ,medicine ,Cardiology ,Fluid Therapy ,Humans ,Cardiac Output ,business - Abstract
Transpulmonary thermodilution devices have been widely shown to be accurate in septic shock patients in assessing fluid responsiveness. We conducted a systematic review to assess the relationship between fluid therapy protocols guided by transpulmonary thermodilution devices on fluid balance and the amount of intravenous fluid used in septic shock. We searched MEDLINE, Embase and The Cochrane Library. Studies were eligible for inclusion if they were prospective, parallel trials that were conducted in an intensive care setting in patients with septic shock. The comparator group was either central venous pressure, early goal-directed therapy or pulmonary artery occlusion pressure. Studies assessing only the accuracy of fluid responsiveness prediction by transpulmonary thermodilution devices were excluded. Two reviewers independently performed the search, extracted data and assessed the bias of each study. In total 27 full-text articles were identified for eligibility; of these, nine studies were identified for inclusion in the systematic review. Three of these trials used dynamic parameters derived from transpulmonary thermodilution devices and six used primarily static parameters to guide fluid therapy. There was evidence for a significant reduction in positive fluid balance in four out of the nine studies. From the available studies, the results suggest the benefit of transpulmonary thermodilution monitoring in the septic shock population with regard to reducing positive fluid balance is seen when the devices are utilised for at least 72 hours. Both dynamic and static parameters derived from transpulmonary thermodilution devices appear to lead to a reduction in positive fluid balance in septic shock patients compared to measurements of central venous pressure and early goal-directed therapy.
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- 2020
17. IFI27 transcription is an early predictor for COVID-19 outcomes; a multi-cohort observational study
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Timothy J. Wells, Ya Wang, Jon Iredell, Amy Phu, Sally Teoh, Win Sen Kuan, Yanshan Zhu, Melissa J. Davis, Timothy McCulloch, Majid Ebrahimi Warkiani, Tiana M Pelaia, Yao Xia, Chin Wee Tan, Timothy Kwan, Lucia de Noronha, Velma Herwanto, Reza Alizadeh-Navaei, Amir Shamshirian, Carmen Lúcia Kuniyoshi Rebelatto, John F. Fraser, Tracy Chew, Reza Valadan, Liliana Lamperti, Kenneth J. O'Byrne, Marek Nalos, Gabrielle T. Belz, Yvette Jee, Quan Nguyen, Keng Yih Chew, Maryam Shojaei, Anthony S. McLean, Benjamin Tang, Alexandra Cristina Senegaglia, Carlos Salomon Gallo, Laura F. Grice, Ben Knippenberg, Arutha Kulasinghe, Kirsty R. Short, Felipe Zuñiga, Omolbanin Amjadi, Sepideh Motamen, Estefania Nova-Lamperti, Rajan Gogna, Anna Flavia Ribeiro dos Santos, Minh Tran, Karan Kim, Fernando Souza-Fonseca-Guimaraes, James Monkman, Gustavo Rodrigues Rossi, Gonzalo Labarca, Esha Madan, and Claudio Luciano Franck
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Oncology ,medicine.medical_specialty ,business.industry ,COVID-19 ,Alpha interferon ,medicine.disease_cause ,Virus ,Coronavirus ,Respiratory failure ,Internal medicine ,Pandemic ,Cohort ,medicine ,Respiratory virus ,business ,Viral load - Abstract
BackgroundRobust biomarkers that predict disease outcomes amongst COVID-19 patients are necessary for both patient triage and resource prioritisation. Numerous candidate biomarkers have been proposed for COVID-19. However, at present, there is no consensus on the best diagnostic approach to predict outcomes in infected patients. Moreover, it is not clear whether such tools would apply to other potentially pandemic pathogens and therefore of use as stockpile for future pandemic preparedness.MethodsWe conducted a multi-cohort observational study to investigate the biology and the prognostic role of interferon alpha-inducible protein 27 (IFI27) in COVID-19 patients.FindingsWe show that IFI27 is expressed in the respiratory tract of COVID-19 patients and elevated IFI27 expression is associated with the presence of a high viral load. We further demonstrate that systemic host response, as measured by blood IFI27 expression, is associated with COVID-19 severity. For clinical outcome prediction (e.g. respiratory failure), IFI27 expression displays a high positive (0.83) and negative (0.95) predictive value, outperforming all other known predictors of COVID-19 severity. Furthermore, IFI27 is upregulated in the blood of infected patients in response to other respiratory viruses. For example, in the pandemic H1N1/09 swine influenza virus infection, IFI27-like genes were highly upregulated in the blood samples of severely infected patients.InterpretationThese data suggest that prognostic biomarkers targeting the family of IFI27 genes could potentially supplement conventional diagnostic tools in future virus pandemics, independent of whether such pandemics are caused by a coronavirus, an influenza virus or another as yet-to-be discovered respiratory virus.Research in contextEvidence before this studyWe searched the scientific literature using PubMed to identify studies that used the IFI27 biomarker to predict outcomes in COVID-19 patients. We used the search terms “IFI27”, “COVID-19, “gene expression” and “outcome prediction”. We did not identify any study that investigated the role of IFI27 biomarker in outcome prediction. Although ten studies were identified using the general terms of “gene expression” and “COVID-19”, IFI27 was only mentioned in passing as one of the identified genes. All these studies addressed the broader question of the host response to COVID-19; none focused solely on using IFI27 to improve the risk stratification of infected patients in a pandemic.Added value of this studyHere, we present the findings of a multi-cohort study of the IFI27 biomarker in COVID-19 patients. Our findings show that the host response, as reflected by blood IFI27 gene expression, accurately predicts COVID-19 disease progression (positive and negative predictive values; 0.83 and 0.95, respectively), outperforming age, comorbidity, C-reactive protein and all other known risk factors. The strong association of IFI27 with disease severity occurs not only in SARS-CoV-2 infection, but also in other respiratory viruses with pandemic potential, such as the influenza virus. These findings suggest that host response biomarkers, such as IFI27, could help identify high-risk COVID-19 patients - those who are more likely to develop infection complications - and therefore may help improve patient triage in a pandemic.Implications of all the available evidenceThis is the first systemic study of the clinical role of IFI27 in the current COVID-19 pandemic and its possible future application in other respiratory virus pandemics. The findings not only could help improve the current management of COVID-19 patients but may also improve future pandemic preparedness.
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- 2021
18. Blood transcriptome analysis of patients with uncomplicated bacterial infection and sepsis
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Amith Shetty, Anthony S. McLean, Marek Nalos, Velma Herwanto, Maryam Shojaei, Kevin Lai, Benjamin Tang, Klaus Schughart, Ya Wang, and HZI,Helmholtz-Zentrum für Infektionsforschung GmbH, Inhoffenstr. 7,38124 Braunschweig, Germany.
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0301 basic medicine ,Hospitalized patients ,Whole blood transcriptome ,lcsh:Medicine ,Data Note ,General Biochemistry, Genetics and Molecular Biology ,Sepsis ,Transcriptome ,03 medical and health sciences ,0302 clinical medicine ,Gene expression ,Medicine ,Humans ,030212 general & internal medicine ,lcsh:Science (General) ,lcsh:QH301-705.5 ,Whole blood ,Messenger RNA ,business.industry ,Septic shock ,Gene Expression Profiling ,lcsh:R ,RNA ,General Medicine ,Bacterial Infections ,Uncomplicated infection ,medicine.disease ,030104 developmental biology ,lcsh:Biology (General) ,Case-Control Studies ,Immunology ,business ,lcsh:Q1-390 - Abstract
Objectives Hospitalized patients who presented within the last 24 h with a bacterial infection were recruited. Participants were assigned into sepsis and uncomplicated infection groups. In addition, healthy volunteers were recruited as controls. RNA was prepared from whole blood, depleted from beta-globin mRNA and sequenced. This dataset represents a highly valuable resource to better understand the biology of sepsis and to identify biomarkers for severe sepsis in humans. Data description The data presented here consists of raw and processed transcriptome data obtained by next generation RNA sequencing from 105 peripheral blood samples from patients with uncomplicated infections, patients who developed sepsis, septic shock patients, and healthy controls. It is provided as raw sequenced reads and as normalized log2 transformed relative expression levels. This data will allow performing detailed analyses of gene expression changes between uncomplicated infections and sepsis patients, such as identification of differentially expressed genes, co-regulated modules as well as pathway activation studies.
- Published
- 2021
19. The association between premorbid beta blocker exposure and mortality in sepsis—a systematic review
- Author
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Kaiquan Tan, Benjamin Tang, Anthony S. McLean, Martin Harazim, and Marek Nalos
- Subjects
medicine.medical_specialty ,medicine.drug_class ,Adrenergic beta-Antagonists ,MEDLINE ,Critical Care and Intensive Care Medicine ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Mortality ,Beta blocker ,Retrospective Studies ,Beta blockers ,Septic shock ,business.industry ,Research ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Correction ,030208 emergency & critical care medicine ,Retrospective cohort study ,Odds ratio ,lcsh:RC86-88.9 ,medicine.disease ,Systematic review ,Meta-analysis ,Hypertension ,business - Abstract
Background The effect of premorbid β-blocker exposure on clinical outcomes in patients with sepsis is not well characterized. We aimed to examine the association between premorbid β-blocker exposure and mortality in sepsis. Methods EMBase, MEDLINE, and Cochrane databases were searched for all studies of premorbid β-blocker and sepsis. The search was last updated on 22 June 2019. Two reviewers independently assessed, selected, and abstracted data from studies reporting chronic β-blocker use prior to sepsis and mortality. Main data extracted were premorbid β-blocker exposure, mortality, study design, and patient data. Two reviewers independently assessed the risk of bias and quality of evidence. Results In total, nine studies comprising 56,414 patients with sepsis including 6576 patients with premorbid exposure to β-blockers were eligible. For the primary outcome of mortality, two retrospective studies reported adjusted odds ratios showing a reduction in mortality with premorbid β-blocker exposure. One study showed that premorbid β-blocker exposure decreases mortality in patients with septic shock. Another study showed that continued β-blockade during sepsis is associated with decreased mortality. Conclusion This systematic review suggests that β-blocker exposure prior to sepsis is associated with reduced mortality. There was insufficient data to conduct a bona fide meta-analysis. Whether the apparent reduction in mortality may be attributed to the mitigation of catecholamine excess is unclear. Trial registration PROSPERO, CRD42019130558 registered June 12, 2019. Electronic supplementary material The online version of this article (10.1186/s13054-019-2562-y) contains supplementary material, which is available to authorized users.
- Published
- 2019
20. Neutrophils-related host factors associated with severe disease and fatality in patients with influenza infection
- Author
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Benjamin Tang, Anthony S. McLean, Damon P. Eisen, Khyobeni Mozhui, Monika Holubova, Rahul Santram, Adrienne F. A. Meyers, Robert Geffers, Mark Gillett, Amarnath Pisipati, T. Blake Ball, Jens Schreiber, Aseem Kumar, Marek Nalos, Maryam Shojaei, Tracy Chew, Yoav Keynan, Sally Teoh, Kevin Lai, David R. Booth, John Ho, Grant P Parnell, Klaus Schughart, Anand Kumar, Stephen Huang, and HZI,Helmholtz-Zentrum für Infektionsforschung GmbH, Inhoffenstr. 7,38124 Braunschweig, Germany.
- Subjects
Male ,0301 basic medicine ,Neutrophils ,Gene Expression ,General Physics and Astronomy ,Host factors ,Pathogenesis ,02 engineering and technology ,medicine.disease_cause ,Extracellular Traps ,Neutrophil Activation ,Influenza A Virus, H1N1 Subtype ,Influenza A virus ,Prospective Studies ,lcsh:Science ,Prospective cohort study ,Lung ,Multidisciplinary ,Cell Cycle ,virus diseases ,Middle Aged ,021001 nanoscience & nanotechnology ,medicine.anatomical_structure ,Female ,Respiratory Insufficiency ,0210 nano-technology ,Immunopathogenesis ,Science ,Severe disease ,macromolecular substances ,Article ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,Influenza, Human ,medicine ,Humans ,In patient ,Respiratory tract diseases ,business.industry ,Influenza A Virus, H3N2 Subtype ,Infectious-disease diagnostics ,General Chemistry ,Neutrophil extracellular traps ,Respiration, Artificial ,Influenza B virus ,030104 developmental biology ,Viral infection ,Immunology ,lcsh:Q ,business ,Human Pathology - Abstract
Severe influenza infection has no effective treatment available. One of the key barriers to developing host-directed therapy is a lack of reliable prognostic factors needed to guide such therapy. Here, we use a network analysis approach to identify host factors associated with severe influenza and fatal outcome. In influenza patients with moderate-to-severe diseases, we uncover a complex landscape of immunological pathways, with the main changes occurring in pathways related to circulating neutrophils. Patients with severe disease display excessive neutrophil extracellular traps formation, neutrophil-inflammation and delayed apoptosis, all of which have been associated with fatal outcome in animal models. Excessive neutrophil activation correlates with worsening oxygenation impairment and predicted fatal outcome (AUROC 0.817–0.898). These findings provide new evidence that neutrophil-dominated host response is associated with poor outcomes. Measuring neutrophil-related changes may improve risk stratification and patient selection, a critical first step in developing host-directed immune therapy., Identification of host factors associated with severe influenza infection could provide insights into treatment options. Here, the authors provide transcriptomic analyses of blood from >100 influenza infected patients and show that changes in circulating neutrophils are associated with severe influenza infection.
- Published
- 2019
21. Feasibility of myocardial perfusion assessment with contrast echocardiography: can it improve recognition of significant coronary artery disease in the ICU?
- Author
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Sam Orde, Faraz Pathan, Michel Slama, Anthony S. McLean, and Stephen Huang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Contrast Media ,Coronary Artery Disease ,Critical Care and Intensive Care Medicine ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Troponin I ,medicine ,Humans ,Medical history ,Prospective Studies ,Adverse effect ,Critically ill ,Aged ,medicine.diagnostic_test ,biology ,business.industry ,Research ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,Blood flow ,lcsh:RC86-88.9 ,Middle Aged ,Contrast ,medicine.disease ,Troponin ,Perfusion ,Intensive Care Units ,Echocardiography ,Angiography ,biology.protein ,Cardiology ,Feasibility Studies ,Female ,New South Wales ,business - Abstract
Background Diagnosis of significant coronary artery disease (CAD) and acute coronary artery occlusion in ICU can be difficult, and an inappropriate intervention is potentially harmful. Myocardial contrast perfusion echo (MCPE) examines ultrasound contrast intensity replenishment curves in individual myocardial segments measuring peak contrast intensity and slope of return as an index of myocardial blood flow (units = intensity of ultrasound per second [dB/s]). MCPE could possibly serve as a triage tool to invasive angiography by estimating blood flow in the myocardium. We sought to assess feasibility in the critically ill and if MCPE could add incremental value to the clinical acumen in predicting significant CAD. Methods This is a single-centre, prospective, observational study. Inclusion criteria were as follows: adult ICU patients with troponin I > 50 ng/L and cardiology referral being made for consideration of inpatient angiography. Exclusion criteria were as follows: poor echo windows (2 patients), known ischaemic heart disease, and contrast contraindications. Seven cardiologists and 6 intensivists blinded to outcome assessed medical history, ECG, troponin, and 2D echo images to estimate likelihood of significant CAD needing intervention (clinical acumen). Clinical acumen, quantitative MCPE, and subjective (visual) MCPE were assessed to predict significant CAD. Results Forty patients underwent MCPE analysis, 6 (15%) had significant CAD, and median 11 of 16 segments (IQR 8–13) could be imaged (68.8% [IQR 50–81]). No adverse events occurred. A significant difference was found in overall MCPE blood flow estimation between those diagnosed with significant CAD and those without (3.3 vs 2.4 dB/s, p = 0.050). A MCPE value of 2.8 dB/s had 67% sensitivity and 88% specificity in detecting significant CAD. Clinical acumen showed no association in prediction of CAD (OR 0.6, p = 0.09); however, if quantitative or visual MCPE analysis was included, a significant association occurred (OR 17.1, p = 0.01; OR 23.0, p = 0.01 respectively). Conclusions MCPE is feasible in the critically ill and shows better association with predicting significant CAD vs clinical acumen alone. MCPE adds incremental value to initial assessment of the presence of significant CAD which may help guide those who require urgent angiography.
- Published
- 2019
22. A decade of progress in critical care echocardiography: a narrative review
- Author
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Michelle S Chew, Anthony S. McLean, Antoine Vieillard-Baron, N. Fletcher, S. J. Millington, J. Pulido, Paul H. Mayo, Michael R. Pinsky, Filippo Sanfilippo, and José L. Díaz-Gómez
- Subjects
medicine.medical_specialty ,Critical Care ,business.industry ,Pain medicine ,Hemodynamics ,030208 emergency & critical care medicine ,Emergency department ,Perioperative ,Certification ,Critical Care and Intensive Care Medicine ,Intensive care unit ,law.invention ,Intensive Care Units ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Echocardiography ,law ,Anesthesiology ,medicine ,Humans ,Narrative review ,Ultrasonography ,business ,Intensive care medicine - Abstract
This narrative review focusing on critical care echocardiography (CCE) has been written by a group of experts in the field, with the aim of outlining the state of the art in CCE in the 10 years after its official recognition and definition. In the last 10 years, CCE has become an essential branch of critical care ultrasonography and has gained general acceptance. Its use, both as a diagnostic tool and for hemodynamic monitoring, has increased markedly, influencing contemporary cardiorespiratory management. Recent studies suggest that the use of CCE may have a positive impact on outcomes. CCE may be used in critically ill patients in many different clinical situations, both in their early evaluation of in the emergency department and during intensive care unit (ICU) admission and stay. CCE has also proven its utility in perioperative settings, as well as in the management of mechanical circulatory support. CCE may be performed with very simple diagnostic objectives. This application, referred to as basic CCE, does not require a high level of training. Advanced CCE, on the other hand, uses ultrasonography for full evaluation of cardiac function and hemodynamics, and requires extensive training, with formal certification now available. Indeed, recent years have seen the creation of worldwide certification in advanced CCE. While transthoracic CCE remains the most commonly used method, the transesophageal route has gained importance, particularly for intubated and ventilated patients. CCE is now widely accepted by the critical care community as a valuable tool in the ICU and emergency department, and in perioperative settings.
- Published
- 2019
23. Prospective validation study of prognostic biomarkers to predict adverse outcomes in patients with COVID-19: A study protocol
- Author
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Velma Herwanto, Andrea De Maria, Benjamin Tang, Ya Wang, Michele Bedognetti, Tim N Kwan, Yoann Zerbib, Nicholas P. West, Allan W. Cripps, Paolo Cremonesi, Marek Nalos, Gunawan Gunawan, Maryam Shojaei, Gabriele Zoppoli, Thomas Karvunidis, Darawan Rinchai, Alberto Ballestrero, Stephen P J Macdonald, Jonathan R. Iredell, Martin Matejovic, Ali Afrasiabi, Stephen Weng, Win Sen Kuan, Klaus Schughart, Amanda J. Cox, Davide Bedognetti, Anthony S. McLean, Damien Chaussabel, and HZI,Helmholtz-Zentrum für Infektionsforschung GmbH, Inhoffenstr. 7,38124 Braunschweig, Germany.
- Subjects
Male ,Time Factors ,lcsh:Medicine ,immunology ,0302 clinical medicine ,Positive predicative value ,Research Methods ,Outpatient clinic ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,0303 health sciences ,Emergency Service ,General Medicine ,Middle Aged ,Prognosis ,Viral pneumonia ,Biomarker (medicine) ,Female ,medicine.symptom ,Emergency Service, Hospital ,adult intensive & critical care ,COVID-19 ,molecular diagnostics ,Adult ,Biomarkers ,Critical Illness ,Follow-Up Studies ,Humans ,Triage ,Pandemics ,SARS-CoV-2 ,medicine.medical_specialty ,Asymptomatic ,03 medical and health sciences ,Hospital ,medicine ,030306 microbiology ,business.industry ,lcsh:R ,Bacterial pneumonia ,medicine.disease ,Coronavirus ,Emergency medicine ,business - Abstract
IntroductionAccurate triage is an important first step to effectively manage the clinical treatment of severe cases in a pandemic outbreak. In the current COVID-19 global pandemic, there is a lack of reliable clinical tools to assist clinicians to perform accurate triage. Host response biomarkers have recently shown promise in risk stratification of disease progression; however, the role of these biomarkers in predicting disease progression in patients with COVID-19 is unknown. Here, we present a protocol outlining a prospective validation study to evaluate the biomarkers’ performance in predicting clinical outcomes of patients with COVID-19.Methods and analysisThis prospective validation study assesses patients infected with COVID-19, in whom blood samples are prospectively collected. Recruited patients include a range of infection severity from asymptomatic to critically ill patients, recruited from the community, outpatient clinics, emergency departments and hospitals. Study samples consist of peripheral blood samples collected into RNA-preserving (PAXgene/Tempus) tubes on patient presentation or immediately on study enrolment. Real-time PCR (RT-PCR) will be performed on total RNA extracted from collected blood samples using primers specific to host response gene expression biomarkers that have been previously identified in studies of respiratory viral infections. The RT-PCR data will be analysed to assess the diagnostic performance of individual biomarkers in predicting COVID-19-related outcomes, such as viral pneumonia, acute respiratory distress syndrome or bacterial pneumonia. Biomarker performance will be evaluated using sensitivity, specificity, positive and negative predictive values, likelihood ratios and area under the receiver operating characteristic curve.Ethics and disseminationThis research protocol aims to study the host response gene expression biomarkers in severe respiratory viral infections with a pandemic potential (COVID-19). It has been approved by the local ethics committee with approval number 2020/ETH00886. The results of this project will be disseminated in international peer-reviewed scientific journals.
- Published
- 2021
24. Impaired peripheral mononuclear cell metabolism in patients at risk of developing sepsis: A cohort study
- Author
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Alamgir Khan, Mandira Chakraborty, Ya Wang, Marek Nalos, Tracy Chew, Kevin Lai, Maryam Shojaei, Anthony S. McLean, Amith Shetty, Stephen Huang, Benjamin Mp. Tang, Velma Herwanto, and Sally Teoh
- Subjects
business.industry ,medicine.medical_treatment ,medicine.disease ,medicine.disease_cause ,Peripheral blood mononuclear cell ,Sepsis ,Immune system ,Cytokine ,Apoptosis ,Immunology ,Medicine ,Tumor necrosis factor alpha ,business ,Oxidative stress ,Whole blood - Abstract
PurposeDysregulated immune response is a key driver of disease progression in sepsis and known to be associated with impaired cellular metabolism. This association has been studied mostly in the late stage sepsis patients. Here, we investigate whether such impairment in cellular metabolism is present in uncomplicated infection patients who do not develop sepsis.MethodsForty sepsis (fulfilled Sepsis-3 criteria) and 27 uncomplicated infection patients were recruited from the emergency department along with 20 healthy volunteers. Whole blood was collected for measurement of gene expression, cytokine levels and cellular metabolic functions (including mitochondrial respiration, oxidative stress and apoptosis).ResultsOur analysis revealed the impairment of mitochondrial respiration in uncomplicated infection and sepsis patients (p value ConclusionsThese findings suggest that impaired immune cell metabolism is present in infection patients without presenting sepsis, thereby opening potential window for early diagnosis and intervention (e.g. antioxidant therapy) in such patients.
- Published
- 2020
25. The PRICES statement: an ESICM expert consensus on methodology for conducting and reporting critical care echocardiography research studies
- Author
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Andrea Morelli, Carlos Corredor, N. Fletcher, Michelle S Chew, Michel Slama, Guillaume Geri, Tatjana Petrinic, Antoine Herpain, Anthony S. McLean, Fernando Clau-Terré, Martin Balik, Daniel De Backer, Stephen Huang, Sam Orde, Antoine Vieillard-Baron, Philippe Vignon, Armand Mekontso-Dessap, Paul H. Mayo, Iwan C. C. van der Horst, Filippo Sanfilippo, MUMC+: MA Intensive Care (3), Intensive Care, MUMC+: MA Medische Staf IC (9), RS: Carim - V04 Surgical intervention, Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), European Society of Intensive Care Medicine, ESICM, and PRICES was endorsed and supported by the European Society of Intensive Care Medicine.
- Subjects
medicine.medical_specialty ,Consensus ,systolic function ,Critical Care ,left ventricle ,[SDV]Life Sciences [q-bio] ,VENTRICULAR DIASTOLIC FUNCTION ,Fluid management ,right ventricle ,Critical Care and Intensive Care Medicine ,RECOMMENDATIONS ,03 medical and health sciences ,0302 clinical medicine ,Diastole ,Anesthesiology ,medicine ,fluid responsiveness ,Humans ,Medical physics ,Critical index ,health care economics and organizations ,Statement (computer science) ,Ventricular function ,business.industry ,MORTALITY ,diastolic function ,Expert consensus ,030208 emergency & critical care medicine ,Heart ,DYSFUNCTION ,Checklist ,3. Good health ,SEPTIC PATIENTS ,030228 respiratory system ,Echocardiography ,Research studies ,business - Abstract
Purpose: Echocardiography is a common tool for cardiac and hemodynamic assessments in critical care research. However, interpretation (and applications) of results and between-study comparisons are often difficult due to the lack of certain important details in the studies. PRICES (Preferred Reporting Items for Critical care Echocardiography Studies) is a project endorsed by the European Society of Intensive Care Medicine and conducted by the Echocardiography Working Group, aiming at producing recommendations for standardized reporting of critical care echocardiography (CCE) research studies.Methods: The PRICE panel identified lists of clinical and echocardiographic parameters (the "items") deemed important in four main areas of CCE research: left ventricular systolic and diastolic functions, right ventricular function and fluid management. Each item was graded using a critical index (CI) that combined the relative importance of each item and the fraction of studies that did not report it, also taking experts' opinion into account.Results: A list of items in each area that deemed essential for the proper interpretation and application of research results is recommended. Additional items which aid interpretation were also proposed.Conclusion: The PRICES recommendations reported in this document, as a checklist, represent an international consensus of experts as to which parameters and information should be included in the design of echocardiography research studies. PRICES recommendations provide guidance to scientists in the field of CCE with the objective of providing a recommended framework for reporting of CCE methodology and results.
- Published
- 2020
26. Basic echocardiography competence program in intensive care units: A multinational survey of intensive care units accredited by the College of Intensive Care Medicine
- Author
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Kollengode Ramanathan, Wai Tat Wong, Jinal Parmar, Moushumi Salvi, Anthony S. McLean, Kerrianne Ngoc Bich Ha Huynh, Johnson Chi Wa Ng, Arvind Rajamani, Stephen Huang, Sebastian Knudsen, Iris Ting, and New Zealand
- Subjects
medicine.medical_specialty ,Critical Care ,Intensivist ,Critical Care and Intensive Care Medicine ,law.invention ,Formative assessment ,03 medical and health sciences ,0302 clinical medicine ,law ,Intensive care ,Surveys and Questionnaires ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Competence (human resources) ,Singapore ,business.industry ,Australia ,Questionnaire ,030208 emergency & critical care medicine ,Intensive care unit ,Intensive Care Units ,Anesthesiology and Pain Medicine ,Summative assessment ,Echocardiography ,Clinical Competence ,business ,Logbook ,New Zealand - Abstract
In 2014, basic critical care echocardiography (BCCE) competence became a mandatory requirement for trainees registered with the College of Intensive Care Medicine (CICM). To determine the proportion of CICM intensive care units (ICUs) that conduct a BCCE competence program and to learn about the barriers/challenges and successful strategies, we conducted a survey of intensivists working in ICUs accredited by CICM for basic/advanced training in Australia, New Zealand, Hong Kong, Singapore, Ireland and India. Following consultations with content experts and a trial phase to improve clarity and minimise ambiguity, an 11-point questionnaire survey was sent to one intensivist from every CICM-accredited ICU by several methods. Participation was voluntary. Consent was implied. No incentives were offered. Results are reported as numbers and percentages. Of the 104 ICUs surveyed, 99 (95.1%) responded, with 75 (75.8%) having no BCCE teaching whatsoever. In the remaining 24 (24.2%) ICUs, the teaching process was widely variable. Only 5/99 (5.1%) ICUs provided a structured BCCE competence program through which trainees performed and archived BCCE scans, maintained a logbook and underwent formative and summative assessments for credentialling. Six more ICUs provided formative assessment but relied on external bodies for competence assessment. Overall, 20/99 (20.2%) ICUs allowed trainees to perform unsupervised scans for clinical management, even if they were not BCCE competent. Nineteen intensivists perceived management errors due to misinterpretation of echocardiographic findings. Very few CICM-accredited ICUs offer a structured BCCE competence program. To fulfil the objective of universal BCCE competence, potential solutions are presented.
- Published
- 2020
27. Pathway mapping of leukocyte transcriptome in influenza patients reveals distinct pathogenic mechanisms associated with progression to severe infection
- Author
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Marek Nalos, Benjamin Tang, Maryam Shojaei, T. Blake Ball, Aseem Kumar, John Ho, Anthony S. McLean, Adrienne F. A. Meyers, Amarnath Pisipati, Yoav Keynan, Klaus Schughart, Anand Kumar, Emily K. Jenkins, Yoann Zerbib, University of Manitoba, and HZI,Helmholtz-Zentrum für Infektionsforschung GmbH, Inhoffenstr. 7,38124 Braunschweig, Germany.
- Subjects
Adult ,Male ,lcsh:Internal medicine ,lcsh:QH426-470 ,Neutrophils ,T cell ,Disease ,macromolecular substances ,Severity of Illness Index ,Transcriptome ,Immune system ,Downregulation and upregulation ,Neutrophil differentiation ,Influenza, Human ,Genetics ,Leukocytes ,Medicine ,Humans ,lcsh:RC31-1245 ,Genetics (clinical) ,Aged ,business.industry ,musculoskeletal, neural, and ocular physiology ,Neutrophil extracellular traps ,Middle Aged ,Influenza ,lcsh:Genetics ,medicine.anatomical_structure ,Gene Expression Regulation ,nervous system ,Immunology ,Female ,business ,Neutrophil extracellular trap ,CD8 ,Research Article - Abstract
Background Influenza infections produce a spectrum of disease severity, ranging from a mild respiratory illness to respiratory failure and death. The host-response pathways associated with the progression to severe influenza disease are not well understood. Methods To gain insight into the disease mechanisms associated with progression to severe infection, we analyzed the leukocyte transcriptome in severe and moderate influenza patients and healthy control subjects. Pathway analysis on differentially expressed genes was performed using a topology-based pathway analysis tool that takes into account the interaction between multiple cellular pathways. The pathway profiles between moderate and severe influenza were then compared to delineate the biological mechanisms underpinning the progression from moderate to severe influenza. Results 107 patients (44 severe and 63 moderate influenza patients) and 52 healthy control subjects were included in the study. Severe influenza was associated with upregulation in several neutrophil-related pathways, including pathways involved in neutrophil differentiation, migration, degranulation and neutrophil extracellular trap (NET) formation. The degree of upregulation in neutrophil-related pathways were significantly higher in severely infected patients compared to moderately infected patients. Severe influenza was also associated with downregulation in immune response pathways, including pathways involved in antigen presentation such as CD4+ T-cell co-stimulation, CD8+ T cell and Natural Killer (NK) cells effector functions. Apoptosis pathways were also downregulated in severe influenza patients compare to moderate and healthy controls. Conclusions These findings showed that there are changes in gene expression profile that may highlight distinct pathogenic mechanisms associated with progression from moderate to severe influenza infection.
- Published
- 2020
28. Accreditation in advanced critical care echocardiography
- Author
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Anthony S. McLean
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,Medical physics ,business ,Accreditation - Abstract
The development of smaller, mobile, sophisticated ultrasound machines has been central to echocardiography becoming an everyday tool in the intensive care setting. However, the parallel process of ensuring quality studies are obtained from these machines places a focus on training standards for the doctors operating them. In response, credentialing and certification programmes in advanced critical care echocardiography have come into existence around the world, and although they are not identical, the programmes share many of the same features whether it is run in France, Scotland, Australia, the United States, or elsewhere. The challenge of determining the optimum training programme is an ongoing process and will no doubt evolve further over time. Yet the development of the programmes to date demonstrate how far critical care physicians have come over the past two decades in achieving quality care in the use of echocardiography.
- Published
- 2020
29. Echocardiography in a patient with chest pain—an integrated approach
- Author
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Anthony S. McLean
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Radiology ,medicine.symptom ,Integrated approach ,Chest pain ,business - Abstract
Investigating the cause of chest pain relies much upon history, and in particular a clear description of the nature of the pain itself. An intubated ventilated patient is usually unable to provide a precise description of chest pain and the physician depends more on ancillary aids including a chest X-ray and electrocardiogram (ECG). Echocardiography can add vital information in a rapid and non-invasive manner, either contributing directly to the diagnosis or else directing the physician to the most appropriate investigation for which the patient requires transfer beyond the intensive care unit. Underlying coronary artery lesions leading to myocardial ischaemia, pericardial pathology, and thoracic aorta anomalies usually require prompt attention but other conditions including pathologies of the lung, oesophagus, and chest wall may also be identified.
- Published
- 2020
30. LV Diastolic Function and PAOP
- Author
-
Anthony S. McLean
- Subjects
medicine.medical_specialty ,Icu patients ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Diastolic function ,Pulmonary wedge pressure ,business - Abstract
Diastolic function and PAOP measurements are hard to assess in ICU patients because many factors affect all used variables to assess this function and this pressure.
- Published
- 2020
31. A novel sampling method to detect airborne influenza and other respiratory viruses in mechanically ventilated patients: a feasibility study
- Author
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Anthony S. McLean, Marek Nalos, Maryam Shojaei, Benjamin Tang, Lachlan S. Barnes, Alicia B. Mitchell, and Brian G. Oliver
- Subjects
0301 basic medicine ,Opportunistic infection ,medicine.medical_treatment ,viruses ,030106 microbiology ,Critical Care and Intensive Care Medicine ,medicine.disease_cause ,Virus ,03 medical and health sciences ,Human metapneumovirus ,medicine ,Influenza A virus ,Intensive care unit ,Respiratory system ,Ventilator ,Mechanical ventilation ,biology ,business.industry ,Research ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,lcsh:RC86-88.9 ,biology.organism_classification ,medicine.disease ,Virology ,Influenza ,Airborne ,Sample collection ,Rhinovirus ,business - Abstract
Background Respiratory viruses circulate constantly in the ambient air. The risk of opportunistic infection from these viruses can be increased in mechanically ventilated patients. The present study evaluates the feasibility of detecting airborne respiratory viruses in mechanically ventilated patients using a novel sample collection method involving ventilator filters. Methods We collected inspiratory and expiratory filters from the ventilator circuits of mechanically ventilated patients in an intensive care unit over a 14-month period. To evaluate whether we could detect respiratory viruses collected in these filters, we performed a reverse transcription polymerase chain reaction on the extracted filter membrane with primers specific for rhinovirus, respiratory syncytial virus, influenza virus A and B, parainfluenza virus (type 1, 2 and 3) and human metapneumovirus. For each patient, we also performed a full virology screen (virus particles, antibody titres and virus-induced biomarkers) on respiratory samples (nasopharyngeal swab, tracheal aspirate or bronchoalveolar fluid) and blood samples. Results Respiratory viruses were detected in the ventilator filters of nearly half the patients in the study cohort (n = 33/70). The most common virus detected was influenza A virus (n = 29). There were more viruses detected in the inspiratory filters (n = 18) than in the expiratory filters (n = 15). A third of the patients with a positive virus detection in the ventilator filters had a hospital laboratory confirmed viral infection. In the remaining cases, the detected viruses were different from viruses already identified in the same patient, suggesting that these additional viruses come from the ambient air or from cross-contamination (staff or visitors). In patients in whom new viruses were detected in the ventilator filters, there was no evidence of clinical signs of an active viral infection. Additionally, the levels of virus-induced biomarker in these patients were not statistically different from those of non-infected patients (p = 0.33). Conclusions Respiratory viruses were present within the ventilator circuits of patients receiving mechanical ventilation. Although no adverse clinical effect was evident in these patients, further studies are warranted, given the small sample size of the study and the recognition that ventilated patients are potentially susceptible to opportunistic infection from airborne respiratory viruses. Electronic supplementary material The online version of this article (10.1186/s13613-018-0396-4) contains supplementary material, which is available to authorized users.
- Published
- 2018
32. Paradoxical septal motion: A diagnostic approach and clinical relevance
- Author
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Michel Slama, David J. Clancy, Anthony S. McLean, and Sam Orde
- Subjects
congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Radiological and Ultrasound Technology ,Cardiac pacing ,business.industry ,Left bundle branch block ,Review Article ,030204 cardiovascular system & hematology ,medicine.disease ,Pulmonary hypertension ,Motion (physics) ,Cardiac surgery ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,030228 respiratory system ,Form and function ,Internal medicine ,Cardiology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Clinical significance ,cardiovascular diseases ,business - Abstract
Abnormal septal motion (commonly referred to as septal bounce) is a common echocardiographic finding that occurs with several conditions, including the following: mitral stenosis, left bundle branch block, pericardial syndromes and severe pulmonary hypertension. We explore the subtle changes that occur on M-mode imaging of the septum, other associated echocardiographic features, the impact of inspiratory effort on septal motion and relevant clinical findings. Finally, we discuss the impact of abnormal septal motion on cardiac form and function, proposing there is a clinically significant impact on biventricular filling and ejection.
- Published
- 2018
33. Association of Positive Fluid Balance and Mortality in Sepsis and Septic Shock in An Australian Cohort
- Author
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Anthony S. McLean, M G Pittard, Stephen Huang, and Sam Orde
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Severity of illness ,medicine ,Humans ,Hospital Mortality ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Mechanical ventilation ,business.industry ,Septic shock ,030208 emergency & critical care medicine ,Retrospective cohort study ,Middle Aged ,Water-Electrolyte Balance ,medicine.disease ,Shock, Septic ,Confidence interval ,Anesthesiology and Pain Medicine ,Cohort ,Emergency medicine ,Female ,Observational study ,business - Abstract
In patients with septic shock, a correlation between positive fluid balance and worsened outcomes has been reported in multiple observational studies worldwide. No published data exists in an Australasian cohort. We set out to explore this association in our institution. We conducted a retrospective audit of patient records from August 2012 to May 2015 in a single-centre, 24-bed surgical and medical intensive care unit (ICU) in Sydney, Australia. All patients with septic shock were included. Exclusion criteria included length of stay less than 24 hours or vasopressors needed for less than six hours. Data was gathered on fluid balance for the first seven days of ICU admission, biochemical data and other clinical indices. The primary outcome measure was survival to hospital discharge. One hundred and eighty-six patients with septic shock were included, with an overall hospital mortality of 23.7%. Seventy-five percent of patients required mechanical ventilation, and 27.4% required haemodialysis. The mean daily fluid balance on the first day of admission was positive 1,424 ml and 1,394 ml for ICU and hospital survivors, respectively. On average, the daily fluid balance for non-survivors was higher than the survivors: ICU non-survivors were 602 (95% confidence intervals 230, 974) ml (P=0.0015) and hospital non-survivors were 530 [95% confidence intervals 197, 863] ml (P=0.0017) higher than the survivors. In line with other recently published data, after adjustment for confounders (severity of illness based on the Acute Physiology and Chronic Health Evaluation score) we found a correlation between positive fluid balance and worsened hospital mortality in critically ill patients with sepsis and septic shock. Further research investigating rational use of fluids in this patient group is needed.
- Published
- 2017
34. Surviving Sepsis Campaign
- Author
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Thiago Lisboa, Lisa Shieh, Khalid A. Shukri, Craig French, Jorge Hidalgo, Andrew Rhodes, Dilip R. Karnad, Daniel De Backer, B. Taylor Thompson, Derek C. Angus, Thomas Van der Poll, Anthony S. McLean, Mark E. Nunnally, Jean Daniel Chiche, Ruth M. Kleinpell, Charles L. Sprung, Anand Kumar, John E. Mazuski, Sangeeta Mehta, Waleed Alhazzani, Laura Evans, Steven Q. Simpson, Christa A. Schorr, John J. Marini, Maureen A. Seckel, Alan E. Jones, Craig M. Coopersmith, Janice L. Zimmerman, Paolo Navalesi, John Myburgh, Gordon R. Bernard, Bram Rochwerg, Sean R. Townsend, Marco Ranieri, Christopher W. Seymour, Tiffany M. Osborn, Jean Louis Vincent, Herwig Gerlach, W. Joost Wiersinga, Gordon D. Rubenfeld, Anders Perner, Flávia Ribeiro Machado, Mitchell M. Levy, Lauralyn McIntyre, Steven M. Hollenberg, Richard Beale, Younsuck Koh, Djillali Annane, Rui Moreno, Geoffrey J. Bellinghan, Colleen M. Plunkett, John C. Marshall, Osamu Nishida, Jonathan E. Sevransky, Ricard Ferrer, Massimo Antonelli, Seitaro Fujishima, R. Phillip Dellinger, and Mervyn Singer
- Subjects
medicine.medical_specialty ,Surviving Sepsis Campaign ,business.industry ,Septic shock ,health care facilities, manpower, and services ,education ,Sepsis syndrome ,030208 emergency & critical care medicine ,Critical Care and Intensive Care Medicine ,medicine.disease ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Fluid therapy ,medicine ,030212 general & internal medicine ,Intensive care medicine ,business ,health care economics and organizations - Abstract
Objective:To provide an update to “Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012.”Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for
- Published
- 2017
35. The Association of Premorbid Metformin Exposure With Mortality and Organ Dysfunction in Sepsis: A Systematic Review and Meta-Analysis
- Author
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Benjamin Tang, Stephen Huang, Marek Nalos, Kaiquan Tan, Anthony S. McLean, and Andrew Simpson
- Subjects
medicine.medical_specialty ,business.industry ,Organ dysfunction ,metformin-associated lactic acidosis ,MEDLINE ,organ dysfunction ,General Medicine ,Odds ratio ,Review Article ,medicine.disease ,mortality ,Metformin ,Sepsis ,sepsis ,systematic review ,Meta-analysis ,Internal medicine ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Medicine ,Hyperlactatemia ,Observational study ,medicine.symptom ,business ,metformin ,medicine.drug - Abstract
Supplemental Digital Content is available in the text., Objectives: To examine the association between premorbid metformin exposure and mortality, hyperlactatemia, and organ dysfunction in sepsis. Data Sources: PubMed and EMBASE (with Medline via Ovid) databases were searched for all studies of premorbid metformin exposure and sepsis published between January 1974 and August 2018. Study Selection: Studies of at least 20 patients with sepsis that reported data on metformin use, mortality, and/or organ dysfunction were independently selected. Data Extraction: Two reviewers abstracted data on study design, settings, study quality, participants, metformin exposure, mortality, initial lactate levels, and organ dysfunction. Risk of bias was independently assessed. Data Synthesis: Eight observational studies fulfilled our criteria, comprising 4,144 patients with sepsis including 562 diabetics on metformin. Premorbid metformin exposure was associated with reduced mortality in sepsis (odds ratio, 0.57; 95% CI, 0.40–0.80). Between studies heterogeneity was low (i2 = 43%; τ2 = 0.1; p = 0.09). Premorbid metformin exposure was not significantly associated with initial lactate levels (mean difference, 0.39 [–0.50 to 1.28]; i2 = 72%; p = 0.39). Conclusions: The meta-analysis suggests that premorbid metformin exposure is associated with decreased mortality in sepsis but not with hyperlactatemia. What are the potential mechanisms and whether there is any effect on organ dysfunction remain unclear.
- Published
- 2019
36. Editorial: Haemodynamic monitoring: the why, when, which and what
- Author
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Anthony S, McLean
- Subjects
Hemodynamic Monitoring ,Hemodynamics ,Humans ,Monitoring, Physiologic - Published
- 2019
37. From Influenza-Induced Acute Lung Injury to Multiorgan Failure
- Author
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Benjamin Tang, T. Cootes, and Anthony S. McLean
- Subjects
medicine.medical_specialty ,education.field_of_study ,business.industry ,Population ,Respiratory infection ,Lung injury ,Influenza pandemic ,Multiorgan failure ,High morbidity ,Emergency medicine ,Pandemic ,Medicine ,business ,education - Abstract
Influenza viruses are among the most common causes of human respiratory infection, causing high morbidity and mortality. In the United States, influenza results in approximately 200,000 hospitalizations and 36,000 deaths during a seasonal epidemic [1]. During a pandemic, up to 50% of the population can be infected by influenza, increasing the number of deaths [2]. In 1918, the worst influenza pandemic recorded in history caused up to 50 million deaths worldwide, with elderly, infants, and people with underlying illness having the highest risk of fatality [3].
- Published
- 2019
38. Subcostal TAPSE: a retrospective analysis of a novel right ventricle function assessment method from the subcostal position in patients with sepsis
- Author
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Sam Orde, Anthony S. McLean, Andrew J. Inglis, Rachel Braham, Daniel Campbell, and Alison B. Main
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,Poor prognosis ,Adverse outcomes ,lcsh:R895-920 ,Apical four chamber ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Retrospective analysis ,Radiology, Nuclear Medicine and imaging ,In patient ,Subcostal ,Radiological and Ultrasound Technology ,business.industry ,Critically ill ,030208 emergency & critical care medicine ,medicine.disease ,Tricuspid annular plane systolic excursion ,medicine.anatomical_structure ,030228 respiratory system ,Ventricle ,Assessment methods ,Cardiology ,Right ventricle ,Original Article ,business - Abstract
Background Tricuspid annular plane systolic excursion (TAPSE) is frequently used as an objective measure of right-ventricular dysfunction. Abnormal TAPSE values are associated with poor prognosis in a number of disease states; however, the measure is not always easy to obtain in the critically ill. The purpose of this study is to assess the feasibility and accuracy of using a subcostal view and TAPSE measurement as a measure of right-ventricular dysfunction. A secondary aim was to perform a pilot study to assess whether right-ventricular dysfunction was associated with adverse outcomes including mortality. Results Subcostal TAPSE corresponds well with TAPSE obtained from the apical window at low and moderate TAPSE values (mean difference 1.2 mm (CI 0.04–2.36; 100% data pairs
- Published
- 2018
39. Understanding the role of host response in influenza pneumonitis
- Author
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Benjamin Tang, Anthony S. McLean, and Carl G. Feng
- Subjects
medicine.medical_specialty ,Pain medicine ,Health Status ,T-Lymphocytes ,Pneumonia, Viral ,MEDLINE ,Host response ,Critical Care and Intensive Care Medicine ,Immunity ,Anesthesiology ,Neoplasms ,Influenza, Human ,Macrophages, Alveolar ,medicine ,Animals ,Humans ,Intensive care medicine ,Viral immunology ,Pneumonitis ,business.industry ,Age Factors ,medicine.disease ,Immunity, Innate ,Pneumonia ,Host-Pathogen Interactions ,Inflammation Mediators ,business - Published
- 2018
40. Reassessment of the Accuracy of Cardiac Doppler Pulmonary Artery Pressure Measurements in Ventilated ICU Patients: A Simultaneous Doppler-Catheterization Study
- Author
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Loay Kontar, Julien Maizel, Stephen Huang, Pablo Mercado, Christophe Beyls, Anthony S. McLean, Christophe Tribouilloy, Michel Slama, and Sam Orde
- Subjects
Male ,medicine.medical_specialty ,Central Venous Pressure ,Systole ,medicine.medical_treatment ,Hypertension, Pulmonary ,Diastole ,Blood Pressure ,Regurgitation (circulation) ,Doppler echocardiography ,Pulmonary Artery ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,medicine ,Humans ,Prospective Studies ,Mechanical ventilation ,medicine.diagnostic_test ,business.industry ,Central venous pressure ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Respiration, Artificial ,Echocardiography, Doppler ,Tricuspid Valve Insufficiency ,Intensive Care Units ,030228 respiratory system ,Pulmonary artery ,Cardiology ,Female ,Isovolumic relaxation time ,business ,Blood Flow Velocity - Abstract
Objectives Doppler echocardiography is a well-recognized technique for the noninvasive evaluation of pulmonary artery pressure; however, little information is available concerning patients receiving mechanical ventilation. Furthermore, recent studies have debatable results regarding the relevance of this technique to assess pulmonary artery pressure. The aim of our study was to reassess the accuracy of Doppler echocardiography to evaluate pulmonary artery pressure and to predict pulmonary hypertension. Design Prospective observational study. Setting Amiens ICU, France. Patients ICU patients receiving mechanical ventilation. Interventions In 40 patients, we simultaneously recorded Doppler echocardiography variables (including tricuspid regurgitation and pulmonary regurgitation) and invasive central venous pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, and mean pulmonary artery pressure. Measurements and main results Systolic pulmonary artery pressure assessed from the tricuspid regurgitation derived maximal pressure gradient added to the central venous pressure demonstrated the best correlation with the invasive systolic pulmonary artery pressure (r = 0.87) with a small bias (-3 mm Hg) and a precision of 9 mm Hg. A Doppler echocardiography systolic pulmonary artery pressure greater than 39 mm Hg predicted pulmonary hypertension (mean pulmonary artery pressure ≥ 25 mm Hg) with 100% sensitivity and specificity. Tricuspid regurgitation maximal velocity greater than 2.82 m/s as well as tricuspid regurgitation pressure gradient greater than 32 mm Hg predicted the presence of pulmonary hypertension. Pulmonary regurgitation was recorded in 10 patients (25%). No correlation was found between pulmonary regurgitation velocities and either mean pulmonary artery pressure or diastolic pulmonary artery pressure. Pulmonary acceleration time less than 57 ms and isovolumic relaxation time less than 40 ms respectively predicted pulmonary hypertension 100% of the time and had a 100% negative predictive value. Conclusions Tricuspid regurgitation maximal velocity pressure gradient added to invasive central venous pressure accurately estimates systolic pulmonary artery pressure and mean pulmonary artery pressure in ICU patients receiving mechanical ventilation and may predict pulmonary hypertension.
- Published
- 2018
41. Part II – Critical Care Ultrasound
- Author
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Anthony S. McLean
- Subjects
medicine.medical_specialty ,Opinion ,Radiological and Ultrasound Technology ,business.industry ,Ultrasound ,Medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,business - Published
- 2015
42. Deliberate practice model effectively directs student learning in the critical care rotation: The impact of assessment on medical student learning
- Author
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Louise Cole, Sarah Whereat, Stuart Lane, Anthony S. McLean, Graham D. Hendry, and Tim Suharto
- Subjects
Medical education ,education ,Student learning ,Psychology ,Rotation (mathematics) - Abstract
This article was migrated. The article was not marked as recommended. Introduction: AustralianResidents (Junior Doctors) identified their clinical experience for acute clinical episodes as insufficient. Absence of clinical assessments during their critical care experience, within their medical degree, was thought to be a reason. The 'deliberate practice' model was used to explore medical student learning, during the Critical Care Medicine Rotation (CCMR) at Sydney Medical School, Nepean. Method: The interpretative-constructive theoretical study utilized theory, practical (simulation/clinical) standardized assessments and focus groups. Focus group questions directed student exploration of their learning during the rotation, and use of an assessment of basic airway management skills. The mixed method study design was conducted over 18 months (Jan 2014-May 2015), 96% (46) of possible cohort (27 male,19 female) enrolled during their clinical years. The 'Biggs' Model of 'knowledge' was used to understand student declarative, procedural and conditional knowledge. Results: Analysis of pre/post declarative knowledge n=37(80%) demonstrated a significant p value < 0.00001. From within the total cohort, n=12(26%) students were assessed for both procedural and conditional knowledge. This change was not significant at p ≤ 0.05. In this complex clinical environment, knowledge did not automatically translate directly into practical skill attainment. Students (focus groups n=36(78%))identified the model of 'deliberate practice' effective, indicated a desire for more simulations and clinical experience, clear faculty direction for required learning activities and valued peer support. Discussion: Application of 'deliberate practice' model in the CCMR was effective. The pre-and-post assessments provided students the knowledge their own skill level and was effective in encouraging individual skill development. It highlighted a need to review other aspects of critical care clinical skills education. A follow up study, examining the role of peer/near peer assessment in this area has been conducted, with studies in different complex clinical environments, examining workplace learning contrasted with simulation, in post graduate trainees, a new area of research.
- Published
- 2020
43. Correction to: The association between premorbid beta blocker exposure and mortality in sepsis—a systematic review
- Author
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Kaiquan Tan, Anthony S. McLean, Martin Harazim, Benjamin Tang, and Marek Nalos
- Subjects
medicine.medical_specialty ,medicine.drug_class ,business.industry ,Published Erratum ,MEDLINE ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,Critical Care and Intensive Care Medicine ,medicine.disease ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,business ,Beta blocker - Abstract
In the publication of this article [1], there was an error in the cited reference 23 [2] within the Family Name. This has now been updated in the original article.
- Published
- 2020
44. Pre-eclampsia and long-term cardiac dysfunction: A review of asymptomatic cardiac changes existing well beyond the post-partum period
- Author
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Sandra Lowe, Anthony S. McLean, Joanne M Said, Yang Yang, and Archana S Thayaparan
- Subjects
Cardiac function curve ,medicine.medical_specialty ,Eclampsia ,Radiological and Ultrasound Technology ,Heart disease ,business.industry ,Cardiomyopathy ,Diastole ,Concentric hypertrophy ,Review Article ,medicine.disease ,Asymptomatic ,female genital diseases and pregnancy complications ,Heart failure ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,medicine.symptom ,business ,reproductive and urinary physiology - Abstract
BACKGROUND: Pre‐eclampsia is a disease of pregnancy characterised by the manifestations of multi‐organ dysfunction. The recent use of transthoracic echocardiography in the assessment of women with pre‐eclampsia has allowed the detection of cardiac systolic and diastolic dysfunction in the acute phase. Women with a history of pre‐eclampsia also have increased lifelong risks of cardiovascular disease and mortality that persists well beyond the post‐partum period. These developments raise the possibility that pre‐eclampsia may be an early marker of cardiovascular disease and the potential role for echocardiography in guiding the detection and management of this. This review aims to summarise the existing evidence of echocardiographic cardiac assessment of women with a history of pre‐eclampsia performed more than 12 weeks post‐partum. METHODS: A systematic search of PubMed and OVID EMBASE databases was performed to identify studies featuring assessment of cardiac function performed after 12 weeks post‐partum in women with a history of pre‐eclampsia. Studies without post‐partum cardiac assessment or with other documented causes for cardiomyopathy were excluded. RESULTS: Thirteen studies were identified that measured cardiac function by transthoracic echocardiography between 6 months and 18 years following a pregnancy complicated by pre‐eclampsia. Common findings across the studies were of increased diastolic dysfunction, increased left ventricular mass index (LVMI) and concentric hypertrophy in women with a history of pre‐eclampsia, as compared to women with uncomplicated pregnancy histories. This was predominantly seen in those with a history of early or preterm pre‐eclampsia. CONCLUSIONS: Women with a history of early or preterm pre‐eclampsia have an increased prevalence of diastolic dysfunction. This review demonstrates that the cardiac dysfunction associated with previous pre‐eclampsia is quantifiable and persistent. Progression of heart failure from asymptomatic to symptomatic stages carries a fivefold increase in mortality. The use of echocardiography could detect cardiac dysfunction in the asymptomatic stage and guide more intensive risk factor modification in these women.
- Published
- 2018
45. Feasibility of biventricular 3D transthoracic echocardiography in the critically ill and comparison with conventional parameters
- Author
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Nicola Stanley, Stephen Huang, Michel Slama, Anthony S. McLean, and Sam Orde
- Subjects
Male ,Critical Illness ,Echocardiography, Three-Dimensional ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Biplane ,law.invention ,Cohort Studies ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,law ,medicine ,Humans ,Critically ill ,Aged ,Monitoring, Physiologic ,medicine.diagnostic_test ,business.industry ,Research ,Australia ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Reproducibility of Results ,030208 emergency & critical care medicine ,Magnetic resonance imaging ,Atrial fibrillation ,lcsh:RC86-88.9 ,Stroke volume ,Middle Aged ,Weights and Measures ,medicine.disease ,Intensive care unit ,Echocardiography ,ICU ,Ventilation (architecture) ,symbols ,Female ,Nuclear medicine ,business ,Doppler effect ,Perfusion ,3D - Abstract
Background Transthoracic 3D cardiac analysis is enticing in its potential simplicity and wealth of data available. It has been suggested to be accurate vs magnetic resonance imaging in relatively stable patients, but feasibility and agreement with conventional echocardiographic assessment of stroke volume (SV) have not been thoroughly assessed in critically ill patients, who are traditionally harder to image. The objectives of this study were to compare 3D transthoracic volumetric analysis vs Doppler assessment of SV (which is suggested to be accurate in the critically ill) and Simpson’s biplane assessment in a cohort typical of the intensive care unit (ICU), where accurate assessment is important: mechanically ventilated patients with a significant ventilation/perfusion (V/Q) mismatch. We hypothesised that it would be feasible but might lack agreement. Methods Patients were imaged within 24 hours of admission. Inclusion criteria were adult patients, V/Q mismatch present (defined as a ratio of arterial oxygen partial pressure to fractional inspired oxygen
- Published
- 2018
46. Moderate and Severe Acute Respiratory Distress Syndrome: Hemodynamic and Cardiac Effects of an Open Lung Strategy With Recruitment Maneuver Analyzed Using Echocardiography
- Author
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Michel Slama, Pablo Mercado, Anthony S. McLean, Marek Nalos, Sam Orde, Loay Kontar, Stephen Huang, and Julien Maizel
- Subjects
Male ,medicine.medical_specialty ,Hemodynamics ,Acute respiratory distress ,Critical Care and Intensive Care Medicine ,Cardiac dysfunction ,Positive-Pressure Respiration ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Recruitment maneuver ,Internal medicine ,Outcome Assessment, Health Care ,Tidal Volume ,Medicine ,Humans ,Lung ventilation ,Aged ,Respiratory Distress Syndrome ,Lung ,Airway pressures ,business.industry ,030208 emergency & critical care medicine ,Limiting ,respiratory system ,Middle Aged ,medicine.anatomical_structure ,Cardiology ,Respiratory Mechanics ,Female ,France ,business ,Echocardiography, Transesophageal - Abstract
Open lung ventilation with a recruitment maneuver could be beneficial for acute respiratory distress syndrome patients. However, the increased airway pressures resulting from the recruitment maneuver may induce cardiac dysfunction, limiting the benefit of this maneuver. We analyzed the effect of a recruitment maneuver and decremental positive end-expiratory pressure titration on cardiac function.Medical ICU Amiens, France.Twenty patients with moderate to severe acute respiratory distress syndrome INTERVENTIONS:: Patients underwent a stepwise recruitment maneuver with respiratory evaluation and echocardiography assessment of cardiac function including longitudinal strain at baseline, peak positive end-expiratory pressure of recruitment maneuver (positive end-expiratory pressure 40 cm H2O), and at "optimal" positive end-expiratory pressure. The patients were divided into two groups based on change on the PaO2/FIO2 ratio (nonresponders50%; responders ≥ 50%).At peak positive end-expiratory pressure during the recruitment maneuver, the arterial pressure, cardiac output, left ventricular size decreased and right ventricular size increased. The left ventricular ejection fraction decreased from 60% ± 13% to 48% ± 18% (p = 0.05). Both left and right ventricular global longitudinal strain were impaired (-15.8% ± 4.5% to -11% ± 4.7% and -19% ± 5% to -14% ± 6% [p = 0.05] respectively). Fifty percent of patients were nonresponders and demonstrated a lower hemodynamic tolerance to the recruitment maneuver than responders. Optimal positive end-expiratory pressure was 14 ± 5 cm H2O (vs 11 ± 4 cm H2O at baseline), and PaO2/FIO2 ratio increased from 111 ± 25 to 197 ± 89 mm Hg (p0.0001). All hemodynamic variables returned to their baseline value after the recruitment maneuver despite a higher positive end-expiratory pressure.An open lung strategy with a stepwise recruitment maneuver permitted a higher positive end-expiratory pressure and improved oxygenation without any cardiac impairment. The recruitment maneuver was associated with mild and transient, cardiac dysfunction, with nonresponders demonstrating poorer tolerance.
- Published
- 2018
47. The comparative effects of 3% saline and 0.5M sodium lactate on cardiac function:a randomised, crossover study in volunteers
- Author
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Marek, Nalos, Euguenia, Kholodniak, Louise, Smith, Sam, Orde, Iris, Ting, Michel, Slama, Ian, Seppelt, Anthony S, McLean, and Stephen, Huang
- Subjects
Saline Solution, Hypertonic ,Sodium Lactate ,Volunteers ,Cross-Over Studies ,Double-Blind Method ,Humans ,Heart ,Sodium Chloride - Abstract
To investigate the metabolic and cardiac effects of intravenous administration of two hypertonic solutions - 3% saline (SAL) and 0.5M sodium lactate (LAC).A randomised, doubleblind, crossover study in ten human volunteers. Intravenous bolus of either SAL or LAC at 3 mL/kg over 20 min followed by a 2 mL/kg infusion over 60 min.Acid base parameters and echocardiographic indices of cardiac function, cardiac output (CO), left ventricular ejection fraction (LVEF) and mitral annular peak systolic velocity (Sm) before and after infusion of SAL or LAC.Despite haemodilution, we observed an increase in sodium (139 ± 2 mmol/L to 142 ± 2 mmol/L in both groups) and respective anions, chloride (106 ± 2 mmol/L to 112 ± 3 mmol/L) and lactate (1.01 ± 0.28 mmol/L to 2.38 ± 0.38 mmol/L) with SAL and LAC, respectively. The pH (7.37 ± 0.03 to 7.45 ± 0.03; P0.01) and simplified strong ion difference (SID) (36.3 ± 4.6 mmol/L to 39.2 ± 3.6 mmol/L; P0.01) increased during the LAC infusion. The pH was unchanged, but SID decreased during SAL infusion (36.3 ± 2.5 mmol/L to 33.9 ± 3.1 mmol/L; P = 0.01). Both solutions led to an increase in preload and cardiac function, CO (4.36 ± 0.79 L/min to 4.98 ± 1.37 L/ min v 4.62 ± 1.30 L/min to 5.13 ± 1.44 L/min), LVEF (61 ± 6% to 63 ± 8% v 64 ± 6% to 68 ± 7%). The averaged Sm improved in the LAC group as compared with the SAL group (0.088 ± 0.008 to 0.096 ± 0.016 v 0.086 ± 0.012 to 0.082 ± 0.012; P = 0.032).The administration of SAL or LAC has opposing effects on acid base variables such as SID. Hypertonic fluid infusion lead to increased cardiac preload and performance with Sm, suggesting better left ventricular systolic function during LAC as compared with SAL. Lactated hypertonic solutions should be evaluated as resuscitation fluids.
- Published
- 2018
48. Post-partum catastrophic antiphospholipid syndrome presenting with shock and digital ischaemia – A diagnostic and management challenge
- Author
-
Stuart Lane, Anthony S. McLean, Ian Seppelt, Victoria Sadick, Eddy Fischer, and Anita Shetty
- Subjects
medicine.medical_specialty ,Ischemia ,Case Reports ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Critical Care Nursing ,Catastrophic antiphospholipid syndrome ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Antiphospholipid syndrome ,immune system diseases ,medicine ,Intensive care medicine ,skin and connective tissue diseases ,Post partum ,030203 arthritis & rheumatology ,Pregnancy ,business.industry ,medicine.disease ,Intensive care unit ,Thrombosis ,Shock (circulatory) ,medicine.symptom ,business - Abstract
Catastrophic antiphospholipid syndrome is a rare multisystem autoimmune condition characterised by rapid development of widespread thrombotic disease and subsequent multi-organ failure. It is the most severe complication of antiphospholipid syndrome, carrying significant morbidity and mortality. We report a patient with post-partum catastrophic antiphospholipid syndrome with cardiac, hepatic, renal and cutaneous manifestations. The diagnostic challenges in establishing a definitive diagnosis in catastrophic antiphospholipid syndrome is discussed, along with the difficulties in managing these patients in the intensive care unit.
- Published
- 2018
49. The use of echocardiographic indices in defining and assessing right ventricular systolic function in critical care research
- Author
-
Louise Smith, Stephen Huang, Arvind Rajamani, Marek Nalos, and Anthony S. McLean
- Subjects
medicine.medical_specialty ,Critical Care ,Ventricular Dysfunction, Right ,Systolic function ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Care setting ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Intensive care ,Medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Retrospective Studies ,business.industry ,Reproducibility of Results ,030208 emergency & critical care medicine ,Retrospective cohort study ,Stroke Volume ,Stroke volume ,Echocardiography ,Rv function ,Cardiology ,Ventricular Function, Right ,business - Abstract
Many echocardiographic indices (or methods) for assessing right ventricular (RV) function are available, but each has its strengths and limitations. In some cases, there might be discordance between the indices. We conducted a systematic review to audit the echocardiographic RV assessments in critical care research to see if a consistent pattern existed. We specifically looked into the kind and number of RV indices used, and how RV dysfunction was defined in each study. Studies conducted in critical care settings and reported echocardiographic RV function indices from 1997 to 2017 were searched systematically from three databases. Non-adult studies, case reports, reviews and secondary studies were excluded. These studies’ characteristics and RV indices reported were summarized. Out of 495 non-duplicated publications found, 81 studies were included in our systematic review. There has been an increasing trend of studying RV function by echocardiography since 2001, and most were conducted in ICU. Thirty-one studies use a single index, mostly TAPSE, to define RV dysfunction; 33 used composite indices and the combinations varied between studies. Seventeen studies did not define RV dysfunction. For those using composite indices, many did not explain their choices. TAPSE seemed to be the most popular index in the last 2–3 years. Many studies used combinations of indices but, apart from cor pulmonale, we could not find a consistent pattern of RV assessment and definition of RV dysfunction amongst these studies.
- Published
- 2018
50. Does this patient have takotsubo syndrome?
- Author
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Michelle S Chew, Michel Slama, and Anthony S. McLean
- Subjects
medicine.medical_specialty ,Takotsubo syndrome ,Chest Pain ,business.industry ,Pain medicine ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Coronary Angiography ,03 medical and health sciences ,0302 clinical medicine ,Echocardiography ,Takotsubo Cardiomyopathy ,Anesthesiology ,Emergency medicine ,medicine ,Prevalence ,Humans ,Female ,030212 general & internal medicine ,business - Published
- 2018
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