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Background Metabolic acidosis is a major complication of critical illness. However, its current epidemiology and its treatment with sodium bicarbonate given to correct metabolic acidosis in the ICU are poorly understood. Method This was an international retrospective observational study in 18 ICUs in Australia, Japan, and Taiwan. Adult patients were consecutively screened, and those with early metabolic acidosis (pH Results We screened 9437 patients. Of these, 1292 had early metabolic acidosis (14.0%). Early sodium bicarbonate was given to 18.0% (233/1292) of these patients. Dosing, physiological, and clinical outcome data were assessed in 360 patients. The median dose of sodium bicarbonate in the first 24 h was 110 mmol, which was not correlated with bodyweight or the severity of metabolic acidosis. Patients who received early sodium bicarbonate had higher APACHE III scores, lower pH, lower base excess, lower PaCO2, and a higher lactate and received higher doses of vasopressors. After adjusting for confounders, the early administration of sodium bicarbonate was associated with an adjusted odds ratio (aOR) of 0.85 (95% CI, 0.44 to 1.62) for ICU mortality. In patients with vasopressor dependency, early sodium bicarbonate was associated with higher mean arterial pressure at 6 h and an aOR of 0.52 (95% CI, 0.22 to 1.19) for ICU mortality. Conclusions Early metabolic acidosis is common in critically ill patients. Early sodium bicarbonate is administered by clinicians to more severely ill patients but without correction for weight or acidosis severity. Bicarbonate therapy in acidotic vasopressor-dependent patients may be beneficial and warrants further investigation.

Since Stenhouse (1975) called for teachers to have ownership of research, there have been initial forays into teacher led research and evidence-based practice in schools. However, the notion of translational research in schools remains contested, in significant part because it still has not been rigorously conceptualised. This is an issue of increasing concern, in our rapidly developing world. Now, more than ever, we need research-informed education, to address the complex challenges faced by school communities, and those with the most significant role in supporting them: teachers. To address the gap in understanding how best to promote translational research in schools, this systematic literature review asked, what do innovative and impactful translational, teacher research infrastructures look like? By translational research, we mean a process of agentic and agonistic democracy within which teachers critically develop and, or use research to support their classroom practice. The purpose and focus of this paper therefore, is to present the current extent and form of translational research practices in schools by undertaking a comprehensive, systematic review of the published literature on the issue. We found that the potential for translational research in education can be considerably enhanced when five key themes are taken into consideration, these being: Teacher-Researcher Collaboration; Teachers as Researchers; Research Cultures in Schools; Teacher Agency; Sharing, Accessing and Utilizing Research. The notion of technology - as a theme in its own right - was notable by its absence. From the findings we have been able to propose a foundational framework of translational research in schools. To date there have been no other systematic literature reviews on translational research in education, nor any frameworks proposed; and thus this paper addresses a significant gap in the field. peer-reviewed

In a shrinking, more connected world where we all face common challenges, such as those posed by economic recessions, mass migration or climate change, the acquisition of international skills and transversal competencies has become increasingly important (OECD, 2009; Facer, 2011; Clifford and Montgomery, 2011; Picardo, 2012). However, there is a paucity of research and tools that assist in the acquisition of such skills and competencies at secondary education level. This paper addresses this challenge, presenting the research findings and tangible outputs from an Erasmus+ funded KA2 project. These include a student survey to determine both the skills and values of students regarding international skills; a set of student courses to enable students to learn about international skills and competencies; a teacher toolkit for teaching international skills in secondary education and finally an overview of the research process that has informed the creation and development of these outputs.

Design and objectives To identify and compare how intensive care unit specialists in the United Kingdom and Australia and New Zealand self-reportedly define, assess and manage fluid overload in critically ill patients using a structured online questionnaire. Results We assessed 219 responses. Australia and New Zealand and United Kingdom intensive care unit specialists reported using clinical examination findings, bedside tools and radiological features to assess fluid status, diagnose fluid overload and initiate fluid removal in the critically ill. An elevated central venous pressure is not regarded as helpful in diagnosing fluid overload and targeting a clinician-set fluid balance is the most popular management strategy. Renal replacement therapy is used ahead of more diuretic therapy in patients who are oligo/anuric, or when diuretic therapy has not generated an adequate response. Conclusions This self-reported account of practice by United Kingdom and Australia and New Zealand intensivists demonstrates that fluid overload remains poorly defined with variability in both management and practice.

Purpose: The purpose of the study is to understand what clinicians believe defines fluid bolus therapy (FBT) and the expected response to such intervention. Methods: We asked intensive care specialists in 30 countries to participate in an electronic questionnaire of their practice, definition, and expectations of FBT. Results: We obtained 3138 responses. Despite much variation, more than 80% of respondents felt that more than 250 mL of either colloid or crystalloid fluid given over less than 30 minutes defined FBT, with crystalloids most acceptable. The most acceptable crystalloid and colloid for use as FBT were 0.9% saline and 4% albumin solution, respectively. Most respondents believed that one or more of the following physiological changes indicates a response to FBT: a mean arterial pressure increase greater than 10 mm Hg, a heart rate decrease greater than 10 beats per minute, an increase in urinary output by more than 10 mL/h, an increase in central venous oxygen saturation greater than 4%, or a lactate decrease greater than 1 mmol/L. Conclusions: Despite wide variability between individuals and countries, clear majority views emerged to describe practice, define FBT, and identify a response to it. Further investigation is now required to describe actual FBT practice and to identify the magnitude and duration of the physiological response to FBT and its relationship to patient-centered outcomes., Facultad de Ciencias Médicas

Introduction Assessment of fluid status in critically ill patients is challenging. We aimed to assess the feasibility and validity of bioelectrical impedance vector analysis (BIVA) as a measure of hydration in critically ill patients. Methods We performed twice-daily BIVA measurements and fluid balance calculations and recorded physiological variables in mechanically ventilated patients within 24 h of intensive care unit (ICU) admission for up to 5 days. Treating clinicians were blinded to BIVA results. Results We performed 344 BIVA measurements in 61 patients. According to BIVA, 14 patients (23 %) were dehydrated, 22 (36 %) were normally hydrated and 25 (41 %) were overhydrated upon ICU admission. Patients with normal BIVA hydration were less sick, had fewer comorbidities and had less deranged physiology than patients found to be dehydrated or overhydrated with BIVA. Cumulative fluid balance increased in patients found to be dehydrated with BIVA by a mean of 3.4±2.2 L, whereas in patients found to be overhydrated with BIVA, it decreased by a mean of 4.5±6.9 L. In patients found to be normally hydrated with BIVA, fluid balance remained unchanged. BIVA-defined hydration increased with 1 L (median change 1.5 %, P =0.09) or 2 L (median change 0.7 %, P =0.09) of calculated fluid gains. BIVA-defined hydration decreased (median change −0.8 %, P =0.02) with a negative cumulative fluid balance of >2 L. BIVA-defined hydration between first and last measurement correlated with the corresponding change in fluid balance (ρ =0.25, P =0.05). Conclusions BIVA is feasible in critically ill patients. Its validity is supported by the observed characteristics of patients with different degrees of BIVA hydration upon admission and by different fluid management of such patients by blinded clinicians. The sensitivity of repeated BIVA hydration measurements to detect fluid accumulation or fluid balance changes

The file attached to this record is the author's final peer reviewed version. The publisher's final version of record can be found by following the DOI link. Research alone does not inform practice, rather a process of knowledge translation is required to enable research findings to become meaningful for practitioners in their contextual settings. However, the translational process needs to be an iterative cycle so that the practice itself can be reflected upon and thereby inform the ongoing research agenda. This paper presents the initial findings of a study into an international, participatory model of knowledge mobilization in the context of translational research in the field of education. Using a mixed methods approach, the study draws upon data collected from the Education Futures Collaboration, an educational charity, which has developed an international knowledge mobilization strategy. Through the innovative use of technologies this initiative improves the link between research and practice by finding new and practical ways to improve the knowledge base for practitioners. The EFC has developed two work strands within the international knowledge mobilization strategy, which utilise two complementary digital platforms. The first is the online MESHGuides (Mapping Educational Specialist knowHow), a collaborative tool for connecting educators with visual summaries of educational research from which practice can be developed. The second is the online Education Communities of Practice network, which is used to support international partnerships for collaboration between researchers and practitioners. Findings indicate that utilising web 2.0 tools to develop translational research through MESHGuides is significantly groundbreaking in its vision and scope with respect to practitioners accessing and building the knowledge base of the teaching profession internationally and strengthening the link between researchers and practitioners, thereby increasing the impact of research in education.N/A

To describe the self-reported practice of loop diuretic therapy (LDT) administration by intensivists in Australia and New Zealand and to ascertain the anticipated clinical and physiological effects of LDT for several common clinical indications.Structured online questionnaire distributed to intensivists via the Australian and New Zealand Intensive Care Society Clinical Trials Group email contact list. Descriptive statistics were used to analyse the results.Intensivists in Australia and New Zealand.A total of 146 intensivists responded to the survey with most (99 [67.8%]) being Fellows of the College of Intensive Care Medicine or the Joint Faculty of Intensive Care Medicine. Overall, 88 (60.2%) had worked in ICUs for 10 years or more. A positive fluid balance, acute pulmonary oedema (APO) and acute lung injury (ALI) were considered key indications for LDT (80.0% positive response), in contrast to an elevated central venous pressure (CVP) (20.3%) and acute kidney injury (AKI) (3.8%), which were not. LDT by bolus therapy was preferred (by 60.0%-89.4%, according to indication) over continuous infusion (3.6%- 11.1%, according to indication). The dominant initial LDT dose was furosemide 40 mg as an intravenous (IV) bolus. There was a lack of consensus regarding what would be an adequate response, and for many of the clinical indications, no target was specified.Australian and New Zealand intensivists typically give frusemide as a 40 mg IV bolus for a positive fluid balance, ALI and APO, but not for an elevated CVP or AKI. However, such therapy is given without explicit definitions of an adequate response under these different clinical circumstances.

There is little consensus on the definition or optimal constituents of fluid bolus therapy (FBT), and there is uncertainty regarding its physiological effects. The aims of this study were to determine clinician-reported definitions of FBT and to explore the physiological responses clinicians expect from such FBT. In June and October 2014, intensive care and emergency physicians in Australia and New Zealand were asked to participate in an electronic questionnaire of the reported practice and expectations of FBT. Two hundred and fifty-one questionnaires were completed, 65.3% from intensivists. We identified the prototypical FBT given by intensivists is more than 250 ml of compound sodium lactate, saline or 4% albumin given in less than 30 minutes, while that given by emergency department physicians is a similar volume of saline delivered over a similar time frame. Intensive care and emergency physicians expected significantly different changes in mean arterial pressure ( P=0.001) and heart rate ( P=0.033) following FBT. Substantial variation was demonstrated in the magnitude of expected response within both specialties for each variable. Major variations exist in self-reported FBT practice, both within and between acute specialties, and wide variation can be demonstrated in the expected physiological responses to FBT. International explorations of practice and prospective quantification of the actual physiological response to FBT are warranted.

Labile iron is important in the pathogenesis of acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL) and hepcidin control iron metabolism and are upregulated during renal stress. However, higher levels of urinary NGAL are associated with AKI severity whereas higher urinary hepcidin levels are associated with absence of AKI. We aimed to investigate the value of combining both biomarkers to estimate the severity and progression of AKI in intensive care unit (ICU) patients.Urinary NGAL and hepcidin were quantified within 48 hours of ICU admission in patients with the systemic inflammatory response syndrome and early kidney dysfunction (oliguria for ≥ 2 hours and/or a 25 µmol/L creatinine rise from baseline). Diagnostic and prognostic characteristics were assessed by logistic regression and receiver operating characteristics (ROC) analysis.Of 102 patients, 26 had mild AKI and 28 patients had severe AKI on admission. Sepsis (21%), cardiac surgery (17%) and liver failure (9%) were primary admission diagnoses. NGAL increased (P=0.03) whereas hepcidin decreased (P=0.01) with increasing AKI severity. The value of NGAL/hepcidin ratio to detect severe AKI was higher than when NGAL and hepcidin were used individually and persisted after adjusting for potential confounders (adjusted OR 2.40, 95% CI 1.20-4.78). The ROC areas for predicting worsening AKI were 0.50, 0.52 and 0.48 for NGAL, 1/hepcidin and the NGAL/hepcidin ratio.The NGAL/hepcidin ratio is more strongly associated with severe AKI than the single biomarkers alone. NGAL and hepcidin, alone or combined as a ratio, were unable to predict progressive AKI in this selected ICU cohort.