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  1. Article: Should critically ill patients with COVID-19 be managed in high-volume ICUs?

    Ramanan, Mahesh / Burrell, Aidan / Udy, Andrew

    Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine

    2023  Volume 22, Issue 4, Page(s) 394–396

    Language English
    Publishing date 2023-10-18
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2401976-8
    ISSN 1441-2772
    ISSN 1441-2772
    DOI 10.51893/2020.4.l1
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    Zs.A 6672: Show issues Location:
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  2. Article ; Online: Fluid therapy in diabetic ketoacidosis.

    Ramanan, Mahesh / Delaney, Anthony / Venkatesh, Balasubramanian

    Current opinion in clinical nutrition and metabolic care

    2023  Volume 27, Issue 2, Page(s) 178–183

    Abstract: Purpose of review: To evaluate recent evidence (2021-2023) on fluid therapy in diabetic ketoacidosis. Key evidence gaps which require generation of new evidence are discussed.: Recent findings: Balanced crystalloid solutions, compared to the commonly ...

    Abstract Purpose of review: To evaluate recent evidence (2021-2023) on fluid therapy in diabetic ketoacidosis. Key evidence gaps which require generation of new evidence are discussed.
    Recent findings: Balanced crystalloid solutions, compared to the commonly recommended and used 0.9% sodium chloride solution (saline), may result in better outcomes for patients with diabetic ketoacidosis, including faster resolution of acidosis, less hyperchloremia and shorter hospital length of stay. Upcoming results from randomized trials may provide definitive evidence on the use of balanced crystalloid solutions in diabetic ketoacidosis. Evidence remains scarce or conflicting for the use of "two-bag" compared to conventional "one-bag" fluid, and rates of fluid administration, especially for adult patients. In children, concerns about cerebral oedema from faster fluid administration rates have not been demonstrated in cohort studies nor randomized trials.
    Summary: Fluid therapy is a key aspect of diabetic ketoacidosis management, with important evidence gaps persisting for several aspects of management despite recent evidence.
    MeSH term(s) Child ; Humans ; Diabetic Ketoacidosis/therapy ; Fluid Therapy/methods ; Saline Solution ; Diabetes Mellitus
    Chemical Substances Saline Solution
    Language English
    Publishing date 2023-11-30
    Publishing country England
    Document type Review ; Journal Article
    ZDB-ID 1460178-3
    ISSN 1473-6519 ; 1363-1950
    ISSN (online) 1473-6519
    ISSN 1363-1950
    DOI 10.1097/MCO.0000000000001005
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    Zs.A 5586: Show issues Location:
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  3. Article ; Online: Tofacitinib for Refractory Uveitis and Scleritis in Children: A Case Series.

    Dutta Majumder, Parthopratim / Abraham, Sharanya / Sudharshan, Sridharan / Janarthanan, Mahesh / Ramanan, Athimalaipet V

    Ocular immunology and inflammation

    2024  , Page(s) 1–4

    Abstract: Purpose: This study analyzes the efficacy and safety of tofacitinib in pediatric patients presenting with treatment-resistant uveitis and scleritis.: Method: Retrospective Chart Review.: Result: Nine children diagnosed with uveitis and one with ... ...

    Abstract Purpose: This study analyzes the efficacy and safety of tofacitinib in pediatric patients presenting with treatment-resistant uveitis and scleritis.
    Method: Retrospective Chart Review.
    Result: Nine children diagnosed with uveitis and one with scleritis received oral tofacitinib treatment. The median age of these patients was 9 years, with bilateral involvement observed in nine of them. Juvenile idiopathic arthritis was the most identifiable cause of uveitis, with anterior uveitis (50%) being the most frequent subtype of inflammation among these children. The median duration of immunosuppressive treatment before switching to tofacitinib was 18 (16-49) months. Remission of uveitis was achieved in all but two children, who experienced recurrence - manifesting as anterior uveitis. The median duration of follow-up in these children after tofacitinib treatment was 277.5 (183-549) days. At the end of follow-up, topical steroids could be withdrawn in six children, and two children were on topical steroids once a day. None of the children developed any systemic side-effect during the follow-up period. The mean BCVA at presentation was 0.62 ± 0.55, which improved to a mean of 0.27 ± 0.325 at the final follow-up (
    Conclusion: Treatment of pediatric uveitis with tofacitinib can be a valuable second-line treatment option and useful alternative in low- and middle-income countries.
    Language English
    Publishing date 2024-03-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 1193873-0
    ISSN 1744-5078 ; 0927-3948
    ISSN (online) 1744-5078
    ISSN 0927-3948
    DOI 10.1080/09273948.2024.2323671
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  4. Article ; Online: Details and the devil within: the case of sepsis associated AKI. Author's reply.

    White, Kyle C / Laupland, Kevin B / Tabah, Alexis / Ramanan, Mahesh / Bellomo, Rinaldo

    Intensive care medicine

    2023  Volume 49, Issue 11, Page(s) 1426–1427

    MeSH term(s) Humans ; Sepsis/complications ; Acute Kidney Injury/etiology
    Language English
    Publishing date 2023-09-10
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-023-07209-2
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  5. Article ; Online: Clinical implications of urine output-based sepsis-associated acute kidney injury. Author's reply.

    White, Kyle C / Laupland, Kevin B / Tabah, Alexis / Ramanan, Mahesh / Bellomo, Rinaldo

    Intensive care medicine

    2023  Volume 49, Issue 10, Page(s) 1266–1267

    MeSH term(s) Humans ; Acute Kidney Injury/etiology ; Sepsis/complications
    Language English
    Publishing date 2023-08-28
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-023-07205-6
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  6. Article ; Online: Double the risk of death and other 'inconvenient truths' about oliguria. Author's reply.

    White, Kyle C / Laupland, Kevin B / Tabah, Alexis / Ramanan, Mahesh / Bellomo, Rinaldo

    Intensive care medicine

    2023  Volume 49, Issue 11, Page(s) 1422–1423

    MeSH term(s) Humans ; Oliguria/etiology
    Language English
    Publishing date 2023-09-14
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-023-07218-1
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  7. Article ; Online: Geographical Representation of Low- and Middle-Income Countries in Randomized Clinical Trials for COVID-19.

    Ramanan, Mahesh / Tong, Steven Y C / Kumar, Aashish / Venkatesh, Balasubramanian

    JAMA network open

    2022  Volume 5, Issue 2, Page(s) e220444

    MeSH term(s) COVID-19/epidemiology ; Developing Countries ; Global Health ; Humans ; Pandemics ; Periodicals as Topic ; Randomized Controlled Trials as Topic/statistics & numerical data ; SARS-CoV-2
    Language English
    Publishing date 2022-02-01
    Publishing country United States
    Document type Journal Article ; Systematic Review
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2022.0444
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  8. Article: Ventriculitis: Infection or Inflammation.

    Ramanan, Mahesh / Shorr, Andrew / Lipman, Jeffrey

    Antibiotics (Basel, Switzerland)

    2021  Volume 10, Issue 10

    Abstract: Ventriculitis, or infection of the cerebrospinal fluid, in the presence of external ventricular drains (EVD), is an important complication and associated with substantial mortality, morbidity, and healthcare costs. Further, the conditions that require ... ...

    Abstract Ventriculitis, or infection of the cerebrospinal fluid, in the presence of external ventricular drains (EVD), is an important complication and associated with substantial mortality, morbidity, and healthcare costs. Further, the conditions that require the insertion of an EVD, such as neurotrauma and subarachnoid hemorrhage, are themselves associated with inflammation of the cerebrospinal fluid. Phenotypically, patients with inflammation of the cerebrospinal fluid can present with very similar symptoms, signs, and laboratory findings to those with infection. This review examines various controversies relating to the definitions, diagnosis, challenges of differentiating infection from inflammation, prevention, and treatment of ventriculitis in patients with EVDs.
    Language English
    Publishing date 2021-10-14
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2681345-2
    ISSN 2079-6382
    ISSN 2079-6382
    DOI 10.3390/antibiotics10101246
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  9. Article ; Online: Time in ICU and post-intensive care syndrome: how long is long enough?

    Flaws, Dylan / Fraser, John F / Laupland, Kevin / Lavana, Jayshree / Patterson, Sue / Tabah, Alexis / Tronstad, Oystein / Ramanan, Mahesh

    Critical care (London, England)

    2024  Volume 28, Issue 1, Page(s) 34

    Abstract: Background: Our understanding of post-ICU recovery is influenced by which patients are selected to study and treat. Many studies currently list an ICU length of stay of at least 24, 48, or 72 h as an inclusion criterion. This may be driven by ... ...

    Abstract Background: Our understanding of post-ICU recovery is influenced by which patients are selected to study and treat. Many studies currently list an ICU length of stay of at least 24, 48, or 72 h as an inclusion criterion. This may be driven by established evidence that prolonged time in an ICU bed and prolonged ventilation can complicate post-ICU rehabilitation. However, recovery after short ICU stays still needs to be explored.
    Methods: This is a secondary analysis from the tracking outcomes post-intensive care (TOPIC) study. One hundred and thirty-two participants were assessed 6-months post-ICU discharge using standardised and validated self-report tools for physical function, cognitive function, anxiety, depression and post-traumatic stress disorder (with clinically significant impairment on any tool being considered a complicated recovery). Routinely collected data relating to the ICU stay were retrospectively accessed, including length of stay and duration of mechanical ventilation. Patients with short ICU stays were intentionally included, with 77 (58%) participants having an ICU length of stay < 72 h.
    Results: Of 132 participants, 40 (30%) had at least one identified post-ICU impairment 6 months after leaving ICU, 22 (17%) of whom had an ICU length of stay < 72 h.
    Conclusion: Many patients with an ICU length of stay < 72 h are reporting post-ICU impairment 6 months after leaving ICU. This is a population often excluded from studies and interventions. Future research should further explore post-ICU impairment among shorter stays.
    MeSH term(s) Humans ; Retrospective Studies ; Critical Illness ; Anxiety ; Intensive Care Units
    Language English
    Publishing date 2024-01-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/s13054-024-04812-7
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    Zs.A 5517: Show issues Location:
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  10. Article ; Online: Institution-free days after critical illness: A multicenter retrospective study.

    Marella, Prashanti / Laupland, Kevin B / Shekar, Kiran / Tabah, Alexis / Edwards, Felicity / Ramanan, Mahesh

    Journal of critical care

    2023  Volume 74, Page(s) 154253

    Abstract: Background: Patient-centered outcomes beyond mortality such as institution-free days (IFD) are becoming increasingly relevant in critical care trials.: Methods: We calculated IFD using three definitions which differed in the way death and censoring ... ...

    Abstract Background: Patient-centered outcomes beyond mortality such as institution-free days (IFD) are becoming increasingly relevant in critical care trials.
    Methods: We calculated IFD using three definitions which differed in the way death and censoring of after-hospital deaths were handled analysing data from adult patient databases admitted to four ICUs of North Brisbane, Australia. Differences in distribution of IFD using different definitions were explored with descriptive statistics and histograms. Six pre-specified variables (age, illness severity, comorbidities index, elective status, surgical/medical admission and treatment limitations) were assessed and reported as determinants of IFDs for the proposed definitions.
    Results: Data from 25,371 ICU admissions was analysed. The density distribution of IFD was bimodal with a peak at 0 days and a variable right-sided peak depending on the definition used. The mean IFD varied from 253 (standard deviation(SD) 151.3) to 295 (SD 116.2) depending on definition used. Multivariable zero-inflated negative binomial regression modelling showed that the six pre-specified variables had significant associations with IFD and their magnitude of effect varied with the definition used.
    Conclusions: IFD is a simple, easily measurable patient-centered outcome that varies depending on the definition used. Patient input should be sought to define the optimum definition and clinical use of IFD.
    MeSH term(s) Adult ; Humans ; Critical Illness ; Retrospective Studies ; Intensive Care Units ; Critical Care ; Outcome Assessment, Health Care
    Language English
    Publishing date 2023-01-12
    Publishing country United States
    Document type Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 632818-0
    ISSN 1557-8615 ; 0883-9441
    ISSN (online) 1557-8615
    ISSN 0883-9441
    DOI 10.1016/j.jcrc.2023.154253
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