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Article ; Online: Randomised-control trials do not support midodrine as an intravenous vasopressor weaning strategy.

Costa-Pinto, Rahul / Bellomo, Rinaldo

2022 Volume 72, Page(s) 153996

MeSH term(s)	Humans ; Midodrine/therapeutic use ; Weaning ; Vasoconstrictor Agents/therapeutic use ; Administration, Intravenous
Chemical Substances	Midodrine (6YE7PBM15H) ; Vasoconstrictor Agents
Language	English
Publishing date	2022-01-31
Publishing country	United States
Document type	Letter
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2022.153996
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Article: Midodrine use in critically ill patients: a narrative review.

Costa-Pinto, Rahul / Jones, Daryl A / Udy, Andrew A / Warrillow, Stephen J / Bellomo, Rinaldo

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

2023 Volume 24, Issue 4, Page(s) 298–308

Abstract: Midodrine is a peripherally acting, oral α-agonist that is increasingly used in intensive care units despite conflicting evidence for its effectiveness. It has pharmacological effects on blood vessels as well as pupillary, cardiac, renal, ... ...

Abstract	Midodrine is a peripherally acting, oral α-agonist that is increasingly used in intensive care units despite conflicting evidence for its effectiveness. It has pharmacological effects on blood vessels as well as pupillary, cardiac, renal, gastrointestinal, genitourinary, lymphatic and skin tissue. It has approval for use as a treatment for orthostatic hypotension, but a surge in interest over the past decade has prompted its use for a growing number of off-label indications. In critically ill patients, midodrine has been used as either an adjunctive oral therapy to wean vasoplegic patients off low dose intravenous vasopressor infusions, or as an oral vasopressor agent to prevent or minimise the need for intravenous infusion. Clinical trials have mostly focused on midodrine as an intravenous vasopressor weaning agent. Early retrospective studies supported its use for this indication, but more recent randomised controlled trials have largely refuted this practice. Key questions remain on its role in managing critically ill patients before intensive care admission, during intensive care stay, and following discharge. This narrative review presents a comprehensive overview of midodrine use for the critical care physician and highlights why lingering questions around ideal patient selection, dosing, timing of initiation, and efficacy of midodrine for critically ill patients remain unanswered.
Language	English
Publishing date	2023-10-16
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2401976-8
ISSN	1441-2772
ISSN	1441-2772
DOI	10.51893/2022.4.R
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Article ; Online: Medical emergency team training: needs assessment, feedback and learning objectives.

Le Guen, Maurice / Costa-Pinto, Rahul

Internal medicine journal

2020 Volume 51, Issue 8, Page(s) 1298–1303

Abstract: Background: There are no published studies assessing learning needs and attitudes prior to attending a medical emergency team (MET) education programme.: Aims: To conduct a learning needs assessment of MET education programme participants to assess ... ...

Abstract	Background: There are no published studies assessing learning needs and attitudes prior to attending a medical emergency team (MET) education programme. Aims: To conduct a learning needs assessment of MET education programme participants to assess what technical and non-technical skills should be incorporated. Methods: All participants in a MET education programme over a 12-month period were invited to complete a self-administered electronic survey. Participants were ICU team members (intensive care registrars and nurses) and medical registrars. Responses were captured through a 5-point Likert scale. Results: There were 62 responses out of 112 participants (55% response rate). Most participants either agreed or strongly agreed that MET training was valuable (59 respondents) and should be multidisciplinary (61 respondents). ICU team members were more likely to select 'Management of End-of-Life Care' (72% compared with only 16% of medical registrars, P < 0.05) as an important learning objective. Non-technical skills such as 'Task Management' (67% compared with 37%, P < 0.05) and 'Team Communication' (79% compared with 32%, P < 0.05) were also more likely to be selected by ICU team members. Nursing team members were more likely to select 'Approach to Common MET Calls' (100% compared with 50% of medical team members, P < 0.05). Conclusions: MET education programme participants overwhelmingly feel that training should be multidisciplinary. However, there are disparities between the perceived learning needs of medical and nursing personnel, and between intensive care team members and medical registrars, which may impact on the design and implementation of a multidisciplinary education programme.
Language	English
Publishing date	2020-05-25
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2045436-3
ISSN	1445-5994 ; 1444-0903
ISSN (online)	1445-5994
ISSN	1444-0903
DOI	10.1111/imj.14923
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Zs.A 792: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Assessing the safety profile of voriconazole use in suspected COVID-19-associated pulmonary aspergillosis-a two-centre observational study.

Costa-Pinto, Rahul / Klink, Sarah / Rotherham, Hannah / Perera, Padeepa / Finlay, Liam / Urbancic, Karen / Vaz, Karl / Trubiano, Jason / Bellomo, Rinaldo

Medical mycology

2023 Volume 61, Issue 6

Abstract: The decision to use voriconazole for suspected COVID-19-associated pulmonary aspergillosis (CAPA) is based on clinical judgement weighed against concerns about its potential toxicity. We assessed the safety profile of voriconazole for patients with ... ...

Abstract	The decision to use voriconazole for suspected COVID-19-associated pulmonary aspergillosis (CAPA) is based on clinical judgement weighed against concerns about its potential toxicity. We assessed the safety profile of voriconazole for patients with suspected CAPA by conducting a retrospective study of patients across two intensive care units. We compared changes in any liver enzymes or bilirubin and any new or increasing corrected QT interval (QTc) prolongation following voriconazole use to patient baseline to indicate possible drug effect. In total, 48 patients with presumed CAPA treated with voriconazole were identified. Voriconazole therapy was administered for a median of 8 days (interquartile range [IQR] 5-22) and the median level was 1.86 mg/L (IQR 1.22-2.94). At baseline, 2% of patients had a hepatocellular injury profile, 54% had a cholestatic injury profile, and 21% had a mixed injury profile. There were no statistically significant changes in liver function tests over the first 7 days after voriconazole initiation. At day 28, there was a significant increase in alkaline phospahte only (81-122 U/L, P = 0.006), driven by changes in patients with baseline cholestatic injury. In contrast, patients with baseline hepatocellular or mixed injury had a significant decrease in alanine transaminase and aspartate transaminase. Baseline QTc was 437 ms and remained unchanged after 7 days of voriconazole therapy even after sensitivity analysis for concomitantly administered QT prolonging agents. Therefore, at the doses used in this study, we did not detect evidence of significant liver or cardiac toxicity related to voriconazole use. Such information can be used to assist clinicians in the decision to initiate such treatment.
MeSH term(s)	Animals ; Voriconazole/adverse effects ; Antifungal Agents/adverse effects ; Retrospective Studies ; Triazoles/adverse effects ; COVID-19/veterinary ; Pulmonary Aspergillosis/drug therapy ; Pulmonary Aspergillosis/veterinary
Chemical Substances	Voriconazole (JFU09I87TR) ; Antifungal Agents ; Triazoles
Language	English
Publishing date	2023-06-07
Publishing country	England
Document type	Observational Study, Veterinary ; Journal Article
ZDB-ID	1421796-x
ISSN	1460-2709 ; 1369-3786
ISSN (online)	1460-2709
ISSN	1369-3786
DOI	10.1093/mmy/myad054
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Article ; Online: Evaluating an inquiry-based learning program.

Nadkarni, Aniket / Costa-Pinto, Rahul / Hensman, Tamishta / Harman, Emily V / Yanase, Fumitaka / Lister, Bruce G / Nickson, Christopher P / Thomas, Josephine S

Advances in physiology education

2023 Volume 47, Issue 4, Page(s) 930–939

Abstract: Inquiry-based learning (IBL) is a promising educational framework that is understudied in graduate medical education. To determine participant satisfaction and engagement with phases of an IBL postgraduate education program, a mixed-methods study ... ...

Abstract	Inquiry-based learning (IBL) is a promising educational framework that is understudied in graduate medical education. To determine participant satisfaction and engagement with phases of an IBL postgraduate education program, a mixed-methods study collected data via survey statements and open-ended responses. The authors included participants attending an intensive care medicine (ICM) IBL program from May to November 2020. Quantitative outcomes included participants' satisfaction with the IBL format and impact of engagement with IBL on the learning experience. Qualitative outcomes explored determinants of engagement with IBL phases and the impact on the learning experience. Of 378 attendees, 167 submitted survey responses (44.2%). There was strong agreement relating to overall satisfaction (93.4%). Responses indicated engagement with "orientation" (94.6%), "conceptualization" (97.3%), "discussion" (91.1%), and "conclusion" (91.0%) but limited engagement with the "investigation" phase (48.1%). Greater engagement with IBL phases had positive impacts, with repeat attenders having clearer learning objectives (79.1% vs. 56.6%,
MeSH term(s)	Humans ; Problem-Based Learning ; Education, Medical, Graduate ; Educational Status ; Personal Satisfaction
Language	English
Publishing date	2023-10-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1024917-5
ISSN	1522-1229 ; 1043-4046
ISSN (online)	1522-1229
ISSN	1043-4046
DOI	10.1152/advan.00050.2023
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Article ; Online: Dose equivalence for metaraminol and noradrenaline - A retrospective analysis.

Costa-Pinto, Rahul / Neto, Ary Serpa / Matthewman, Madeline Coxwell / Osrin, Dean / Liskaser, Grace / Li, Jasun / Young, Marcus / Jones, Daryl / Udy, Andrew / Warrillow, Stephen / Bellomo, Rinaldo

Journal of critical care

2024 Volume 80, Page(s) 154430

Abstract: Background: Noradrenaline and metaraminol are commonly used vasopressors in critically ill patients. However, little is known of their dose equivalence.: Methods: We conducted a single centre retrospective cohort study of all ICU patients who ... ...

Abstract	Background: Noradrenaline and metaraminol are commonly used vasopressors in critically ill patients. However, little is known of their dose equivalence. Methods: We conducted a single centre retrospective cohort study of all ICU patients who transitioned from metaraminol to noradrenaline infusions between August 26, 2016 and December 31, 2020. Patients receiving additional vasoactive drug infusion were excluded. Dose equivalence was calculated based on the last hour metaraminol dose (in μg/min) and the first hour noradrenaline dose (in μg/min) with the closest matched mean arterial pressure (MAP). Sensitivity analyses were performed on patients with acute kidney injury (AKI), sepsis and mechanical ventilation. Results: We studied 195 patients. The median conversion ratio of metaraminol to noradrenaline was 12.5:1 (IQR 7.5-20.0) for the overall cohort. However, the coefficient of variation was 77% and standard deviation was 11.8. Conversion ratios were unaffected by sepsis or mechanical ventilation but increased (14:1) with AKI. One in five patients had a MAP decrease of >10 mmHg during the transition period from metaraminol to noradrenaline. Post-transition noradrenaline dose (p < 0.001) and AKI (p = 0.045) were independently associated with metaraminol dose. The proportion of variation in noradrenaline dose predicted from metaraminol dose was low (R Conclusions: The median dose equivalence for metaraminol and noradrenaline in this study was 12.5:1. However, there was significant variance in dose equivalence, only half the proportion of variation in noradrenaline infusion dose was predicted by metaraminol dose, and conversion-associated hypotension was common.
MeSH term(s)	Humans ; Metaraminol ; Norepinephrine ; Retrospective Studies ; Sepsis/complications ; Acute Kidney Injury/complications
Chemical Substances	Metaraminol (818U2PZ2EH) ; Norepinephrine (X4W3ENH1CV)
Language	English
Publishing date	2024-01-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2023.154430
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Article ; Online: Pressure injuries in mechanically ventilated COVID-19 patients utilising different prone positioning techniques - A prospective observational study.

Woolger, Cara / Rollinson, Thomas / Oliphant, Fiona / Ross, Kristy / Ryan, Brooke / Bacolas, Zoe / Burleigh, Sarah / Jameson, Stephanie / McDonald, Luke A / Rose, Joleen / Modra, Lucy / Costa-Pinto, Rahul

Intensive & critical care nursing

2024 Volume 82, Page(s) 103623

Abstract: Objectives: To compare the incidence and distribution of pressure injuries (PIs) with two approaches to prone positioning for mechanically ventilated COVID-19 patients, and to determine the prevalence of these PIs on intensive care unit (ICU) and ... ...

Abstract	Objectives: To compare the incidence and distribution of pressure injuries (PIs) with two approaches to prone positioning for mechanically ventilated COVID-19 patients, and to determine the prevalence of these PIs on intensive care unit (ICU) and hospital discharge. Design: A prospective observational study. Setting: Adult patients admitted to a quaternary ICU with COVID-19-associated acute lung injury, between September 2021 and February 2022. Main outcome measures: Incidence and anatomical distribution of PIs during ICU stay for "Face Down" and "Swimmers Position" as well as on ICU and hospital discharge. Results: We investigated 206 prone episodes in 63 patients. In the Face Down group, 26 of 34 patients (76 %) developed at least one PI, compared to 10 of 22 patients (45 %) in the Swimmers Position group (p = 0.02). Compared to the Swimmers Position group, the Face Down group developed more pressure injuries per patient (median 1 [1, 3] vs 0 [0, 2], p = 0.04) and had more facial PIs (p = 0.002). In a multivariate logistic regression model, patients were more likely to have at least one PI with Face Down position (OR 4.67, 95 % CI 1.28, 17.04, p = 0.02) and greater number of prone episodes (OR 1.75, 95 % CI 1.12, 2.74, p = 0.01). Over 80 % of all PIs were either stage 1 or stage 2. By ICU discharge, 29 % had healed and by hospital discharge, 73 % of all PIs had healed. Conclusion: Swimmers Position had a significantly lower incidence of PIs compared to the Face Down approach. One-quarter of PIs had healed by time of ICU discharge and three-quarters by time of hospital discharge. Implications for clinical practice: There are differences in incidence of PIs related to prone positioning approaches. This study validates and helps better inform current prone position guidelines recommending the use of Swimmers Position. The low prevalence of PIs at hospital discharge is reassuring.
MeSH term(s)	Adult ; Humans ; COVID-19/epidemiology ; COVID-19/complications ; Respiration, Artificial/adverse effects ; Prone Position ; Pressure Ulcer/epidemiology ; Pressure Ulcer/etiology ; Intensive Care Units
Language	English
Publishing date	2024-01-11
Publishing country	Netherlands
Document type	Observational Study ; Journal Article
ZDB-ID	1105892-4
ISSN	1532-4036 ; 0964-3397
ISSN (online)	1532-4036
ISSN	0964-3397
DOI	10.1016/j.iccn.2024.103623
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Article ; Online: Severe hand sanitiser (isopropanol) toxicity managed with continuous venovenous haemodiafiltration and angiotensin II.

Chieng, Sam / Malouf, Saada / Costa-Pinto, Rahul / Bellomo, Rinaldo / Gerostamoulos, Dimitri / Wong, Anselm

Clinical toxicology (Philadelphia, Pa.)

2021 Volume 59, Issue 12, Page(s) 1277–1278

MeSH term(s)	2-Propanol ; Acute Kidney Injury/therapy ; Angiotensin II ; Continuous Renal Replacement Therapy ; Critical Illness ; Hand Sanitizers ; Hemodiafiltration ; Hemofiltration ; Humans
Chemical Substances	Hand Sanitizers ; Angiotensin II (11128-99-7) ; 2-Propanol (ND2M416302)
Language	English
Publishing date	2021-04-13
Publishing country	England
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	204476-6
ISSN	1556-9519 ; 0009-9309 ; 0731-3810 ; 1556-3650
ISSN (online)	1556-9519
ISSN	0009-9309 ; 0731-3810 ; 1556-3650
DOI	10.1080/15563650.2021.1910289
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Article ; Online: Combined Hemoperfusion and Continuous Veno-Venous Hemofiltration for Carbamazepine Intoxication.

Baylis, Simon / Costa-Pinto, Rahul / Hodgson, Sarah / Bellomo, Rinaldo / Baldwin, Ian

Blood purification

2021 Volume 51, Issue 9, Page(s) 721–725

Abstract: Introduction: Carbamazepine (CBZ) is a widely used anticonvulsant with a low molecular weight that allows for extracorporeal removal of free drug by both dialytic and hemoperfusion techniques, particularly in a massive overdose where serum protein ... ...

Abstract	Introduction: Carbamazepine (CBZ) is a widely used anticonvulsant with a low molecular weight that allows for extracorporeal removal of free drug by both dialytic and hemoperfusion techniques, particularly in a massive overdose where serum protein binding is saturated. This report presents a case of CBZ intoxication where we were able to compare the mass removal of CBZ using hemoperfusion, with the mass removal of CBZ achieved with continuous renal replacement therapy (CRRT) during combined treatment. Methods: The Jafron HA230 resin hemoperfusion cartridge was applied in series with the continuous veno-venous hemofiltration (CVVH) circuit. Baseline and ongoing serum drug levels along with further samples from pre- and post-hemoperfusion cartridges and from CVVH effluent were collected. Results: Combined CVVH and resin hemoperfusion therapy in series was associated with a 50% reduction in the CBZ level from 16 mg/L to 8 mg/L over 3 h, far more rapid than that observed with CVVH alone or in the absence of extracorporeal drug clearance in the preceding hours. The combination therapy removed close to 35 mg/h of CBZ. Conclusion: The combination of CRRT and hemoperfusion can be easily deployed, appears safe, and is able to combine the CBZ mass removal achieved with each technique, thus to maximize CBZ extraction.
MeSH term(s)	Benzodiazepines ; Carbamazepine ; Continuous Renal Replacement Therapy ; Hemofiltration/methods ; Hemoperfusion/methods ; Humans ; Renal Dialysis/methods
Chemical Substances	Benzodiazepines (12794-10-4) ; Carbamazepine (33CM23913M)
Language	English
Publishing date	2021-12-08
Publishing country	Switzerland
Document type	Case Reports ; Journal Article
ZDB-ID	605548-5
ISSN	1421-9735 ; 0253-5068
ISSN (online)	1421-9735
ISSN	0253-5068
DOI	10.1159/000520520
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Article ; Online: A PILOT STUDY OF ANGIOTENSIN II AS PRIMARY VASOPRESSOR IN CRITICALLY ILL ADULTS WITH VASODILATORY HYPOTENSION: THE ARAMIS STUDY.

See, Emily J / Clapham, Caroline / Liu, Jasmine / Khasin, Monique / Liskaser, Grace / Chan, Jian Wen / Serpa Neto, Ary / Costa Pinto, Rahul / Bellomo, Rinaldo

Shock (Augusta, Ga.)

2023 Volume 59, Issue 5, Page(s) 691–696

Abstract: Abstract: Objective: The aim of the study is to evaluate the efficacy and safety of using angiotensin II (Ang2) as primary vasopressor for vasodilatory hypotension. Methods: This was a prospective observational study of critically ill adults admitted to ...

Abstract	Abstract: Objective: The aim of the study is to evaluate the efficacy and safety of using angiotensin II (Ang2) as primary vasopressor for vasodilatory hypotension. Methods: This was a prospective observational study of critically ill adults admitted to an academic intensive care unit (ICU) with vasodilatory hypotension. We treated 40 patients with Ang2 as primary vasopressor and compared them with 80 matched controls who received conventional vasopressors (norepinephrine, vasopressin, metaraminol, epinephrine, or combinations). Results : Mean age was 63 years and median Acute Physiology and Chronic Health Evaluation III score was 65. Ang2 patients had lower ICU mortality (10% vs 26%, P = 0.04); however, their 28- and 90-day mortality was not significantly different (18% vs 29%, P = 0.18; 22% vs 30%, P = 0.39). Peak serum creatinine levels were similar (128 vs 126 μmol/L, P = 0.81), as was the incidence and stage of acute kidney injury (70% vs 74%, P = 0.66), requirement for continuous renal replacement therapy (14% vs 13%, P = 0.84), and risk of major adverse kidney events at 7 days (20% vs 29%, P = 0.30). However, Ang2 patients with prior exposure to renin angiotensin aldosterone system inhibitors had a lower peak serum creatinine ( P = 0.03 for interaction) than conventional vasopressors patients, and serum troponin elevations were less common with Ang2 (8% vs 22%, P = 0.04). The incidence of thromboembolic complications was similar. Conclusions: Primary Ang2 administration in vasodilatory hypotension did not seem harmful compared with conventional vasopressors. Although Ang2 did not decrease peak serum creatinine levels or major adverse kidney events, its effects on intensive care unit survival, serum troponin, and renal function in patients on renin angiotensin aldosterone system inhibitors warrant further exploration in randomized trials (ACTRN12621000281897).
MeSH term(s)	Humans ; Adult ; Middle Aged ; Angiotensin II/therapeutic use ; Pilot Projects ; Critical Illness/therapy ; Creatinine ; Vasoconstrictor Agents/therapeutic use ; Hypotension/drug therapy ; Hypotension/chemically induced ; Intensive Care Units ; Peptide Hormones
Chemical Substances	Angiotensin II (11128-99-7) ; Creatinine (AYI8EX34EU) ; Vasoconstrictor Agents ; Peptide Hormones
Language	English
Publishing date	2023-03-18
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	1185432-7
ISSN	1540-0514 ; 1073-2322
ISSN (online)	1540-0514
ISSN	1073-2322
DOI	10.1097/SHK.0000000000002109
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