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  1. Article ; Online: Manifestations and Management of Trimethoprim/Sulfamethoxazole-Resistant Nocardia otitidiscaviarum Infection.

    Fu, Katherine / White, Kyle / Ramaniuk, Aliaksandr / Kollu, Vidya / Urbine, Daniel

    Emerging infectious diseases

    2023  Volume 29, Issue 6, Page(s) 1266–1267

    Abstract: Nocardia can cause systemic infections with varying manifestations. Resistance patterns vary by species. We describe N. otitidiscavarium infection with pulmonary and cutaneous manifestations in a man in the United States. He received multidrug treatment ... ...

    Abstract Nocardia can cause systemic infections with varying manifestations. Resistance patterns vary by species. We describe N. otitidiscavarium infection with pulmonary and cutaneous manifestations in a man in the United States. He received multidrug treatment that included trimethoprim/sulfamethoxazole but died. Our case highlights the need to treat with combination therapy until drug susceptibilities are known.
    MeSH term(s) Male ; Humans ; Nocardia Infections/diagnosis ; Nocardia Infections/drug therapy ; Nocardia ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use
    Chemical Substances Trimethoprim, Sulfamethoxazole Drug Combination (8064-90-2) ; Anti-Bacterial Agents
    Language English
    Publishing date 2023-05-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1380686-5
    ISSN 1080-6059 ; 1080-6040
    ISSN (online) 1080-6059
    ISSN 1080-6040
    DOI 10.3201/eid2906.221854
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  2. Article: Current management of fluid balance in critically ill patients with acute kidney injury: A scoping review.

    White, Kyle C / Nasser, Ahmad / Gatton, Michelle L / Laupland, Kevin B

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

    2023  Volume 25, Issue 3, Page(s) 126–135

    Abstract: Objective: The overall objective of this scoping review is to assess the extent of the literature related to the fluid management of critically ill patients with acute kidney injury (AKI).: Introduction: AKI is common in critically ill patients where ...

    Abstract Objective: The overall objective of this scoping review is to assess the extent of the literature related to the fluid management of critically ill patients with acute kidney injury (AKI).
    Introduction: AKI is common in critically ill patients where fluid therapy is a mainstay of treatment. An association between fluid balance (FB) and adverse patient-centred outcomes in critically ill patients with AKI regardless of severity has been demonstrated. The evidence for the prospective intervention of FB and its impact on outcomes is unknown.
    Inclusion criteria: All studies investigating FB in patients with AKI admitted to an intensive care unit were included. Literature not related to FB in the critically ill patient with AKI population was excluded.
    Methods: We searched MEDLINE, EMBASE, and CINAHL from January 1st, 2012, onwards. We included primary research studies, experimental and observational, recruiting adult participants admitted to an intensive care unit who had an AKI. We extracted data on study and patient characteristics, as well as FB, renal-based outcomes, and patient-centred outcomes. Two reviewers independently screened citations for eligible studies and performed data extraction.
    Results: Of the 13,767 studies reviewed, 22 met the inclusion criteria. Two studies examined manipulation of fluid input, 18 studies assessed enhancing fluid removal, and two studies applied a restrictive fluid protocol. Sixteen studies examined patients receiving renal replacement therapy, five studies included non-renal replacement therapy patients, and one study included both. Current evidence is broad with varied approaches to managing fluid input and fluid removal. The studies did not demonstrate a consensus approach for any aspect of the fluid management of critically ill patients. There was a limited application of a restrictive fluid protocol with no conclusions possible.
    Conclusions: The current body of evidence for the management of FB in critically ill patients with AKI is limited in nature. The current quality of evidence is unable to guide current clinical practice. The key outcome of this review is to highlight areas for future research.
    Language English
    Publishing date 2023-07-27
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 2401976-8
    ISSN 1441-2772
    ISSN 1441-2772
    DOI 10.1016/j.ccrj.2023.06.002
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  3. Article ; Online: Diagnostic features, management and prognosis of type 2 myocardial infarction compared to type 1 myocardial infarction: a systematic review and meta-analysis.

    White, Kyle / Kinarivala, Mansey / Scott, Ian

    BMJ open

    2022  Volume 12, Issue 2, Page(s) e055755

    Abstract: Importance: Distinguishing type 2 (T2MI) from type 1 myocardial infarction (T1MI) in clinical practice can be difficult, and the management and prognosis for T2MI remain uncertain.: Objective: To compare precipitating factors, risk factors, ... ...

    Abstract Importance: Distinguishing type 2 (T2MI) from type 1 myocardial infarction (T1MI) in clinical practice can be difficult, and the management and prognosis for T2MI remain uncertain.
    Objective: To compare precipitating factors, risk factors, investigations, management and outcomes for T2MI and T1MI.
    Data sources: Medline and Embase databases as well as reference list of recent articles were searched January 2009 to December 2020 for term 'type 2 myocardial infarction'.
    Study selection: Studies were included if they used a universal definition of MI and reported quantitative data on at least one variable of interest.
    Data extraction and synthesis: Data were pooled using random-effect meta-analysis. Risk of bias was assessed using Newcastle-Ottawa quality assessment tool. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. All review stages were conducted by two reviewers.
    Main outcomes and measures: Risk factors, presenting symptoms, cardiac investigations such as troponin and angiogram, management and outcomes such as mortality.
    Results: 40 cohort studies comprising 98 930 patients with T1MI and 13 803 patients with T2MI were included. Compared with T1MI, patients with T2MI were: more likely to have pre-existing chronic kidney disease (OR 1.87; 95% CI 1.53 to 2.28) and chronic heart failure (OR 2.35; 95% CI 1.82 to 3.03), less likely to present with typical cardiac symptoms of chest pain (OR 0.19; 95% CI 0.13 to 0.26) and more likely to present with dyspnoea (OR 2.64; 95% CI 1.86 to 3.74); more likely to demonstrate non-specific ST-T wave changes on ECG (OR 2.62; 95% CI 1.81 to 3.79) and less likely to show ST elevation (OR 0.22; 95% CI 0.17 to 0.28); less likely to undergo coronary angiography (OR 0.09; 95% CI 0.06 to 0.12) and percutaneous coronary intervention (OR 0.06; 95% CI 0.04 to 0.10) or receive cardioprotective medications, such as statins (OR 0.25; 95% CI 0.16 to 0.38) and beta-blockers (OR 0.45; 95% CI 0.33 to 0.63). T2MI had greater risk of all cause 1-year mortality (OR 3.11; 95% CI 1.91 to 5.08), with no differences in short-term mortality (OR 1.34; 95% CI 0.63 to 2.85).
    Conclusion and relevance: This review has identified clinical, management and survival differences between T2MI and T1MI with greater precision and scope than previously reported. Differential use of coronary revascularisation and cardioprotective medications highlight ongoing uncertainty of their utility in T2MI compared with T1MI.
    MeSH term(s) Cohort Studies ; Coronary Angiography ; Humans ; Myocardial Infarction/diagnosis ; Myocardial Infarction/therapy ; Percutaneous Coronary Intervention ; Prognosis
    Language English
    Publishing date 2022-02-17
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2021-055755
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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
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    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: Current fluid management practice in critically ill adults on continuous renal replacement therapy: A binational, observational study.

    White, Kyle C / Laupland, Kevin B / Ostermann, Marlies / Neto, Ary Serpa / Gatton, Michelle L / Hurford, Rod / Clement, Pierre / Sanderson, Barnaby / Bellomo, Rinaldo

    Blood purification

    2024  

    Abstract: Introduction In critically ill patients undergoing continuous renal replacement therapy (CRRT), a positive fluid balance (FB) is associated with adverse outcomes. However, current FB management practices in CRRT patients are poorly understood. We aimed ... ...

    Abstract Introduction In critically ill patients undergoing continuous renal replacement therapy (CRRT), a positive fluid balance (FB) is associated with adverse outcomes. However, current FB management practices in CRRT patients are poorly understood. We aimed to study FB and its components in British and Australian CRRT patients to inform future trials. Methods We obtained detailed electronic health record data on all fluid-related variables during CRRT and hourly FB for the first seven days of treatment. Results We studied 1,616 patients from three tertiary ICUs in two countries. After the start of CRRT, the mean cumulative FB became negative at 31 hours and remained negative over seven days to a mean nadir of -4.1 L (95% confidence intervals (CI) of -4.6 to -3.5). The net ultrafiltration (NUF) rate was the dominant fluid variable (-67.7 mL/h; SD 75.7); however, residual urine output (-34.7 mL/h; SD 54.5), crystalloid administration (48.1 mL/h; SD 44.6), and nutritional input (36.4 mL/h; SD 29.7) significantly contributed to FB. Patients with a positive FB after 72 hours of CRRT, were more severely ill, required high-dose vasopressors and had high lactate concentrations (5.0 mmol/L; IQR 2.3 - 10.5). A positive FB was independently associated with increased hospital mortality (OR 1.70; 95% CI; p=0.004). Conclusion In the study ICUs, most CRRT patients achieved a predominantly NUF-dependent negative FB. Patients with a positive FB at 72 hours had greater illness severity and haemodynamic instability. Achieving equipoise for conducting trials that target a negative early FB in such patients may be difficult.
    Language English
    Publishing date 2024-04-16
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 605548-5
    ISSN 1421-9735 ; 0253-5068
    ISSN (online) 1421-9735
    ISSN 0253-5068
    DOI 10.1159/000538421
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  8. Article ; Online: Impact of Continuous Renal Replacement Therapy Initiation on Urine Output and Fluid Balance: A Multicenter Study.

    White, Kyle Christopher / Laupland, Kevin B / See, Emily / Serpa-Neto, Ary / Bellomo, Rinaldo

    Blood purification

    2023  Volume 52, Issue 6, Page(s) 532–540

    Abstract: Introduction: The effect of continuous renal replacement therapy (CRRT) on renal function is poorly understood. However, the initiation of CRRT may induce oliguria. We aimed to investigate the impact of CRRT commencement on urine output (UO).: Methods! ...

    Abstract Introduction: The effect of continuous renal replacement therapy (CRRT) on renal function is poorly understood. However, the initiation of CRRT may induce oliguria. We aimed to investigate the impact of CRRT commencement on urine output (UO).
    Methods: This was a retrospective cohort study in two intensive care units. We included all patients who underwent CRRT and collected data on hourly UO and fluid balance before and after CRRT commencement. We performed an interrupted time series analysis using segmented regression to assess the relationship between CRRT commencement and UO.
    Results: We studied 1,057 patients. Median age was 60.7 years (interquartile range [IQR], 48.3-70.6), and the median APACHE III was 95 (IQR, 76-115). Median time to CRRT was 17 h (IQR, 5-49). With start of CRRT, the absolute difference in mean hourly UO and mean hourly fluid balance was -27.0 mL/h (95% CI: -32.1 to -21.8; p value < 0.01) and - 129.3 mL/h (95% CI: -169.2 to -133.3), respectively. When controlling for pre-CRRT temporal trends and patient characteristics, there was a rapid post-initiation decrease in UO (-0.12 mL/kg/h; 95% CI: -0.17 to -0.08; p value < 0.01) and fluid balance (-78.1 mL/h; 95% CI: -87.9 to -68.3; p value < 0.01), which was sustained over the first 24 h of CRRT. Change in UO and fluid balance were only weakly correlated (r -0.29; 95% CI: -0.35 to -0.23; p value < 0.01).
    Conclusion: Commencement of CRRT was associated with a significant decrease in UO that could not be explained by extracorporeal fluid removal.
    MeSH term(s) Humans ; Middle Aged ; Acute Kidney Injury/therapy ; Continuous Renal Replacement Therapy ; Critical Illness/therapy ; Renal Replacement Therapy ; Retrospective Studies ; Water-Electrolyte Balance ; Aged
    Language English
    Publishing date 2023-04-18
    Publishing country Switzerland
    Document type Multicenter Study ; Journal Article
    ZDB-ID 605548-5
    ISSN 1421-9735 ; 0253-5068
    ISSN (online) 1421-9735
    ISSN 0253-5068
    DOI 10.1159/000530146
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  9. Article ; Online: How a positive fluid balance develops in acute kidney injury: A binational, observational study.

    White, Kyle C / Serpa-Neto, Ary / Hurford, Rod / Clement, Pierre / Laupland, Kevin B / Ostermann, Marlies / Sanderson, Barnaby / Gatton, Michelle / Bellomo, Rinaldo

    Journal of critical care

    2024  , Page(s) 154809

    Abstract: Purpose: A positive fluid balance (FB) is associated with harm in intensive care unit (ICU) patients with acute kidney injury (AKI). We aimed to understand how a positive balance develops in such patients.: Methods: Multinational, retrospective ... ...

    Abstract Purpose: A positive fluid balance (FB) is associated with harm in intensive care unit (ICU) patients with acute kidney injury (AKI). We aimed to understand how a positive balance develops in such patients.
    Methods: Multinational, retrospective cohort study of critically ill patients with AKI not requiring renal replacement therapy.
    Results: AKI occurred at a median of two days after admission in 7894 (17.3%) patients. Cumulative FB became progressively positive, peaking on day three despite only 848 (10.7%) patients receiving fluid resuscitation in the ICU. In those three days, persistent crystalloid use (median:60.0 mL/h; IQR 28.9-89.2), nutritional intake (median:18.2 mL/h; IQR 0.0-45.9) and limited urine output (UO) (median:70.8 mL/h; IQR 49.0-96.7) contributed to a positive FB. Although UO increased each day, it failed to match input, with only 797 (10.1%) patients receiving diuretics in ICU. After adjustment, a positive FB four days after AKI diagnosis was associated with an increased risk of hospital mortality (OR 1.12;95% confidence intervals 1.05-1.19;p-value <0.001).
    Conclusion: Among ICU patients with AKI, cumulative FB increased after diagnosis and was associated with an increased risk of mortality. Continued crystalloid administration, increased nutritional intake, limited UO, and minimal use of diuretics all contributed to positive FB.
    Key points: Question How does a positive fluid balance develop in critically ill patients with acute kidney injury? Findings Cumulative FB increased after AKI diagnosis and was secondary to persistent crystalloid fluid administration, increasing nutritional fluid intake, and insufficient urine output. Despite the absence of resuscitation fluid and an increasing cumulative FB, there was persistently low diuretics use, ongoing crystalloid use, and a progressive escalation of nutritional fluid therapy. Meaning Current management results in fluid accumulation after diagnosis of AKI, as a result of ongoing crystalloid administration, increasing nutritional fluid, limited urine output and minimal diuretic use.
    Language English
    Publishing date 2024-04-11
    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.2024.154809
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    Zs.A 2152: Show issues Location:
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  10. Article ; Online: 90-day Case-Fatality in Critically ill Patients with Chronic Liver Disease Influenced by Presence of Portal Hypertension, Results from a Multicentre Retrospective Cohort Study.

    White, Kyle / Tabah, Alexis / Ramanan, Mahesh / Shekar, Kiran / Edwards, Felicity / Laupland, Kevin B

    Journal of intensive care medicine

    2022  Volume 38, Issue 1, Page(s) 5–10

    Abstract: Background: Critical illness in patients with chronic liver disease (CLD) is increasing in occurrence, and by virtue of its adverse effect on prognosis, its presence may influence the decision to offer admission to intensive care units (ICU). Our ... ...

    Abstract Background: Critical illness in patients with chronic liver disease (CLD) is increasing in occurrence, and by virtue of its adverse effect on prognosis, its presence may influence the decision to offer admission to intensive care units (ICU). Our objective was to examine the determinants and outcome of patients with CLD admitted to ICU.
    Methods: A retrospective cohort of patients admitted to four adult ICUs in Queensland, Australia from 2017 to 2019. Patients with mild or moderate-severe CLD were defined by the absence and presence of portal hypertension, respectively, and were was determined using granular ICU and state-wide administrative databases. The primary outcome was 90-day all cause case-fatality.
    Results: We included 3836 patients in the analysis, of which, 60 (2%) had mild liver disease and 132 (3%) had moderate-severe liver disease . Patients with CLD had higher incidence of other co-morbidities with the median adjusted-Charlson co-morbidity index (CCI) was 1 (interquartile range; IQR 0-3) for no CLD, 2 (IQR 1.5-4) for mild CLD, and 3 (IQR 2-5) for moderate-severe CLD. Case-fatality rates at 90 days was 17% for no CLD, 25% for mild CLD, and 41% for moderate-severe CLD. Among those with mild and moderate-severe CLD, an increased co-morbidity burden as measured by an adjusted CCI score of low (0-3), medium (4-5), high (6-7) and very high (>7) resulted in increasing case-fatality rates of 24-40%, 11-28.5%, 33-62%, and 50% respectively. Moderate-severe CLD, but not mild CLD, was independently associated with increased case-fatality at 90 days (Odds Ratio 1.58; 95% confidence interval 1.01-2.48; p = 0.004) after adjusting for medical co-morbidities and severity of illness using logistic regression analysis.
    Conclusions: Although patients with moderate-severe CLD have an increased risk for 90-day case-fatality, patients with mild CLD are not at higher risk for death following ICU admission.
    MeSH term(s) Adult ; Humans ; Critical Illness ; Retrospective Studies ; Intensive Care Units ; Cohort Studies ; Hypertension, Portal/complications
    Language English
    Publishing date 2022-07-26
    Publishing country United States
    Document type Multicenter Study ; Journal Article
    ZDB-ID 632828-3
    ISSN 1525-1489 ; 0885-0666
    ISSN (online) 1525-1489
    ISSN 0885-0666
    DOI 10.1177/08850666221100408
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