The specialty of intensive care medicine is characterised by rapid changes and constant evolution. Especially over the past two decades, the direction of the specialty in Australia and New Zealand has been very much directed toward an expansion of services to the rest of the hospital, particularly in the form of the Medical Emergency Team (MET), even in the paediatric world. 1
Gelbart B, Vidmar S, Stephens D, et al. Characteristics and outcomes of children receiving intensive care therapy within 12 hours following a medical emergency team event. Crit Care Resusc 2021; 23: 254-61
In many teaching hospitals, MET calls now exceed 3000 a year and highlight the need to further improve safety in hospital wards. In this issue of CCR, the Austin Health Critical Care Outreach Physician Investigators 2report the first findings on the new concept of the critical care outreach physician. As highlighted in the accompanying editorial, 3this new function of the intensive care team is now developing in Victoria and may represent yet another major way in which the intensive care unit (ICU) provides pervasive preventive assessment, care, and rescue for deteriorating ward patients. It may be that a major aspect of the future of the specialty is not in the ICU but outside!
Austin Health Critical Care Outreach Physician (CCOP) Investigators. Features and perceptions of a critical care outreach physician role. Crit Care Resusc 2021; 23: 248-53
Presneill J. Critical care reaching out (further) to help? Crit Care Resusc 2021; 23: 243-4
Like METs, organ donation is another key function that has been taken over by the intensive care team. 4, 5Thus, the implications of the new Victoria Human Tissue Amendment Act 2020(Vic) are of great interest as reviewed by Philpot and Anderson. 6
Radford S, D’Costa R, Opdam H, et al. The impact of organ donation specialists on consent rates in challenging organ donation conversations. Crit Care Resusc 2020; 22: 297-302
D’Costa RL, Radford S, Opdam H, et al. Expedited organ donation in Victoria, Australia: donor characteristics and donation outcomes. Crit Care Resusc 2020; 22: 303-11
Philpot S, Anderson D. The ethical and legal implications of the Human Tissue Amendment Act 2020 (Vic). Crit Care Resusc 2021; 23: 245-7
CCR has been committed to the publication of protocols and statistical analysis plans of pivotal Australian and New Zealand trials and results of phase 2 studies. 7, 8, 9, 10This is because they highlight the role that our two countries have had and continue to have in evidence-based medicine. In this issue, we present both the TEAM trial 11and BLING III trial protocols. 12
Billot L, Bellomo R, Gallagher M, et al. The Plasma-Lyte 148 versus saline (PLUS) statistical analysis plan: a multicenter randomized controlled trial of the effect of intensive care fluid therapy on mortality. Crit Care Resusc 2021; 23: 24-31
Winearls J, Wullschleger M, Wake E, et al. Fibrinogen early in severe trauma study (FEISTY): results from an Australian multicenter randomized controlled trial. Crit Care Resusc 2021; 23: 32-46
Gibbons KS, Schlapbach LJ, Horton SB, et al. Statistical analysis plan for the NITRIC oxide during cardiopulmonary bypass to improve recovery in infants with congenital heart disease (NITRIC) trial. Crit Care Resusc 2021; 23: 47-58
SuDDICU Investigators. Protocol summary and statistical analysis plan for the selective decontamination of the digestive tract in intensive care unit patients (SuDDICU) cross over, cluster randomized controlled trial. Crit Care Resusc 2021; 23: 183-193
Presneill JJ, Bellomo R, Brickell K, et al. Protocol and statistical analysis plan for the phase 3 randomised controlled Treatment of Invasively Ventilated Adults with Early Activity and Mobilisation (TEAM III) trial. Crit Care Resusc 2021; 23: 262-72
Billot L, Lipman J, Brett SJ, et al. Statistical analysis plan for the BLING III study: a phase 3 multicentre randomised controlled trial of continuous versus intermittent β-lactam antibiotic infusion in critically ill patients with sepsis. Crit Care Resusc 2021; 23: 273-84
Assessment of quality of care and performance and safety are also part of the intensive care community 13and are highlighted by articles on hospital-acquired complications of critical illness, 14interhospital transport of sick children, 15and assessment of ICU activity and strain. 16
Tseitkin B, Martensson J, Eastwood GM, et al. Nature and impact of in-hospital complications associated with persistent critical illness. Crit Care Resusc 2020; 22: 378-87
Duke G, Shann F, Knott C, et al. Hospital-acquired complications in critically ill patients. Crit Care Resusc 2021; 23: 285-91
Fahey KP, Gelbart B, Oberender F, et al. Interhospital transport of children with bronchiolitis by a statewide emergency transport service. Crit Care Resusc 2021; 23: 292-9
Pilcher DV, Duke G, Rosenow M, et al. Assessment of a novel marker of ICU strain, the ICU Activity Index, during the COVID-19 pandemic in Victoria, Australia. Crit Care Resusc 2021; 23: 300-7
Coronavirus disease 2019 (COVID-19) has been a dominant topic in the pages of CCRsince the onset of the pandemic. 17, 18, 19, 20, 21, 22, 23In this issue, Burrell and colleagues 24present the changes in patient characteristics and outcomes between the first and the second wave of COVID-19 in Australia.
Zangrillo A, Colombo S, Scandroglio AM, et al. Angiotensin II infusion and markers of organ function in invasively ventilated COVID-19 patients. Crit Care Resusc 2021; 23: 215-24
Nguyen T, Gupta S, Raman J et al. Geolocated twitter-based population mobility in Victoria, Australia during the stages COVID-19 restrictions. Crit Care Resusc 2020; 22: 293-4
Martensson J, Engerstrom L, Walther S, et al. COVID-19 critical illness in Sweden: characteristics and outcomes at a national population level. Crit Care Resusc 2020; 22: 312-20
Zangrillo A, Beretta L, Scandroglio AM, et al. Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy. Crit Care Resusc 2020; 22: 200-11
Monti G, Cremona G, Zangrillo A, et al Home ventilators for invasive ventilation of patients with COVID-19. Crit Care Resusc 2020; 22: 266-70
Coombes ID, Dooley MJ, Townsend S, et al. Physician drug prescribing preferences and availability for ventilation of patients with COVID-19. Crit Care Resusc 2020; 22: 271-4
Ling L, So C, Shum HP, et al. Criticlaly ill patients with COVID-19 in Hong Kong: a multicenter retrospective observational cohort study. Crit Care Resusc 2020; 22: 119-25
Burrell AJC, Serpa Neto A, Broadley T, et al. Comparison of baseline characteristics, treatment and clinical outcomes of critically ill COVID-19 patients admitted in the first and second waves in Australia. Crit Care Resusc 2021; 23: 308-19
The importance and the optimal use of albumin have been the subject of several recent investigations in CCR. 25, 26, 27In this issue, Yanase et al 28study the importance of the speed of albumin fluid bolus administration in cardiac surgery patients.
Cutuli S, Bitker L, Osawa E, et al. Haemodynamic effect of a 20% albumin fluid bolus in post-cardiac surgery patients. Crit Care Resusc 2020; 22: 15-25
Bihari S, Bannard-Smith J, Bellomo R. Albumin as a drug: its biological effects beyond volume expansion. Crit Care Resusc 2020; 22: 257-65
Yanase F, Cutuli SL, Naorungroj T, et al. Temperature and haemodynamic effects of a 100 mL bolus of 20% albumin at room versus body temperature in cardiac surgery patients. Crit Care Resusc 2021; 23: 14-23
Yanase F, Naorungroj T, Cutuli SL, et al. Rapid 500 mL albumin bolus versus rapid 200 mL bolus followed by slower continuous infusion in post-cardiac surgery patients: a pilot before-and-after study. Crit Care Resusc 2021; 23: 320-8
Higgins and colleagues 29focus on the cost-effectiveness of early goal-directed resuscitation, and Thomson et al 30report on sepsis in Indigenous Australians. Both are important health economics and quality of care indicators.
Higgins AM, Peake SL, Bellomo R, et al. The cost-effectiveness of early goal-directed therapy: an economic evaluation alongside the ARISE trial . Crit Care Resusc 2021; 23: 329-36
Thompson KJ, Finfer SR, Coombes J, et al. Incidence and outcomes of sepsis in Aboriginal and Torres Strait Islander and non-Indigenous residents of New South Wales: population-based cohort study. Crit Care Resusc 2021; 23: 337-45
Finally, the monitoring and importance of the vital sign of temperature has also been the focus of much research recently presented in CCR. 31, 32In this issue, Cutuli and colleagues 33present overwhelming evidence that non-invasive body temperature measurement is highly inaccurate in critically ill patients.
Cutuli S, See EJ, Osawa E, et al. Accuracy of non-invasive body temperature measurement methods in adult patients admitted to the intensive care unit: a systematic review and meta-analysis. Crit Care Resusc 2021; 23: 6-13
Anstey JR, Forrest PR, Cass H, et al. Sustained normothermia in septic shock and the energy transfer required: a report of a pilot feasibility study using newer generation surface cooling devices. Crit Care Resusc 2020; 23: 113-6
Cutuli SL, Osawa EA, Eyeington CT, et al. Accuracy of non-invasive body temperature measurement methods in critically ill patients: a prospective, bicentric, observational study. Crit Care Resusc 2021; 23: 346-53
Once again, CCR brings out the best of Australian and New Zealand research to its readers and tries to educate and trigger reflection and new ideas.