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Blood flow rate and circuit life in continuous renal replacement therapy (CRRT): A pilot randomised controlled trial
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Papers and Poster Abstracts / Australian Critical Care 29 (2016) 110–123
Blood flow rate and circuit life in continuous renal replacement therapy (CRRT): A pilot randomised controlled trial Nigel Fealy 1,∗ , Leanne Aitken 2 , Eugene du Toit 3 , Ian Baldwin 4
An intervention to allow early speech in ventilated tracheostomy patients in an Australian Intensive Care Unit (ICU): A randomised controlled trial
1
Amy Freeman-Sanderson 1,2,∗ , Leanne Togher 2 , Mark Elkins 1,2 , Paul Phipps 1,2
2
1
Austin Health, Melbourne, Australia Griffith University, Brisbane, Australia 3 Griffith University, Gold Coast, Australia 4 Austin Health, Melbourne, Australia
There is variability in the practical prescription for CRRT and minimal evidence to inform basic settings such as blood flow rate (BFR). Blood flow is important for solute control and may also have an association with circuit clotting and premature CRRT failure. The purpose of this pilot study was to collect data and assess the feasibility for a larger randomised controlled trial (RCT) investigating the impact of BFR on circuit life in patients treated with CRRT. A prospective RCT conducted over one year in a tertiary ICU in Melbourne. Adult patients with acute kidney injury requiring CRRT were randomised to a BFR of either 150 mls/min or 250 mls/min. Circuit and patient data were collected until the circuit was clotted according to a standardised definition, or ceased electively for other reasons. Duration data are presented as median (inter-quartile range) and differences were examined using Mann–Whitney U, p < 0.05 was considered significant. One hundred patients were randomised with 96 completing the study (150 mls/min–49; 250 mls/min–47). Groups were well matched for baseline characteristics with the exception that patients in the 150 mls/min group were slightly heavier (83.5 vs. 75.8 kg, p = 0.039). The primary outcome measure of filter life for the first circuit prior to failing or clotting was not different (150 mls/min: 9.1 [5.5, 26] hrs vs. 10 [4.2, 17] hrs; p = 0.367). Kaplan Meier survival for the first circuit also did not differ between groups (p = 0.45). BFR was not associated with any effect on circuit life. A power calculation from these results indicate a sample size of 465 patients would be required to assess the impact of BFR on circuit life more definitively. The methodology used in this study would be valuable in the preparation of a larger RCT. http://dx.doi.org/10.1016/j.aucc.2015.12.011
Royal Prince Alfred Hospital, Camperdown, Australia 2 University of Sydney, Sydney, Australia Winner: Best Allied Health Paper sponsored by
Introduction: Loss of voice results from insertion of a tracheostomy tube and inflation of the cuff. Lack of voice is a major source of increased stress and frustration, being described by patients as one of the worst aspects of ICU. Use of speaking valves is common once a patient has commenced weaning from mechanical ventilation. Early speech intervention (ESI) for return of voice is possible with use of an in-line speaking valve. The effect of ESI on time to return to speaking, safety, length of stay and quality of life (QOL) has not been published. Study objectives: To compare the effects of early verses standard intervention for return of voice in mechanically ventilated tracheostomy patients. Methods: A randomised trial of ESI versus standard management for tracheostomy patients was conducted in the ICU at Royal Prince Alfred Hospital, Australia. ESI included cuff deflation and use of the Passy Muir ventilation and speaking valve during mechanical ventilation. Standard management was cuff deflation and use of a Portex-orator speaking valve during self-ventilation. A Speech Pathologist provided all interventions. Results: Thirty participants were randomly allocated into two equal groups. The primary outcome measure was time from tracheostomy insertion to phonation. ESI significantly hastened return to phonation (median difference = 11 days, Hazard ratio = 3.66, 95% CI = 1.54–8.68). ESI however did not significantly affect duration of tracheostomy cannulation, ventilation, length of stay or safety. ESI did significantly improve domains of communication-related QOL. Conclusion(s): ESI allowed earlier return of voice which improves communication effectiveness and greater patient participation in their care. This may have been the mechanism by which ESI also improved QOL. These benefits were achieved without any adverse events or detriment to the other secondary outcomes. ESI should be considered for ventilated tracheostomy patients within an ICU setting. http://dx.doi.org/10.1016/j.aucc.2015.12.012
Papers and Poster Abstracts / Australian Critical Care 29 (2016) 110–123
Blood flow rate and circuit life in continuous renal replacement therapy (CRRT): A pilot randomised controlled trial Nigel Fealy 1,∗ , Leanne Aitken 2 , Eugene du Toit 3 , Ian Baldwin 4
An intervention to allow early speech in ventilated tracheostomy patients in an Australian Intensive Care Unit (ICU): A randomised controlled trial
1
Amy Freeman-Sanderson 1,2,∗ , Leanne Togher 2 , Mark Elkins 1,2 , Paul Phipps 1,2
2
1
Austin Health, Melbourne, Australia Griffith University, Brisbane, Australia 3 Griffith University, Gold Coast, Australia 4 Austin Health, Melbourne, Australia
There is variability in the practical prescription for CRRT and minimal evidence to inform basic settings such as blood flow rate (BFR). Blood flow is important for solute control and may also have an association with circuit clotting and premature CRRT failure. The purpose of this pilot study was to collect data and assess the feasibility for a larger randomised controlled trial (RCT) investigating the impact of BFR on circuit life in patients treated with CRRT. A prospective RCT conducted over one year in a tertiary ICU in Melbourne. Adult patients with acute kidney injury requiring CRRT were randomised to a BFR of either 150 mls/min or 250 mls/min. Circuit and patient data were collected until the circuit was clotted according to a standardised definition, or ceased electively for other reasons. Duration data are presented as median (inter-quartile range) and differences were examined using Mann–Whitney U, p < 0.05 was considered significant. One hundred patients were randomised with 96 completing the study (150 mls/min–49; 250 mls/min–47). Groups were well matched for baseline characteristics with the exception that patients in the 150 mls/min group were slightly heavier (83.5 vs. 75.8 kg, p = 0.039). The primary outcome measure of filter life for the first circuit prior to failing or clotting was not different (150 mls/min: 9.1 [5.5, 26] hrs vs. 10 [4.2, 17] hrs; p = 0.367). Kaplan Meier survival for the first circuit also did not differ between groups (p = 0.45). BFR was not associated with any effect on circuit life. A power calculation from these results indicate a sample size of 465 patients would be required to assess the impact of BFR on circuit life more definitively. The methodology used in this study would be valuable in the preparation of a larger RCT. http://dx.doi.org/10.1016/j.aucc.2015.12.011
Royal Prince Alfred Hospital, Camperdown, Australia 2 University of Sydney, Sydney, Australia Winner: Best Allied Health Paper sponsored by
Introduction: Loss of voice results from insertion of a tracheostomy tube and inflation of the cuff. Lack of voice is a major source of increased stress and frustration, being described by patients as one of the worst aspects of ICU. Use of speaking valves is common once a patient has commenced weaning from mechanical ventilation. Early speech intervention (ESI) for return of voice is possible with use of an in-line speaking valve. The effect of ESI on time to return to speaking, safety, length of stay and quality of life (QOL) has not been published. Study objectives: To compare the effects of early verses standard intervention for return of voice in mechanically ventilated tracheostomy patients. Methods: A randomised trial of ESI versus standard management for tracheostomy patients was conducted in the ICU at Royal Prince Alfred Hospital, Australia. ESI included cuff deflation and use of the Passy Muir ventilation and speaking valve during mechanical ventilation. Standard management was cuff deflation and use of a Portex-orator speaking valve during self-ventilation. A Speech Pathologist provided all interventions. Results: Thirty participants were randomly allocated into two equal groups. The primary outcome measure was time from tracheostomy insertion to phonation. ESI significantly hastened return to phonation (median difference = 11 days, Hazard ratio = 3.66, 95% CI = 1.54–8.68). ESI however did not significantly affect duration of tracheostomy cannulation, ventilation, length of stay or safety. ESI did significantly improve domains of communication-related QOL. Conclusion(s): ESI allowed earlier return of voice which improves communication effectiveness and greater patient participation in their care. This may have been the mechanism by which ESI also improved QOL. These benefits were achieved without any adverse events or detriment to the other secondary outcomes. ESI should be considered for ventilated tracheostomy patients within an ICU setting. http://dx.doi.org/10.1016/j.aucc.2015.12.012