scholarly journals Sedation and Delirium in the Intensive Care Unit: An Australian and New Zealand Perspective

2008 ◽  
Vol 36 (4) ◽  
pp. 570-578 ◽  
Author(s):  
Y. Shehabi ◽  
J. A. Botha ◽  
M. S. Boyle ◽  
D. Ernest ◽  
R. C. Freebairn ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand

Māori health outcomes in an intensive care unit in Aotearoa New Zealand

2021 ◽  
pp. 0310057X2198971
Author(s):  
M Atif Mohd Slim ◽  
Hamish M Lala ◽  
Nicholas Barnes ◽  
Robert A Martynoga
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand ◽  
Renal Replacement Therapy ◽  
Confidence Interval ◽  
Health Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
One Year ◽  
Maori Health

Māori are the indigenous people of New Zealand, and suffer disparate health outcomes compared to non-Māori. Waikato District Health Board provides level III intensive care unit services to New Zealand’s Midland region. In 2016, our institution formalised a corporate strategy to eliminate health inequities for Māori. Our study aimed to describe Māori health outcomes in our intensive care unit and identify inequities. We performed a retrospective audit of prospectively entered data in the Australian and New Zealand Intensive Care Society database for all general intensive care unit admissions over 15 years of age to Waikato Hospital from 2014 to 2018 ( n = 3009). Primary outcomes were in–intensive care unit and in-hospital mortality. The secondary outcome was one-year mortality. In our study, Māori were over-represented relative to the general population. Compared to non-Māori, Māori patients were younger (51 versus 61 years, P < 0.001), and were more likely to reside outside of the Waikato region (37.2% versus 28.0%, P < 0.001) and in areas of higher deprivation ( P < 0.001). Māori had higher admission rates for trauma and sepsis ( P < 0.001 overall) and required more renal replacement therapy ( P < 0.001). There was no difference in crude and adjusted mortality in–intensive care unit (16.8% versus 16.5%, P = 0.853; adjusted odds ratio 0.98 (95% confidence interval 0.68 to 1.40)) or in-hospital (23.7% versus 25.7%, P = 0.269; adjusted odds ratio 0.84 (95% confidence interval 0.60 to 1.18)). One-year mortality was similar (26.1% versus 27.1%, P=0.6823). Our study found significant ethnic inequity in the intensive care unit for Māori, who require more renal replacement therapy and are over-represented in admissions, especially for trauma and sepsis. These findings suggest upstream factors increasing Māori risk for critical illness. There was no difference in mortality outcomes.

Qua pote quisque, in ea conterat arte diem: COVID-19 and Australian and New Zealand intensive care

2020 ◽  
Vol 22 (2) ◽  
pp. 103-104
Author(s):  
Andrew Udy ◽  
◽  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand ◽  
Severe Acute Respiratory Syndrome ◽  
Clinical Care ◽  
Public Health Emergency ◽  
Care Practice ◽  
Health Care Practice

The current global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has thrust intensive care medicine to the forefront of health care practice in Australia and New Zealand. Indeed, reports from other countries and jurisdictions convey highly confronting statistics about the scale of this public health emergency, particularly in terms of the demand on intensive care unit (ICU)services. Whether this occurs here remains to be seen, although if such a scenario does eventuate, it will represent an unprecedented challenge to our community. In parallel, these events offer the opportunity for greater coordination, improved communication, and innovation in clinical care, which are principles that in many ways define our specialty.

Intensive care unit strain and mortality risk in patients admitted from the ward in Australia and New Zealand

2021 ◽  
Author(s):  
Shailesh Bihari ◽  
Patrick McElduff ◽  
Jim Pearse ◽  
Owen Cho ◽  
David Pilcher
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand ◽  
Mortality Risk

scholarly journals Defining fluid removal in the intensive care unit: A national and international survey of critical care practice

2017 ◽  
Vol 18 (4) ◽  
pp. 282-288 ◽  
Author(s):  
Michael E O’Connor ◽  
Sarah L Jones ◽  
Neil J Glassford ◽  
Rinaldo Bellomo ◽  
John R Prowle
Keyword(s):  
Intensive Care Unit ◽  
United Kingdom ◽  
Intensive Care ◽  
New Zealand ◽  
Critically Ill ◽  
Fluid Overload ◽  
Venous Pressure ◽  
Diuretic Therapy ◽  
Care Practice ◽  
Fluid Removal

Design and objectives To identify and compare how intensive care unit specialists in the United Kingdom and Australia and New Zealand self-reportedly define, assess and manage fluid overload in critically ill patients using a structured online questionnaire. Results We assessed 219 responses. Australia and New Zealand and United Kingdom intensive care unit specialists reported using clinical examination findings, bedside tools and radiological features to assess fluid status, diagnose fluid overload and initiate fluid removal in the critically ill. An elevated central venous pressure is not regarded as helpful in diagnosing fluid overload and targeting a clinician-set fluid balance is the most popular management strategy. Renal replacement therapy is used ahead of more diuretic therapy in patients who are oligo/anuric, or when diuretic therapy has not generated an adequate response. Conclusions This self-reported account of practice by United Kingdom and Australia and New Zealand intensivists demonstrates that fluid overload remains poorly defined with variability in both management and practice.

Admission time to hospital: a varying standard for a critical definition for admissions to an intensive care unit from the emergency department

2014 ◽  
Vol 38 (5) ◽  
pp. 575
Author(s):  
Shane Nanayakkara ◽  
Heike Weiss ◽  
Michael Bailey ◽  
Allison van Lint ◽  
Peter Cameron ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand ◽  
Length Of Stay ◽  
Performance Indicators ◽  
Decision Method ◽  
Admission Time ◽  
Definition Of ◽  
Time Of Admission ◽  
The Impact

Objective Time spent in the emergency department (ED) before admission to hospital is often considered an important key performance indicator (KPI). Throughout Australia and New Zealand, there is no standard definition of ‘time of admission’ for patients admitted through the ED. By using data submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database, the aim was to determine the differing methods used to define hospital admission time and assess how these impact on the calculation of time spent in the ED before admission to an intensive care unit (ICU). Methods Between March and December of 2010, 61 hospitals were contacted directly. Decision methods for determining time of admission to the ED were matched to 67787 patient records. Univariate and multivariate analyses were conducted to assess the relationship between decision method and the reported time spent in the ED. Results Four mechanisms of recording time of admission were identified, with time of triage being the most common (28/61 hospitals). Reported median time spent in the ED varied from 2.5 (IQR 0.83–5.35) to 5.1 h (2.82–8.68), depending on the decision method. After adjusting for illness severity, hospital type and location, decision method remained a significant factor in determining measurement of ED length of stay. Conclusions Different methods are used in Australia and New Zealand to define admission time to hospital. Professional bodies, hospitals and jurisdictions should ensure standardisation of definitions for appropriate interpretation of KPIs as well as for the interpretation of studies assessing the impact of admission time to ICU from the ED. What is known about the topic? There are standards for the maximum time spent in the ED internationally, but these standards vary greatly across Australia. The definition of such a standard is critically important not only to patient care, but also in the assessment of hospital outcomes. Key performance indicators rely on quality data to improve decision-making. What does this paper add? This paper quantifies the variability of times measured and analyses why the variability exists. It also discusses the impact of this variability on assessment of outcomes and provides suggestions to improve standardisation. What are the implications for practitioners? This paper provides a clearer view on standards regarding length of stay in the ICU, highlighting the importance of key performance indicators, as well as the quality of data that underlies them. This will lead to significant changes in the way we standardise and interpret data regarding length of stay.

scholarly journals Evidence of High Mortality and Increasing Burden of Sepsis in a Regional Sample of the New Zealand Population

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Paul J Huggan ◽  
Anita Bell ◽  
James Waetford ◽  
Zuzanna Obertova ◽  
Ross Lawrenson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand ◽  
Multiorgan Failure ◽  
Age Groups ◽  
Admission Rate ◽  
The United States ◽  
Population Based ◽  
Socioeconomic Deprivation ◽  
Zealand Population

Abstract Background Sepsis is a life-threatening complication of infection. The incidence of sepsis is thought to be on the increase, but estimates making use of administrative data in the United States may be affected by administrative bias. Methods We studied the population-based incidence of sepsis in the Waikato region of New Zealand from 2007 to 2012 using International Classification of Diseases, Tenth Revision, Australian Modification, which lacks a specific code for sepsis. Results Between 2007 and 2012, 1643 patients met coding criteria for sepsis in our hospitals. Sixty-three percent of patients were 65 or over, 17% of cases were admitted to an intensive care unit, and the in-hospital and 1-year mortality with sepsis was 19% and 38%, respectively. Age-standardized rate ratios (ASRRs) demonstrated that sepsis was associated with male sex (ASRR 1.4; 95% confidence interval [CI], 1.23–1.59), Maori ethnicity (ASRR 3.22 compared with non-Maori; 95% CI, 2.85–3.65), study year (ASRR 1.62 comparing 2012 with 2008; 95% CI, 1.18–2.24), and socioeconomic deprivation (ASRR 1.72 comparing the highest with the lowest quintile of socioeconomic deprivation; 95% CI, 1.5–1.97). Multiorgan failure was present in approximately 20% of cases in all age groups. Intensive care unit admission rate fell from 30% amongst 25- to 34-year-olds to less than 10% amongst those aged 75 and over. Conclusions In a 9% sample of the New Zealand population, the incidence of sepsis increased by 62% over a 5-year period. Maori, elderly, and disadvantaged populations were most affected.

scholarly journals Premature Personhoods In A Neonatal Intensive Care Unit In Aotearoa New Zealand

2021 ◽  
Author(s):  
◽  
Zoe Poppelwell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Participant Observation ◽  
Ethnographic Fieldwork ◽  
Ethnographic Interviews ◽  
Aotearoa New Zealand ◽  
One Year

<p>The Neonatal Intensive Care Unit (NICU) provides medical care for some of the most unwell newborns, including those born premature. Infants born prior to 28 completed weeks gestation, classified as extremely premature, often require long admissions and close management. These infants, and those who care for them, occupy a unique position of flux. The extremely premature body is not only a locus for clinical dialogue on the reach of biomedicine, but also for wider debates over the personhood of those born at the edge of viability. This thesis is an ethnographic account of some of the ways in which neonatal personhood was strategically articulated in the NICU at various points of the infant’s stay. These articulations, neither contingent nor dependent on the infant’s clinical position, illustrate a multiplicity of relational personhoods that exist alongside, and sometimes at tension with, individualised dynamics of care and emotion between infants, parents, and staff. I conducted over one year of ethnographic fieldwork, including six months of intensive participant observation at a single urban unit, and over 50 ethnographic interviews across New Zealand with a variety of individuals, such as NICU parents and staff. A portion of this thesis is also comprised of autoethnographic vignettes that account for my own neonatal journey and position in the field.</p>

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