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| 1 | Prognostic factors associated with hospital survival in comatose survivors of cardiac arrest显示文摘AIM: To identify patient, cardiac arrest and management factors associated with hospital survival in comatose survivors of cardiac arrest.METHODS: A retrospective, single centre study of comatose patients admitted to our intensive care unit(ICU) following cardiac arrest during the twenty year period between 1993 and 2012. This study was deemed by the Human Research Ethics Committee(HREC) of Monash Health to be a quality assurance exercise, and thus did not require submission to the Monash Health HREC(Research Project Application, No. 13290Q). The study population included all patients admitted to ourICU between 1993 and 2012, with a discharge diagnosis including 'cardiac arrest'. Patients were excluded if they did not have a cardiac arrest prior to ICU admission(i.e.,if their primary arrest was during their admission to ICU),or were not comatose on arrival to ICU. Our primary outcome measure was survival to hospital discharge.Secondary outcome measures were ICU and hospita length of stay(LOS), and factors associated with surviva to hospital discharge.RESULTS: Five hundred and eighty-two comatose patients were admitted to our ICU following cardiac arrest, with 35% surviving to hospital discharge. The median ICU and hospital LOS was 3 and 5 d respectively.There was no survival difference between in-hospital and out-of-hospital cardiac arrests. Males made up 62% of our cardiac arrest population, were more likely to have a shockable rhythm(56% vs 37%, P < 0.001), and were more likely to survive to hospital discharge(40%vs 28%, P = 0.006). On univariate analysis, therapeutic hypothermia, regardless of method used(e.g., rapid infusion of ice cold fluids, topical ice, 'Arctic Sun', passive rewarming, 'Bair Hugger') and location initiated(e.g.,pre-hospital, emergency department, intensive care) was associated with increased survival. There was however no difference in survival associated with target temperature,time at target temperature, location of initial cooling,method of initiating cooling, method of maintaining cooling or method of rewarming. Patients that survived were more likely to have a shockable rhythm(P < 0.001),shorter time to return of spontaneous circulation(P <0.001), receive therapeutic hypothermia(P = 0.03), be of male gender(P = 0.006) and have a lower APACHEⅡ score(P < 0.001). After multivariate analysis, only a shockable initial rhythm(OR = 6.4, 95%CI: 3.95-10.4;P < 0.01) and a shorter time to return of spontaneous circulation(OR = 0.95, 95%CI: 0.93-0.97; P < 0.01) was found to be independently associated with survival to hospital discharge.CONCLUSION: In comatose survivors of cardiac arrest, shockable rhythm and shorter time to return of spontaneous circulation were independently associated with increased survival to hospital discharge. | Kushaharan Sathianathan Ravindranath Tiruvoipati Sanjiv Vij | 2016 | World Journal of Critical Care Medicine2016，5，1： | 3 |
| 2 | Serum bicarbonate may independently predict acute kidney injury in critically ill patients:An observational study显示文摘AIM: To explore whether serum bicarbonate at admission to intensive care unit(ICU) predicted development of acute kidney injury(AKI).METHODS:We studied all patients admitted to our ICU over a 2 year period(February 2010 to 2012).The ICU has a case mix of medical and surgical patients excluding cardiac surgical,trauma and neurosurgical patients.We analysed 2035 consecutive patients admitted to ICU during the study period.Data were collected by two investigators independently and in duplicate using a standardised spread sheet to ensure accuracy.Ambiguous data were checked for accuracy where indicated.AKI was defined using the Kidney Disease Improving Global Outcomes criteria.Patients were divided into two groups;patients who developed AKI or those who did not,in order to compare the baseline characteristics,and laboratory and physiologic data of the two cohorts.Regression analysis was used to identify if serum bicarbonate on admission predicted the development of AKI.RESULTS:Of 2036 patients 152(7.5%)were excluded due to missing data.AKI developed in 43.1%of the patients.The AKI group,compared to the nonAKI group,was sicker based on their lower systolic,diastolic and mean arterial pressures and a higher acutephysiology and chronic health evaluation(APACHE)Ⅲand SAPSⅡscores.Moreover,patients who developed AKI had more co-morbidities and a higher proportion of patients who developed AKI required mechanical ventilation.The multi-regression analysis of independent variables showed that serum bicarbonate on admission(OR=0.821;95%CI:0.796-0.846;P<0.0001),APACHEⅢ(OR=1.011;95%CI:1.007-1.015;P<0.0001),age(OR=1.016;95%CI:1.008-1.024;P<0.0001)and presence of sepsis at ICU admission(OR=2.819;95%CI:2.122-23.744;P=0.004)were each significant independent predictors of AKI.The area under the ROC curve was 0.8(95%CI:0.78-0.83),thereby demonstrating that the predictive model has relatively good discriminating power for predicting AKI.CONCLUSION:Serum bicarbonate on admission may independently be used to make a diagnosis of AKI. | Anuksha Gujadhur Ravindranath Tiruvoipati Elizabeth Cole Saada Malouf Erum Sahid Ansari Kim Wong | 2015 | World Journal of Critical Care Medicine2015，4，1： | 3 |
| 3 | Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure(CESAR):a multicentre randomised controlled trial显示文摘 | Peek GJ Mugford M Tiruvoipati R | 2009 | Lancet2009，374，9698： | 1 |
| 4 | Coronary endarterectomy in the current era显示文摘 | Tiruvoipati R Loubani M Peek G | 2005 | Curr Opin Cardiol2005，20，6： | 1 |
| 5 | Extracorpore-al membrane oxygenation with lepirudin anticoagulation for Wegener' s granulomatosis with heparin induced thrombocytopenia 显示文摘 | Balasubramanian SK Tiruvoipati R Chatterjee S | 2005 | ASAIO J2005，51，4： | 1 |
| 6 | Coronary endarterecto- my: impact on morbidity and mortality when combined with coro- nary artery bypass surgery显示文摘 | Tiruvoipati R Loubani M Lencioni M | 2005 | Ann Thorac Surg2005，79，6： | 1 |
| 7 | Coronary endarterec- tomy: impact on morbidity and mortality when combined with coro- nary artery bypass surgery 显示文摘 | Tiruvoipati R Loubani M Lencioni M | 2005 | Ann Thorac Surg2005，79，6： | 1 |
| 8 | Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR):a multicentre randomised controlled trial显示文摘 | Peek GJ Mugford M Tiruvoipati R | 2009 | Lancet2009，374，： | 1 |
| 9 | Efficacy and economic assessment of conventional ventilatory support versus extraorporeal membrane oxygenation for severe adult respiratory failure (CESAR):a multicentre randomised controlled trial显示文摘 | Peek GJ Mugford M Tiruvoipati R | 2009 | Lancet2009，17，374： | 1 |
| 10 | Efficacy and economicassessment of conventional ventilatory support versus extracorporealmembrane oxygenation for severe adult respiratory failure(CESAR) : a multicentre randomised controlled trial显示文摘 | Peek GJ Mugford M Tiruvoipati R | 2009 | Lancet2009，374，9698： | 1 |
| 11 | Efficacy andeconomic assessment of conventional ventilatory support versusextracorporeal membrane oxygenation for severe adult respiratoryfailure (CESAR) : a multicentre randomised controlled trial 显示文摘 | Peek GJ Mugford M Tiruvoipati R | 2009 | Lancet2009，374，9698： | 1 |
| 12 | Hypothermia predicts mortality in critically ill elderly patients with sepsis 显示文摘 | Tiruvoipati R Ong K Gangopadhyay H | 2010 | BMC Geriatrics2010，10，： | 1 |
| 13 | Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR) : a muhicentre randomised controlled trial 显示文摘 | Peek G J Mugford M Tiruvoipati R | 2009 | Lancet2009，374，9698： | 1 |
| 14 | Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support显示文摘 | Sendhil K Balasubramanian M Ravindranath Tiruvoipati | 2007 | Journal of Cardiothoracic Surgery2007，2，1： | 1 |
| 15 | Efficacy of prone ventilation in adult patients with acute respiratory failure: a rectaanalysis 显示文摘 | Tiruvoipati R Bangash M Manktelow B | 2008 | JCrit Care2008，23，1： | 1 |
| 16 | Efficacy and economic assessnlent of conventional ventilatory support versus extracor- poreal membrane oxygenation for severe adult respiratory failure(CESAR) :a multieentre randomised controlled trial 显示文摘 | Peek GJ Mugford M Tiruvoipati R | 2009 | Lancet2009，374，9698： | 1 |
| 17 | Efficacy and eco- nomic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respira- tory failure (CESAR) : a multicentrerandomised controlled tri- al显示文摘 | Peek GJ Mugford M Tiruvoipati R | 2009 | Lancet2009，374，9698： | 1 |
| 18 | Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR):a multicentre randomised controlled trial显示文摘 | Peek GJ Mugford M Tiruvoipati R | 2009 | Lancet2009，374，9698： | 1 |
| 19 | Efficacy and economic assessment of conventional ventilator/support versus extraeorim- real membrane oxygenation for severe adult respiratory failure (CESAR) : a muhicentre randomised controlled trial 显示文摘 | Peek G J Mugford M Tiruvoipati R | 2009 | Lan- cet2009，374，9698： | 1 |
| 20 | Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomized controlled trial 显示文摘 | Peek GJ Mugford M Tiruvoipati R | 2009 | Lancet2009，374，： | 1 |
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