Papers by Marianne Chapman
Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2016
To determine the effect of calorie delivery on hospital mortality among critically ill adults rec... more To determine the effect of calorie delivery on hospital mortality among critically ill adults receiving enteral nutrition (EN). Secondary outcomes included the effect of calorie delivery on intensive care unit and hospital length of stay (LOS), duration of mechanical ventilation (MV) and incidence of new-onset pneumonia. We identified randomised clinical trials of EN, with or without supplemental parenteral nutrition (PN), involving adult ICU patients for whom mortality data were available, and when there was a significant difference in calorie supplementation between intervention arms (P < 0.05). We searched English language electronic databases (1946-2014), bibliographies of nutrition society guidelines and high-impact nutrition and critical care journals. We calculated summary odds ratio (OR) estimates and 95% confidence intervals using a random effects estimator, and used meta-regression to assess the effect on mortality of average calories delivered. Of 1545 articles identif...
Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2015
The JBI Database of Systematic Reviews and Implementation Reports, 2015
The New England journal of medicine, Jan 20, 2015
Background The appropriate caloric goal for critically ill adults is unclear. We evaluated the ef... more Background The appropriate caloric goal for critically ill adults is unclear. We evaluated the effect of restriction of nonprotein calories (permissive underfeeding), as compared with standard enteral feeding, on 90-day mortality among critically ill adults, with maintenance of the full recommended amount of protein in both groups. Methods At seven centers, we randomly assigned 894 critically ill adults with a medical, surgical, or trauma admission category to permissive underfeeding (40 to 60% of calculated caloric requirements) or standard enteral feeding (70 to 100%) for up to 14 days while maintaining a similar protein intake in the two groups. The primary outcome was 90-day mortality. Results Baseline characteristics were similar in the two groups; 96.8% of the patients were receiving mechanical ventilation. During the intervention period, the permissive-underfeeding group received fewer mean (±SD) calories than did the standard-feeding group (835±297 kcal per day vs. 1299±467 ...
International Journal of Language & Communication Disorders, 2016
Dysphagia is often a comorbidity in patients who require a tracheostomy, yet little is known abou... more Dysphagia is often a comorbidity in patients who require a tracheostomy, yet little is known about patterns of oral intake commencement in tracheostomized patients, or how patterns may vary depending on the clinical population and/or reason for tracheostomy insertion. To document patterns of clinical management around the commencement of oral intake throughout hospital admission and along the decannulation pathway in patients with a new tracheostomy, and to examine the nature of variability across multiple clinical populations. A 12-month retrospective review of 126 patients who had undergone an acute tracheostomy was conducted. Within the cohort, patients were further classified into eight clinical populations representing specialty areas within the tertiary referral centre. Data were collected on timing of milestones and patterns of clinical management related to oral and enteral feeding and decannulation. Relationships between temporal variables were calculated, in addition to descriptive analysis of the overall cohort and by clinical population. Median temporal markers of patient progression post-tracheostomy insertion for the cohort were: continuous cuff deflation after 7.5 days, commencement of oral intake after 10.5 days, decannulation after 15 days and cessation of enteral nutrition (EN) after 17 days. However, considerable individual variation and differences between clinical populations was observed. Overall, 86% of the cohort returned to oral intake, although 25% were discharged with EN via a gastrostomy. A total of 86% of the group were decannulated by hospital discharge. Oral intake was introduced at every stage of the decannulation pathway, including prior to cuff deflation, but the majority of patients commenced diet/fluids following cuff deflation or with an uncuffed tube in situ, and most patients who ceased EN did so following decannulation. Commencement of oral intake was evenly split between the intensive care unit (ICU) and the wards. Increased time to commencement of oral intake correlated with increased time to decannulation (r = .805, p = .001), and increased time to decannulation correlated with increased hospital length of stay (r = .687, p = .006). Whilst cohort patterns were observed within the heterogeneous group, sub-analysis revealed distinct patterns of oral intake management across the different clinical populations. The data provide benchmarks enabling comparison by overall cohort as well as by specialist clinical populations, each with differing reasons for tracheostomy insertion. The data would suggest that tracheostomy patients should not be looked upon as a singular cohort; rather, evaluation of factors with specific attention made to underlying aetiology and individual clinical presentation is essential.
Australian Critical Care, 2016
Tracheostomy cuff deflation is a necessary stage of the decannulation pathway, yet the optimal cl... more Tracheostomy cuff deflation is a necessary stage of the decannulation pathway, yet the optimal clinical indicators to guide successful cuff deflation are unknown. The study aims were to identify (1) the proportion of patients tolerating continuous cuff deflation at first attempt; (2) the clinical observations associated with cuff deflation success or failure, including volume of above cuff secretions and (3) the predictive capacity of these observations within a heterogeneous cohort. A retrospective review of 113 acutely tracheostomised patients with a subglottic suction tube in situ was conducted. Ninety-five percent of patients (n=107) achieved continuous cuff deflation on the first attempt. The clinical observations recorded as present in the 24h preceding cuff deflation included: (1) medical stability, (2) respiratory stability, (3) fraction of inspired oxygen ≤0.4, (4) tracheal suction ≤1-2 hourly, (5) sputum thin and easy to suction, (6) sputum clear or white, (7) ≥moderate cough strength, (8) above cuff secretions ≤1ml per hour and (9) alertness≥eyes open to voice. Using the presence of all 9 indicators as predictors of successful cuff deflation tolerance, specificity and positive predictive value were 100%, although sensitivity was only 77% and negative predictive value 19%. Refinement to a set of 3 clinically driven criteria (medical and respiratory stability, above cuff secretions ≤1ml/h) provided high specificity (100%), sensitivity (95%), positive predictive value (100%) and an improved negative predictive value (55%). Key criteria can help guide clinical decision-making on patient readiness for cuff deflation.
Respiratory care, Jan 9, 2016
Advancements in tracheostomy tube design now provide clinicians with a range of options to facili... more Advancements in tracheostomy tube design now provide clinicians with a range of options to facilitate communication for individuals receiving ventilator assistance through a cuffed tube. Little is known about the impact of these modern design features on resistance to air flow. We undertook a bench model test to measure pressure-flow characteristics and resistance of a range of tubes of similar outer diameter, including those enabling subglottic suction and speech. A constant inspiratory ± expiratory air flow was generated at increasing flows up to 150 L/min through each tube (with or without optional, mandatory, or interchangeable inner cannula). Driving pressures were measured, and resistance was calculated (cm H2O/L/s). Pressures changed with increasing flow (P < .001) and tube type (P < .001), with differing patterns of pressure change according to the type of tube (P < .001) and direction of air flow. The single-lumen reference tube encountered the lowest inspiratory a...
Diabetologia, 2016
In healthy individuals, both insulin and glucagon-like peptide 1 (GLP-1) are secreted in a pulsat... more In healthy individuals, both insulin and glucagon-like peptide 1 (GLP-1) are secreted in a pulsatile fashion. Insulin has greater glucose-lowering properties when administered in pulses compared with a constant i.v. infusion. The primary aim of this randomised double-dummy cross-over study was to compare the insulinotropic response to pulsatile and continuous i.v. infusions of equivalent doses of GLP-1. Twelve healthy participants aged 18-35 years were randomised to three different treatments on separate days: a continuous infusion day (GLP-1 at 0.6 pmol kg(-1) min(-1) [1 ml/min] and a 1 ml placebo bolus every 6 min); a pulsatile infusion day (placebo at 1 ml/min and a 3.6 pmol/kg GLP-1 bolus every 6 min); and a placebo day (placebo at 1 ml/min and a 1 ml placebo bolus every 6 min). Between 45 and 120 min, a hyperglycaemic clamp was used to maintain blood glucose at 9 mmol/l. Venous blood glucose and plasma insulin concentrations were measured every 5 min from 0 to 45 min and every 1 min from 45 to 120 min; plasma glucagon was measured every 15 min. The order of treatment was randomised by the Pharmacy Department and both study investigators and participants were blinded to the treatment arm. The dextrose requirement and glucagon data were analysed using repeated measures ANOVA and insulin data were analysed with a linear mixed effects maximum likelihood model. Continuous and pulsatile infusions of GLP-1 increased the dextrose requirement by ~threefold (p &amp;amp;amp;amp;amp;amp;lt; 0.001) and increased insulin secretion by ~ninefold (p &amp;amp;amp;amp;amp;amp;lt; 0.001). There was no difference in the effect of both treatments. Although hyperglycaemia reduced plasma glucagon concentrations, there was no difference between the treatment days. In healthy individuals, pulsatile and continuous administration of i.v. GLP-1 appears to have comparable insulinotropic effects. ACTRN12612001040853 FUNDING: This study was supported by the National Health and Medical Research Council (NHMRC) of Australia.
Critical Care, 2015
Critical illness following head injury is associated with a hypermetabolic state but there are in... more Critical illness following head injury is associated with a hypermetabolic state but there are insufficient epidemiological data describing acute nutrition delivery to this group of patients. Furthermore, there is little information describing relationships between nutrition and clinical outcomes in this population. We undertook an analysis of observational data, collected prospectively as part of International Nutrition Surveys 2007-2013, and extracted data obtained from critically ill patients with head trauma. Our objective was to describe global nutrition support practices in the first 12 days of hospital admission after head trauma, and to explore relationships between energy and protein intake and clinical outcomes. Data are presented as mean (SD), median (IQR), or percentages. Data for 1045 patients from 341 ICUs were analyzed. The age of patients was 44.5 (19.7) years, 78 % were male, and median ICU length of stay was 13.1 (IQR 7.9-21.6) days. Most patients (94 %) were enterally fed but received only 58 % of estimated energy and 53 % of estimated protein requirements. Patients from an ICU with a feeding protocol had greater energy and protein intakes (p &amp;amp;amp;amp;amp;amp;lt;0.001, 0.002 respectively) and were more likely to survive (OR 0.65; 95 % CI 0.42-0.99; p = 0.043) than those without. Energy or protein intakes were not associated with mortality. However, a greater energy and protein deficit was associated with longer times until discharge alive from both ICU and hospital (all p &amp;amp;amp;amp;amp;amp;lt;0.001). Nutritional deficits are commonplace in critically ill head-injured patients and these deficits are associated with a delay to discharge alive.
The Medical Journal of Australia, Nov 1, 2002
To determine the incidence and appropriateness of use of allogenic packed red blood cell (RBC) tr... more To determine the incidence and appropriateness of use of allogenic packed red blood cell (RBC) transfusion in Australian and New Zealand intensive care practice. Intensive care units of 18 Australian and New Zealand hospitals: March 2001. Prospective, observational, multicentre study. All admissions to participating intensive care units were screened and all patients who received a transfusion of RBC were enrolled. The indications for transfusion were recorded and compared with Australian National Health and Medical Research Council guidelines. Transfusions conforming to these guidelines were deemed appropriate. RBC transfusion in intensive care and transfusion appropriateness. 1808 admissions to intensive care units were screened: 357 (19.8%) admissions (350 patients) received an RBC transfusion while in intensive care. Overall, 1464 RBC units were administered in intensive care on 576 transfusion days. The most common indications for transfusion were acute bleeding (60.1%; 880/1464) and diminished physiological reserve (28.9%; 423/1464). The rate of inappropriate transfusion was 3.0% (44/1464). Diminished physiological reserve with haemogloblin level &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 100 g/L was the indication in 50% (22/44) of inappropriate transfusions; no indication was provided for 31% (15/44). The rate of inappropriate transfusion in Australian and New Zealand intensive care units in 2001 was remarkably low.
Australian Critical Care, 2014
Background: There is a high risk of post-traumatic stress disorder (PTSD) in relatives of intensi... more Background: There is a high risk of post-traumatic stress disorder (PTSD) in relatives of intensive care unit (ICU) patients. Aims: To determine the prevalence and predictors of symptoms of PTSD in relatives of an Australian critically ill population. Methods: 108 consecutive patients staying >48 h in a mixed, level three ICU were identified. On day three of admission, their next-of-kin were contacted and consent obtained for a telephonic questionnaire to be done at 90 days after ICU discharge. This consisted of the Hospital Anxiety and Depression Scale and the Impact of Event Scale-Revised (IES-R) questionnaires administered to relatives at 90 days post-discharge from the ICU. An IES-R score of >26 was used to define PTSD symptoms. Results: Eight subjects were excluded because the next-of-kin details were unavailable. 37 other subjects refused to participate. Out of a total of 108, 63 family members were included, including 49 next-ofkin of patients who survived. The prevalence of PTSD symptoms was 41.2% (26/63, 95% CI 29.0-54.4%). The anxiety score was found to be a predictor of PTSD symptoms (relative risk = 1.07; 95% CI 1.00-1.14, p = 0.05). Conclusion: There is a high prevalence of PTSD symptoms in next-of-kin of Australian patients admitted to the ICU. High anxiety scores were a predictor for developing PTSD symptoms.
Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine
The Medical journal of Australia
TRANSFUSION OF ALLOGENIC packed red blood cells (RBC) is common in intensive care units (ICU), bu... more TRANSFUSION OF ALLOGENIC packed red blood cells (RBC) is common in intensive care units (ICU), but prospective epidemiological data, both national and international, are lacking. In one retrospective study, more than 70% of patients with a length of stay in an intensive care unit of longer than one week received an RBC transfusion, 1 and in a study examining ICU transfusion practice and mortality a third of all ICU admissions received an RBC transfusion. Concerns about the rate of inappropriate transfusion exist, particularly g i ve n t h e r e c o g n i s e d r i s k s o f transfusion 3 and the decreasing availability of donor blood. 4 Previous studies of RBC transfusion in Australian hospitals have found rates of inappropriate transfusion between 16% and 30%. We conducted a prospective, multicentre, observational study to determine the incidence, indications and appropriateness of RBC transfusions in Australasian intensive care practice.
Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine
Critical Care Medicine
ABSTRACT
Anaesthesia and intensive care
Nutritional support is routine practice in critically ill patients and enteral feeding is preferr... more Nutritional support is routine practice in critically ill patients and enteral feeding is preferred to the parenteral route. However this direct delivery of nutrients to the gut is potentially ineffective for a variety of reasons. We performed a prospective audit of 40 consecutive intensive care patients to determine whether enteral feeding met the nutritional requirements of our patients. The ideal requirements for each patient were calculated using the Harris-Benedict equation with an adjustment determined by the patient's diagnosis. We compared the amount of feed delivered with the daily requirements over a seven-day period. Successful feeding was defined as the achievement of 90% of the ideal calorie requirement for two consecutive days. The mean calculated (±SD) energy requirement was 9566kJ (±2586). Patients received only 51% (SD 38) of their energy requirements throughout the study period. Only 10 patients (25%) were successfully fed for at least any two-day period in the seven days. Feeding was limited mainly by gastrointestinal dysfunction or by the need to fast the patient for medical, surgical and airway procedures. Success of feeding was not related to the use of sedative or paralysing agents and had no correlation with plasma albumin concentration. There was no difference in the volume of feed delivered to patients who survived or died. Prokinetic agents were used in 25 patients and in these patients there was a trend towards improved delivery of feed.
The Lancet
Background Low-dose dopamine is commonly administered to critically ill patients in the belief th... more Background Low-dose dopamine is commonly administered to critically ill patients in the belief that it reduces the risk of renal failure by increasing renal blood flow. However, these effects have not been established in a large randomised controlled trial, and use of dopamine remains controversial. We have done a multicentre, randomised, double-blind, placebo-controlled study of low-dose dopamine in patients with at least two criteria for the systemic inflammatory response syndrome and clinical evidence of early renal dysfunction (oliguria or increase in serum creatinine concentration). Methods 328 patients admitted to 23 participating intensive-care units (ICUs) were randomly assigned a continuous intravenous infusion of tow-dose dopamine (2 mug kg(-1) min(-1)) or placebo administered through a central venous catheter while in the ICU. The primary endpoint was the peak serum creatinine concentration during the infusion. Analyses excluded four patients with major protocol violation...
Clinical endocrinology, Jan 20, 2014
Corticosteroid-binding globulin (CBG) is cleaved by neutrophil elastase converting the high-affin... more Corticosteroid-binding globulin (CBG) is cleaved by neutrophil elastase converting the high-affinity (haCBG) conformation of CBG to a low-affinity (laCBG) conformation with a ninefold reduced cortisol-binding affinity. These in vitro data suggest that cortisol release by CBG cleavage results in the targeted delivery of cortisol to areas of inflammation. Our objective was to determine whether CBG cleavage alters circulating levels of haCBG and laCBG in vivo in proportion to sepsis severity. Prospective, observational cohort study in an adult tertiary level Intensive Care Unit in Adelaide, Australia. Thirty-three patients with sepsis or septic shock grouped by illness severity [sepsis, septic shock survivors, septic shock nonsurvivors and other shock]. Plasma levels of haCBG and laCBG were assessed using a recently developed in-house assay in patients. Plasma total and free cortisol levels were also measured. Plasma total CBG and haCBG levels fell significantly, in proportion to disea...
Anaesthesia and intensive care, 2012
The aim of this study was to explore the degree and determinants of satisfaction of family member... more The aim of this study was to explore the degree and determinants of satisfaction of family members of patients being cared for in an Australasian intensive care unit. This was a prospective observational study that took place within a mixed medical/surgical, level three intensive care unit. One hundred and eight family members of patients staying in the intensive care for more than 48 hours were identified. Eight were excluded because next of kin contact details were unavailable. A questionnaire was posted to next of kin four weeks after intensive care unit discharge. Subjects who had not responded after four weeks were contacted by telephone and, if consent was given, a phone questionnaire was performed. Evidence of family meetings with the social worker or medical staff was sought in the patients' case notes retrospectively. Family satisfaction was measured using a 10-item questionnaire incorporating visual analogue scales. Seven subjects refused to participate. Fifty-nine res...
The Medical journal of Australia, Jan 18, 2002
To determine the incidence and appropriateness of use of allogenic packed red blood cell (RBC) tr... more To determine the incidence and appropriateness of use of allogenic packed red blood cell (RBC) transfusion in Australian and New Zealand intensive care practice. Intensive care units of 18 Australian and New Zealand hospitals: March 2001. Prospective, observational, multicentre study. All admissions to participating intensive care units were screened and all patients who received a transfusion of RBC were enrolled. The indications for transfusion were recorded and compared with Australian National Health and Medical Research Council guidelines. Transfusions conforming to these guidelines were deemed appropriate. RBC transfusion in intensive care and transfusion appropriateness. 1808 admissions to intensive care units were screened: 357 (19.8%) admissions (350 patients) received an RBC transfusion while in intensive care. Overall, 1464 RBC units were administered in intensive care on 576 transfusion days. The most common indications for transfusion were acute bleeding (60.1%; 880/146...
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Papers by Marianne Chapman