Andrew Hilton
Austin Hospital
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Publication
Featured researches published by Andrew Hilton.
American Journal of Cardiology | 2011
Dion Stub; Christopher L. Hengel; William Chan; Damon Jackson; Karen Sanders; Anthony M. Dart; Andrew Hilton; Vincent Pellegrino; James Shaw; S. Duffy; Stephen Bernard; David M. Kaye
Survival rates after out-of-hospital cardiac arrest (OHCA) continue to be poor. Recent evidence suggests that a more aggressive approach to postresuscitation care, in particular combining therapeutic hypothermia with early coronary intervention, can improve prognosis. We performed a single-center review of 125 patients who were resuscitated from OHCA in 2 distinct treatment periods, from 2002 to 2003 (control group) and from 2007 to 2009 (contemporary group). Patients in the contemporary group had a higher prevalence of cardiovascular risk factors but similar cardiac arrest duration and prehospital treatment (adrenaline administration and direct cardioversion). Rates of cardiogenic shock (48% vs 41%, p = 0.2) and decreased conscious state on arrival (77% vs 86%, p = 0.2) were similar in the 2 cohorts, as was the incidence of ST-elevation myocardial infarction (33% vs 43%, p = 0.1). The contemporary cohort was more likely to receive therapeutic hypothermia (75% vs 0%, p <0.01), coronary angiography (77% vs 45%, p <0.01), and percutaneous coronary intervention (38% vs 23%, p = 0.03). This contemporary therapeutic strategy was associated with better survival to discharge (64% vs 39%, p <0.01) and improved neurologic recovery (57% vs 29%, p <0.01) and was the only independent predictor of survival (odds ratio 5.5, 95% confidence interval 1.2 to 26.2, p = 0.03). Longer resuscitation time, presence of cardiogenic shock, and decreased conscious state were independent predictors of poor outcomes. In conclusion, modern management of OHCA, including therapeutic hypothermia and early coronary angiography is associated with significant improvement in survival to hospital discharge and neurologic recovery.
Critical Care | 2012
Andrew Hilton; Rinaldo Bellomo
Resuscitation of septic patients by means of one or more fluid boluses is recommended by guidelines from multiple relevant organizations and as a component of surviving sepsis campaigns. The technique is considered a key and life-saving intervention during the initial treatment of severe sepsis in children and adults. Such recommendations, however, are only based on expert opinion and lack adequate experimental or controlled human evidence. Despite these limitations, fluid bolus therapy (20 to 40 ml/kg) is widely practiced and is currently considered a cornerstone of the management of sepsis. In this pointof-view critique, we will argue that such therapy has weak physiological support, has limited experimental support, and is at odds with emerging observational data in several subgroups of critically ill patients or those having major abdominal surgery. Finally, we will argue that this paradigm is now challenged by the findings of a large randomized controlled trial in septic children. In the present article, we contend that the concept of large fluid bolus resuscitation in sepsis needs to be investigated further.
Critical Care | 2011
Andrew Hilton; Rinaldo Bellomo
The need for early, rapid, and substantial fluid resuscitation in septic patients has long been an article of faith in the intensive care community, a tribal totem that is taboo to question. The results of a recent multicenter trial in septic children in Africa, published in The New England Journal of Medicine, powerfully challenge the fluid paradigm. The salient aspects of the trial need to be understood and reflected upon. In this commentary, we discuss the background to and findings of the trial and explain why they will likely trigger a re-evaluation of our thinking about fluids in sepsis, a re-evaluation that is already happening in the treatment of acute respiratory distress syndrome and acute kidney injury and in postoperative care.
Critical Care | 2013
Andrew Hilton; Daryl Jones; Rinaldo Bellomo
In-hospital end-of-life care outside the ICU is a new and increasing aspect of practice for intensive care physicians in countries where rapid response teams have been introduced. As more of these patients die from withdrawal or withholding of artificial life support, determining whether a patient is dying or not has become as important to intensivists as the management of organ support therapy itself. Intensivists have now moved to making such decisions in hospital wards outside the boundaries of their usual closely monitored environment. This strategic change may cause concern to some intensivists; however, as custodians of the highest technology area in the hospital, intensivists are by necessity involved in such processes. Now, more than ever before, intensive care clinicians must consider the usefulness of key concepts surrounding nosocomial death and dying and the importance and value of making a formal diagnosis of dying in the wards. In this article, we assess the conceptual background, reference points, challenges and implications of these emerging aspects of intensive care medicine.
Critical Care | 2017
Sam Orde; Michel Slama; Andrew Hilton; Konstantin Yastrebov; Anthony S. McLean
Critical care echocardiography is developing rapidly with an increasing number of specialists now performing comprehensive studies using Doppler and other advanced techniques. However, this imaging can be challenging, interpretation is far from simple in the complex critically ill patient and mistakes can be easy to make. We aim to address clinically relevant areas where potential errors may occur and suggest methods to hopefully improve accuracy of imaging and interpretation.
Internal Medicine Journal | 2016
G Fennessy; Andrew Hilton; Samuel T Radford; Rinaldo Bellomo; Daryl Jones
The epidemiology of in‐hospital cardiac arrests (IHCA) in Australia and New Zealand (ANZ) has not been systematically assessed.
Journal of Critical Care | 2017
Ida F. Ukor; Andrew Hilton; Michael Bailey; Rinaldo Bellomo
Purpose: This pilot study aimed to characterise the haemodynamic effect of 1L of IV normal saline (NS) administered as a rapid versus slow infusion on cardiac output (CO), heart rate (HR), systemic blood pressures, and carotid blood flow in six healthy volunteers. Materials and methods: Six healthy male volunteers aged 18–65 years were randomized to receive 1L NS given over 30 min or 120 min. On a subsequent study session the alternate fluid regimen was administered. Haemodynamic data was gathered using a non‐invasive finger arterial pressure monitor (Nexfin®), echocardiography and carotid duplex sonography. Time to micturition and urine volume was also assessed. Results: Compared to baseline, rapid infusion of 1 L of saline over 30 min produced a fall in Nexfin®‐measured CO by 0.62 L/min (p < 0.001), whereas there was a marginal but significant increase during infusion of 1L NS over 120 min of 0.02 L/min (p < 0.001). This effect was mirrored by changes in HR and blood pressure (BP) (p < 0.001). There were no significant changes in carotid blood flow, time to micturition, or urine volume produced. Conclusions: Slower infusion of 1L NS in healthy male volunteers produced a greater increase in CO, HR and BP than rapid infusion. HIGHLIGHTSA randomized crossover controlled interventional volunteer studyComparison of rapid versus slower infusion of 1L IV crystalloidSignificantly greater non‐invasively measured CO, HR, and BP effects demonstratedFurther investigation of these comparative effects in patients is needed
Journal of Cardiothoracic and Vascular Anesthesia | 2016
Ulrike Weber; Neil J. Glassford; Glenn M. Eastwood; Rinaldo Bellomo; Andrew Hilton
OBJECTIVES To estimate carotid and brachial artery blood flow with Doppler ultrasound in cardiac surgery patients and relate such estimates to cardiac index, lactate levels, and markers of renal function. DESIGN A prospective observational study. SETTING A teaching hospital. PARTICIPANTS Twenty-five elective cardiac surgery patients. INTERVENTIONS The authors measured bilateral carotid and brachial artery blood flows using Doppler ultrasound and, simultaneously, cardiac index using a pulmonary artery catheter; lactate and serum creatinine levels; and urine output. The relationship between these indices and biomarkers was assessed statistically. MEASUREMENTS AND MAIN RESULTS Median carotid arterial blood flow was estimated at 0.323 L/min (interquartile ratio [IQR], 0.256-0.429 L/min) on the right and 0.308 L/min (IQR, 0.247-0.376 L/min) on the left at baseline. Median brachial arterial blood flow was estimated at 0.063 L/min (IQR, 0.039-0.115 L/min) on the right and 0.063 L/min (IQR, 0.039-0.081 L/min) on the left at baseline. There was a weak correlation between right- and left-sided flows (brachial: rho = 0.285; carotid: rho = 0.384) and between brachial and carotid flow (right: rho = 0.135, left: rho = 0.225). There also was a weak correlation between cardiac index and brachial flow (right: rho = 0.215; left: rho = 0.320) and carotid flow (left: rho = 0.159) immediately after surgery, and no correlation 1 day after surgery (right brachial: rho = -0.010; left brachial: rho = -0.064; left carotid: rho = -0.060). There were no significant correlations between carotid or brachial flows and lactate and serum creatinine levels or urine output. CONCLUSIONS In cardiac surgery patients, Doppler-estimated carotid and brachial arterial blood flows have only a weak correlation with cardiac index and no correlation with lactate or creatinine levels or urine output. Thus, Doppler estimation of these blood flows cannot be used to provide noninvasive estimates of cardiac index in patients after cardiac surgery.
Anaesthesia | 2015
Ulrike Weber; Neil J. Glassford; Glenn M. Eastwood; Rinaldo Bellomo; Andrew Hilton
We measured carotid and brachial artery blood flow by Doppler ultrasound in 11 human volunteers, and related these to cardiac index and to each other. The median (IQR [range]) carotid arterial blood flow was 0.334 (0.223–0.381 [0.052–0.563]) l.min−1 on the right and 0.315 (0.223–0.369 [0.061–0.690]) l.min−1 on the left. The brachial arterial blood flow was 0.049 (0.033–0.062 [0.015–0.204]) l.min−1 on the right and 0.039 (0.027–0.054 [0.011–0.116]) on the left. Cardiac index was 3.2 (2.8–3.5 [1.9–5.4]) l.min−1.m−2. There was a moderate to good correlation between right‐and left‐sided flows (brachial: ρ = 0.45; carotid: ρ = 0.567). Brachial and carotid flow had no or a negative correlation with cardiac index (right brachial: ρ = −0.145, left brachial: ρ = −0.349; right carotid: ρ = −0.376, left carotid: ρ = −0.285). In contrast to some previous studies, we found that Doppler‐estimated peripheral arterial blood flows only show a weak correlation with cardiac index and cannot be used to provide non‐invasive estimates of cardiac index in man.
Current Opinion in Critical Care | 2013
G Godfrey; Andrew Hilton; Rinaldo Bellomo
Purpose of reviewDecisions to limit life-sustaining therapy (DLLST) in the ICU are used to uphold patients’ autonomy, protect them from non-beneficial treatment and fairly distribute resources. The institution of these decisions is complex, with a variety of qualitative and quantitative data published. This review aims to summarize the main issues and review the contemporary research findings on this subject. Recent findingsDLLST are used in a variety of clinical and non-clinical situations, before and after ICU admission, and are not always part of end-of-life management. There are many dilemmas and barriers that beset their institution. Many ICU physicians feel inadequately trained to carry them out and they are frequently a source of conflict. A variety of strategies have been examined to improve their institution, including advanced directives, intensive communication strategies and family information leaflets, many of which have improved patient and family-centred outcomes. SummaryThere are a number of uncertainties that beset the institution of DLLST in the ICU; however, a variety of research has improved our ability to understand and implement them. This review frames some of the dilemmas and discusses some of the procedural strategies that have been used to improve outcomes.