Shay McGuinness
A5062745789- Respiratory Support and Mechanisms
- Cardiac Arrest and Resuscitation
- Sepsis Diagnosis and Treatment
- Acute Kidney Injury Research
- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Mechanical Circulatory Support Devices
- Intensive Care Unit Cognitive Disorders
- Cardiac, Anesthesia and Surgical Outcomes
- Antibiotics Pharmacokinetics and Efficacy
- Hemodynamic Monitoring and Therapy
- COVID-19 Clinical Research Studies
- Airway Management and Intubation Techniques
- Blood transfusion and management
- Antibiotic Use and Resistance
- Renal function and acid-base balance
- Nosocomial Infections in ICU
- Vitamin C and Antioxidants Research
- Long-Term Effects of COVID-19
- Cardiac and Coronary Surgery Techniques
- Electrolyte and hormonal disorders
- Dialysis and Renal Disease Management
- Anesthesia and Sedative Agents
- Obstructive Sleep Apnea Research
- Cardiac Structural Anomalies and Repair
- Muscle and Compartmental Disorders
Auckland City Hospital
2016-2025
Monash University
2015-2025
Monash Health
2025
Medical Research Institute of New Zealand
2015-2024
Australian and New Zealand Intensive Care Society
2014-2024
University Health Network
2021-2024
Sunnybrook Health Science Centre
2021-2024
Mater Misericordiae University Hospital
2024
North York General Hospital
2024
Monash Medical Centre
2024
The efficacy of interleukin-6 receptor antagonists in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear.We evaluated tocilizumab and sarilumab an ongoing international, multifactorial, adaptive platform trial. Adult Covid-19, within 24 hours after starting organ support the intensive care unit (ICU), were randomly assigned to receive (8 mg per kilogram body weight), (400 mg), or standard (control). primary outcome was respiratory cardiovascular support-free days, on...
The safety and efficacy of hydroxyethyl starch (HES) for fluid resuscitation have not been fully evaluated, adverse effects HES on survival renal function reported.We randomly assigned 7000 patients who had admitted to an intensive care unit (ICU) in a 1:1 ratio receive either 6% with molecular weight 130 kD molar substitution 0.4 (130/0.4, Voluven) 0.9% sodium chloride or (saline) all until ICU discharge, death, 90 days after randomization. primary outcome was death within days. Secondary...
The novel influenza A(H1N1) pandemic affected Australia and New Zealand during the 2009 southern hemisphere winter. It caused an epidemic of critical illness some patients developed severe acute respiratory distress syndrome (ARDS) were treated with extracorporeal membrane oxygenation (ECMO).To describe characteristics all A(H1N1)-associated ARDS ECMO to report incidence, resource utilization, patient outcomes.An observational study (n = 68) in 15 intensive care units (ICUs) between June 1...
The optimal intensity of continuous renal-replacement therapy remains unclear. We conducted a multicenter, randomized trial to compare the effect this therapy, delivered at two different levels intensity, on 90-day mortality among critically ill patients with acute kidney injury.We randomly assigned adults injury in form postdilution venovenous hemodiafiltration an effluent flow either 40 ml per kilogram body weight hour (higher intensity) or 25 (lower intensity). primary outcome measure was...
<h3>Importance</h3> Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. <h3>Objective</h3> To determine whether hydrocortisone improves outcome patients with COVID-19. <h3>Design, Setting, and Participants</h3> An ongoing adaptive platform trial testing multiple interventions within therapeutic domains, example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 June 17, 2020, 614 adult suspected confirmed COVID-19 were enrolled...
Guidelines to promote the early recovery of patients undergoing major surgery recommend a restrictive intravenous-fluid strategy for abdominal surgery. However, supporting evidence is limited, and there concern about impaired organ perfusion.
<h3>Importance</h3> Saline (0.9% sodium chloride) is the most commonly administered intravenous fluid; however, its use may be associated with acute kidney injury (AKI) and increased mortality. <h3>Objective</h3> To determine effect of a buffered crystalloid compared saline on renal complications in patients admitted to intensive care unit (ICU). <h3>Design Setting</h3> Double-blind, cluster randomized, double-crossover trial conducted 4 ICUs New Zealand from April 2014 through October 2014....
The effect of a restrictive versus liberal red-cell transfusion strategy on clinical outcomes in patients undergoing cardiac surgery remains unclear.In this multicenter, open-label, noninferiority trial, we randomly assigned 5243 adults who had European System for Cardiac Operative Risk Evaluation (EuroSCORE) I 6 or more (on scale from 0 to 47, with higher scores indicating risk death after surgery) threshold (transfuse if hemoglobin level was <7.5 g per deciliter, starting induction...
Tranexamic acid reduces the risk of bleeding among patients undergoing cardiac surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic may have prothrombotic and proconvulsant effects.In a trial with 2-by-2 factorial design, we randomly assigned who were scheduled undergo coronary-artery surgery at for perioperative complications receive aspirin or placebo placebo. The results comparison reported here. primary outcome was composite...
Surgical occlusion of the left atrial appendage has been hypothesized to prevent ischemic stroke in patients with fibrillation, but this not proved. The procedure can be performed during cardiac surgery undertaken for other reasons.
Acute kidney injury is common in critically ill patients, many of whom receive renal-replacement therapy. However, the most effective timing for initiation such therapy remains uncertain.
The aim of this prospective study was to determine whether a level positive airway pressure generated in participants receiving nasal high flow (NHF) delivered by the Optiflow system (Fisher and Paykel Healthcare Ltd, Auckland, New Zealand) cardiothoracic vascular intensive care unit (ICU).Nasopharyngeal measured 15 postoperative cardiac surgery adult patients who received both NHF standard facemask therapy at rate 35 litre min(-1). Measurements were repeated open mouth closed positions....
Patients who are undergoing mechanical ventilation in the intensive care unit (ICU) often receive a high fraction of inspired oxygen (Fio2) and have arterial tension. The conservative use may reduce exposure, diminish lung systemic oxidative injury, thereby increase number ventilator-free days (days alive free from ventilation).
<h3>BACKGROUND:</h3> Nasal high-flow oxygen therapy increases the mean nasopharyngeal airway pressure in adults, but relationship between flow and is not well defined. <h3>OBJECTIVE:</h3> To determine with Optiflow nasal system. <h3>METHODS:</h3> We invited patients scheduled for elective cardiac surgery to participate. Measurements were performed at flows of 30, 40, 50 L/min, patient9s mouth both open closed. Pressures recorded over one minute breathing, average calculated via simple...
There is broad interest in improved methods to generate robust evidence regarding best practice, especially settings where patient conditions are heterogenous and require multiple concomitant therapies. Here, we present the rationale design of a large, international trial that combines features adaptive platform trials with pragmatic point-of-care determine treatment strategies for patients admitted an intensive care unit severe community-acquired pneumonia. The uses novel design, entitled...
<h3>BACKGROUND:</h3> Nasal high flow (NHF) oxygen therapy and CPAP are modes of noninvasive respiratory support used to improve function in multiple patient groups. Both therapies provide positive pressure, although this varies during the cycle. The purpose study was measure compare airway pressure generated different phases cycle patients receiving NHF at various gas flows. <h3>METHODS:</h3> Patients scheduled for elective cardiac surgery were invited participate. Nasopharyngeal...
Rationale: Current practices regarding mechanical ventilation in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown.Objectives: To report current ECMO severe (ARDS) and their association 6-month outcomes.Methods: This was an international, multicenter, prospective cohort study of undergoing ARDS during a 1-year period 23 international ICUs.Measurements Main Results: We collected demographics, daily pre- per-ECMO settings use...
Studies that have evaluated the use of intravenous vitamin C in adults with sepsis who were receiving vasopressor therapy intensive care unit (ICU) shown mixed results respect to risk death and organ dysfunction.
We reported previously that, in patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive transfusion strategy was noninferior to liberal with respect the composite outcome of death from any cause, myocardial infarction, stroke, or new-onset renal failure dialysis by hospital discharge 28 days after surgery, whichever came first. now report clinical outcomes 6 months surgery.
Acetaminophen is a common therapy for fever in patients the intensive care unit (ICU) who have probable infection, but its effects are unknown.We randomly assigned 700 ICU with (body temperature, ≥38°C) and known or suspected infection to receive either 1 g of intravenous acetaminophen placebo every 6 hours until discharge, resolution fever, cessation antimicrobial therapy, death. The primary outcome was ICU-free days (days alive free from need care) randomization day 28.The number 28 did...
Proton pump inhibitors (PPIs) or histamine-2 receptor blockers (H2RBs) are often prescribed for patients as stress ulcer prophylaxis drugs in the intensive care unit (ICU). The comparative effect of these on mortality is unknown.To compare in-hospital rates using PPIs vs H2RBs prophylaxis.Cluster crossover randomized clinical trial conducted at 50 ICUs 5 countries between August 2016 and January 2019. Patients requiring invasive mechanical ventilation within 24 hours ICU admission were...
Abstract Background The efficacy of interleukin-6 receptor antagonists in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear. Methods We evaluated tocilizumab and sarilumab an ongoing international, multifactorial, adaptive platform trial. Adult Covid-19, within 24 hours commencing organ support intensive care unit, were randomized to receive either (8mg/kg) or (400mg) standard (control). primary outcome was ordinal scale combining in-hospital mortality (assigned −1)...