Dr Jorge Brieva

Dr Jorge Brieva

Conjoint Senior Lecturer

School of Medicine and Public Health

Career Summary

Biography

Completed Medical School at the University of Buenos Aires

Physician training in Argentina. Pulmonary & Critical Care at the Jackson Memorial Hospital in Miami, USA

Intensive care Medicine training in Australia. Fellow of the CICM


Keywords

  • Intensive Care Medicine

Languages

  • Spanish (Mother)

Professional Experience

Professional appointment

Dates Title Organisation / Department
1/2/2005 -  Senior Staff Specialist Intensive Care Unit, John Hunter Hospital
Australia
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Journal article (13 outputs)

Year Citation Altmetrics Link
2018 Potter JE, Perry L, Elliott RM, Aneman A, Brieva JL, Cavazzoni E, et al., 'Communication with Families Regarding Organ and Tissue Donation after Death in Intensive Care (COMFORT): A multicentre before-and-after study', Critical Care and Resuscitation, 20 268-276 (2018)

Objective: To implement a best-practice intervention offering deceased organ donation, testing whether it increased family consent rates. Design: A multicentre before-and-after st... [more]

Objective: To implement a best-practice intervention offering deceased organ donation, testing whether it increased family consent rates. Design: A multicentre before-and-after study of a prospective cohort compared with pre-intervention controls. Setting: Nine Australian intensive care units. Participants: Families and health care professionals caring for donor-eligible patients without registered donation preferences or aged = 16 years. Intervention: A multicomponent intervention including offers of deceased organ donation from specially trained designated requesters using a structured conversation separate to end-of-life discussions. Main outcome measure: Proportion of families consenting to organ donation. Results: Consent was obtained in 87/164 cases (53%) during the intervention period compared with 14/25 cases (56%) pre-intervention (P = 0.83). The odds ratio (OR) of obtaining consent during the intervention period relative to pre-intervention was 1.13 (95% CI, 0.48¿2.63; P = 0.78). During the intervention period, designated requesters obtained consent in 55/98 cases (56%), compared with 32/66 cases (48%) in which the medical team managing patient care raised donation (P = 0.34). Factors independently associated with increased consent were: family-raised organ donation (OR, 4.34; 95% CI, 1.79¿10.52; P = 0.001), presence of an independent designated requester (OR, 3.84; 95% CI, 1.35¿ 10.98; P = 0.012), and multiple donation conversations per case (OR, 3.35; 95% CI, 1.93¿5.81; P < 0.001). Consent decreased when patients were of non-Christian religion (OR, 0.18; 95% CI, 0.04¿0.91; P = 0.038) and end-of-life and donation meetings were separate (OR, 0.38; 95% CI, 0.16¿0.89; P = 0.026). Conclusion: Implementation of a multicomponent intervention did not increase consent rates for organ donation, although some components of the intervention exerted significant effect.

Citations Scopus - 7
2017 Potter JE, Herkes RG, Perry L, Elliott RM, Aneman A, Brieva JL, et al., 'COMmunication with Families regarding ORgan and Tissue donation after death in intensive care (COMFORT): Protocol for an intervention study', BMC Health Services Research, 17 (2017)

Background: Discussing deceased organ donation can be difficult not only for families but for health professionals who initiate and manage the conversations. It is well recognised... [more]

Background: Discussing deceased organ donation can be difficult not only for families but for health professionals who initiate and manage the conversations. It is well recognised that the methods of communication and communication skills of health professionals are key influences on decisions made by families regarding organ donation. Methods: This multicentre study is being performed in nine intensive care units with follow-up conducted by the Organ and Tissue Donation Service in New South Wales (NSW) Australia. The control condition is pre-intervention usual practice for at least six months before each site implements the intervention. The COMFORT intervention consists of six elements: family conversations regarding offers for organ donation to be led by a "designated requester"; family offers for donation are deferred to the designated requester; the offer of donation is separated from the end-of-life discussion that death is inevitable; it takes place within a structured family donation conversation using a "balanced" approach. Designated requesters may be intensivists, critical care nurses or social workers prepared by attending the three-day national "Family Donation Conversation" workshops, and the half-day NSW Simulation Program. The design is pre-post intervention to compare rates of family consent for organ donation six months before and under the intervention. Each ICU crosses from using the control to intervention condition after the site initiation visit. The primary endpoint is the consent rate for deceased organ donation calculated from 140 eligible next of kin families. Secondary endpoints are health professionals' adherence rates to core elements of the intervention; identification of predictors of family donation decision; and the proportion of families who regret their final donation decision at 90 days. Discussion: The pragmatic design of this study may identify 'what works' in usual clinical settings when requesting organ donation in critical care areas, both in terms of changes in practice healthcare professionals are willing and able to adopt, and the effect this may have on desired outcomes. The findings of this study will be indicative of the potential benefits of the intervention and be relevant and transferrable to clinical settings in other states and countries. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000815763 (24 July 2013). ClinicalTrials.gov: NCT01922310 (14 August 2013) (retrospectively registered).

DOI 10.1186/s12913-016-1964-7
Citations Scopus - 11
2014 Brieva J, Coleman N, Lacey J, Harrigan P, Lewin TJ, Carter GL, 'Prediction of death in less than 60 minutes after withdrawal of cardiorespiratory support in potential organ donors after circulatory death', Transplantation, 98 1112-1118 (2014) [C1]

Background: Given the stable number of potential organ donors after brain death, donors after circulatory death have been an increasing source of organs procured for transplant. A... [more]

Background: Given the stable number of potential organ donors after brain death, donors after circulatory death have been an increasing source of organs procured for transplant. Among the most important considerations for donation after circulatory death (DCD) is the prediction that death will occur within a reasonable period of time after the withdrawal of cardiorespiratory support (WCRS). Accurate prediction of time to death is necessary for the procurement process. We aimed to develop simple predictive rules for death in less than 60 min and test the accuracy of these rules in a pool of potential DCD donors. Methods: A multicenter prospective longitudinal cohort design of DCD eligible patients (n=318), with the primary binary outcome being death in less than 60 min after withdrawal of cardiorespiratory support conducted in 28 accredited intensive care units (ICUs) in Australia. We used a random split-half method to produce two samples, first to develop the predictive classification rules and then to estimate accuracy in an independent sample. Results: The best classification model used only three simple classification rules to produce an overall efficiency of 0.79 (0.72-0.85), sensitivity of 0.82 (0.73-0.90), and a positive predictive value of 0.80 (0.70-0.87) in the independent sample. Using only intensive care unit specialist prediction (a single classification rule) produced comparable efficiency 0.80 (0.73-0.86), sensitivity 0.87 (0.78-0.93), and positive predictive value 0.78 (0.68-0.86). Conclusion: This best predictive model missed only 18% of all potential donors. A positive prediction would be incorrect on only 20% of occasions, meaning there is an acceptable level of lost opportunity costs involved in the unnecessary assembly of transplantation teams and theatres.

DOI 10.1097/TP.0000000000000186
Citations Scopus - 15Web of Science - 13
Co-authors Terry Lewin, Gregory Carter
2014 Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lee J, et al., 'Calorie intake and patient outcomes in severe acute kidney injury: Findings from The Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study trial', Critical Care, 18 (2014)

Introduction: Current practice in the delivery of caloric intake (DCI) in patients with severe acute kidney injury (AKI) receiving renal replacement therapy (RRT) is unknown. We a... [more]

Introduction: Current practice in the delivery of caloric intake (DCI) in patients with severe acute kidney injury (AKI) receiving renal replacement therapy (RRT) is unknown. We aimed to describe calorie administration in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy (RENAL) study and to assess the association between DCI and clinical outcomes.Methods: We performed a secondary analysis in 1456 patients from the RENAL trial. We measured the dose and evolution of DCI during treatment and analyzed its association with major clinical outcomes using multivariable logistic regression, Cox proportional hazards models, and time adjusted models.Results: Overall, mean DCI during treatment in ICU was low at only 10.9 ± 9 Kcal/kg/day for non-survivors and 11 ± 9 Kcal/kg/day for survivors. Among patients with a lower DCI (below the median) 334 of 729 (45.8%) had died at 90-days after randomization compared with 316 of 727 (43.3%) patients with a higher DCI (above the median) (P = 0.34). On multivariable logistic regression analysis, mean DCI carried an odds ratio of 0.95 (95% confidence interval (CI): 0.91-1.00; P = 0.06) per 100 Kcal increase for 90-day mortality. DCI was not associated with significant differences in renal replacement (RRT) free days, mechanical ventilation free days, ICU free days and hospital free days. These findings remained essentially unaltered after time adjusted analysis and Cox proportional hazards modeling.Conclusions: In the RENAL study, mean DCI was low. Within the limits of such low caloric intake, greater DCI was not associated with improved clinical outcomes. © 2014 Bellomo et al.; licensee BioMed Central Ltd.

DOI 10.1186/cc13767
Citations Scopus - 28
2013 Brieva J, Coleman N, Lacey J, Harrigan P, Lewin TJ, Carter GL, 'Prediction of death in less than 60 minutes following withdrawal of cardiorespiratory support in ICUs.', Crit Care Med, 41 2677-2687 (2013) [C1]
DOI 10.1097/CCM.0b013e3182987f38
Citations Scopus - 15Web of Science - 14
Co-authors Terry Lewin, Gregory Carter
2013 Hardy BM, Chan S, Martin AB, Brieva J, Gallagher A, Sokolowsky A, Balogh ZJ, 'Temperature change in the helicopter transport of trauma patients', ANZ JOURNAL OF SURGERY, 83 894-895 (2013) [C3]
DOI 10.1111/ans.12138
Citations Scopus - 3Web of Science - 2
Co-authors Zsolt Balogh
2012 Brieva J, Opdam H, Jones D, 'Predicting the time to death after withdrawal of life sustaining therapy: Implications for organ donation', CRITICAL CARE MEDICINE, 40 342-344 (2012)
DOI 10.1097/CCM.0b013e318236e110
Citations Scopus - 1Web of Science - 2
2009 Brieva JL, Cooray P, Rowley M, 'Withholding and withdrawal of life-sustaining therapies in intensive care: an Australian experience', CRITICAL CARE AND RESUSCITATION, 11 266-268 (2009)
Citations Scopus - 20Web of Science - 21
2009 Rashid AH, Brieva JL, Stokes BJ, 'Incidence of contrast-induced nephropathy in intensive care patients undergoing computerised tomography and prevalence of risk factors', Anaesthesia and Intensive Care, 37 968-975 (2009) [C1]
Citations Scopus - 41Web of Science - 42
2008 Coleman N, Brieva J, Crowfoot E, 'Identification of a realistic donation after cardiac death (DCD) donor: Predicting time of death within 60 minutes following withdrawal of futile life sustaining treatment', Transplant Nurses Journal, 17 22-25 (2008)

The international transplant community has, in recent years, focused on donation after cardiac death (DCD) to provide a means of potentially increasing the availability of donor o... [more]

The international transplant community has, in recent years, focused on donation after cardiac death (DCD) to provide a means of potentially increasing the availability of donor organs. New South Wales (NSW) Health released their DCD Guidelines in June 2007 following extensive consultation with key stakeholders. The main purpose of the Guidelines is to provide increased donation opportunities for people who wish to become organ donors following their death, but whose illness or injury means they do not meet the brain death criteria. It was recommended that institutions in NSW intending to implement DCD develop specific local protocols for the management of DCD in their relevant services. To this end, the John Hunter Hospital (JHH) and Calvary Mater Hospital (CMH) are conducting a study within their local patient cohort to validate selected existing predictors from the University of Wisconsin Evaluation Tool and United Network for Organ Sharing (UNOS) DCD criteria. The primary aim of the study is to provide clinicians with a useful set of predictors of death within 60 minutes following withdrawal of futile life sustaining treatment. This will enhance the clinicians' confidence in identifying realistic potential DCD donors, assist in resource allocation within the hospital and optimise the patients' and/or families' wishes to donate.

Citations Scopus - 1
2008 Coleman NL, Brieva JL, Crowfoot E, 'Prediction of death after withdrawal of life-sustaining treatments.', Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 10 278-284 (2008)

OBJECTIVE: To assess the predictive value of respiratory and haemodynamic variables and opinion of the intensivist for determining how soon death occurs after withdrawal of life-s... [more]

OBJECTIVE: To assess the predictive value of respiratory and haemodynamic variables and opinion of the intensivist for determining how soon death occurs after withdrawal of life-sustaining treatments (WLST). DESIGN: Multicentre prospective observational study. PARTICIPANTS AND SETTING: 83 consecutive adult intensive care patients at John Hunter and Calvary Mater Hospitals, Newcastle, New South Wales, for whom a decision was made to withdraw life-sustaining treatment between March 2007 and March 2008. MAIN OUTCOME MEASURES: Data were collected before initiation of palliation. Primary outcome was to recognise in a multivariate analysis the parameters associated with a time to death < or = 60 minutes after WLST. RESULTS: 81 patients underwent WLST: 79 died, and two survived to be discharged from hospital. Thirty-six patients (45%) died within 60 minutes of WLST, and 45 (55%) survived 60 minutes or longer. Mean ICU stay before WLST was 4.8 days (range, 1-85 days). Mean time from WLST to death was 6:31 h (range, 1 minute to 31 days). A modified University of Wisconsin assessment tool showed no statistical association with the time from WLST to death (P = 0.09). The adapted United Network for Organ Sharing tool, systolic blood pressure, APACHE II score, ventilatory dependence, oxygen disruption, Glasgow Coma Scale (GCS) score and staff specialist opinion all showed a statistically significant association with time from WLST to death (P < 0.05). CONCLUSIONS: It is possible to predict the time from WLST to death accurately using a tool that combines GCS, respiratory and haemodynamic parameters and intensivist opinion. These results require validation in a large multicentre study.

Citations Scopus - 14
2007 Brieva J, 'Cyclophosphamide-induced acute respiratory distress syndrome', RESPIROLOGY, 12 769-773 (2007)
DOI 10.1111/j.1440-1843.2007.01128.x
Citations Scopus - 7Web of Science - 7
2005 Brieva J, McFadyen B, Rowley M, 'Severe hypothermia: Challenging normal physiology', ANAESTHESIA AND INTENSIVE CARE, 33 662-664 (2005)
DOI 10.1177/0310057X0503300519
Citations Scopus - 7Web of Science - 3
Show 10 more journal articles

Conference (2 outputs)

Year Citation Altmetrics Link
2017 Brieva J, 'Does Training of Intensive Care Specialists Improve Organ Donation Consent Rates, When Excluding "Family Raised" Cases?', TRANSPLANTATION, Geneva, SWITZERLAND (2017)
DOI 10.1097/01.tp.0000524981.16691.6b
1997 Cassano C, Perez M, Capalbo M, Rial M, Brieva J, Russomando S, et al., 'Outcome of renal transplantation with kidneys from marginal donors (preliminary communication)', Transplantation Proceedings (1997)
DOI 10.1016/S0041-1345(97)01054-3
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Dr Jorge Brieva

Position

Conjoint Senior Lecturer
School of Medicine and Public Health
College of Health, Medicine and Wellbeing

Contact Details

Email jorge.brieva@newcastle.edu.au
Phone 02-49214241

Office

Building John Hunter Hospital
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