Intensive care medicine
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Intensive care medicine · Mar 2011
Randomized Controlled Trial Multicenter Study Comparative StudyA prospective, randomized, double-blind, multicenter study comparing remifentanil with fentanyl in mechanically ventilated patients.
To compare the quality of analgesia provided by a remifentanil-based analgesia regime with that provided by a fentanyl-based regime in critically ill patients. ⋯ The use of remifentanil-based analgesia in critically ill patients was not superior regarding the achievement and maintenance of sufficient analgesia compared with fentanyl-based analgesia.
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Intensive care medicine · Mar 2011
Randomized Controlled Trial Multicenter StudyImmunoparalysis and nosocomial infection in children with multiple organ dysfunction syndrome.
Immunoparalysis defined by prolonged monocyte human leukocyte antigen DR depression is associated with adverse outcomes in adult severe sepsis and can be reversed with granulocyte macrophage colony-stimulating factor (GM-CSF). We hypothesized that immunoparalysis defined by whole-blood ex vivo lipopolysaccharide-induced tumor necrosis factor-alpha (TNFα) response <200 pg/mL beyond day 3 of multiple organ dysfunction syndrome (MODS) is similarly associated with nosocomial infection in children and can be reversed with GM-CSF. ⋯ Similar to in adults, immunoparalysis is a potentially reversible risk factor for development of nosocomial infection in pediatric MODS. Whole-blood ex vivo TNFα response is a promising biomarker for monitoring this condition.
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Intensive care medicine · Mar 2011
ReviewLow-dose steroids for septic shock and severe sepsis: the use of Bayesian statistics to resolve clinical trial controversies.
Low-dose steroids have shown contradictory results in trials and three recent meta-analyses. We aimed to assess the efficacy and safety of low-dose steroids for severe sepsis and septic shock by Bayesian methodology. ⋯ Based on clinically meaningful thresholds (RRR > 15-25%) for mortality reduction in severe sepsis or septic shock, the Bayesian approach to all three meta-analyses consistently showed that low-dose steroids were not associated with survival benefits. The probabilities of developing steroid-induced side effects (superinfections, bleeding, and hyperglycemia) were high for all analyses.
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Intensive care medicine · Mar 2011
Multicenter Study Comparative StudyCost-effectiveness of the Surviving Sepsis Campaign protocol for severe sepsis: a prospective nation-wide study in Spain.
Severe sepsis is associated with high mortality and increased costs. The 'Surviving Sepsis Campaign' (SSC) protocol was developed as an international initiative to reduce mortality. However, its cost-effectiveness is unknown. ⋯ The SSC protocol seems to be a cost-effective option for treating severe sepsis in Spain.
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Intensive care medicine · Mar 2011
Comparative StudyB-type natriuretic peptides for prediction and diagnosis of weaning failure from cardiac origin.
To evaluate and compare BNP and NT-proBNP concentrations to predict weaning failure from mechanical ventilation (MV) due to heart failure (HF) before a spontaneous breathing trial (SBT) and to identify HF as the cause of failure. ⋯ B-type natriuretic peptides, particularly BNP, can predict weaning failure due to HF before an SBT; increases in natriuretic peptides during SBT are diagnostic of HF as the cause of weaning failure. BNP performs better than NT-proBNP in prediction and diagnosis of HF.