Intensive care medicine
-
Intensive care medicine · Sep 2013
Randomized Controlled Trial Multicenter Study Comparative StudyHigh-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial.
Septic shock is a leading cause of death among critically ill patients, in particular when complicated by acute kidney injury (AKI). Small experimental and human clinical studies have suggested that high-volume haemofiltration (HVHF) may improve haemodynamic profile and mortality. We sought to determine the impact of HVHF on 28-day mortality in critically ill patients with septic shock and AKI. ⋯ In the IVOIRE trial, there was no evidence that HVHF at 70 mL/kg/h, when compared with contemporary SVHF at 35 mL/kg/h, leads to a reduction of 28-day mortality or contributes to early improvements in haemodynamic profile or organ function. HVHF, as applied in this trial, cannot be recommended for treatment of septic shock complicated by AKI.
-
Intensive care medicine · Sep 2013
Randomized Controlled TrialPre-emptive broad-spectrum treatment for ventilator-associated pneumonia in high-risk patients.
Patients requiring mechanical ventilation (MV) for >48 h after major heart surgery (MHS) are at a high risk of acquiring ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT). Most non-pharmacological interventions to prevent VAP in such patients are usually already implemented. The objective of this study was to evaluate the efficacy in preventing lower respiratory infections of antibiotics active against multidrug-resistant pathogens in this very high-risk population. ⋯ A pre-emptive approach with broad-spectrum antibiotics may be effective in reducing the incidence and delaying the onset of VAP + VAT after MHS. The ecological consequences have to be carefully evaluated in future trials.
-
Intensive care medicine · Sep 2013
Randomized Controlled Trial Observational StudyThe ETHICA study (part II): simulation study of determinants and variability of ICU physician decisions in patients aged 80 or over.
To assess physician decisions about ICU admission for life-sustaining treatments (LSTs). ⋯ Physician decisions for elderly patients had low agreement and varied greatly with bed availability and knowledge of patient preferences.
-
Intensive care medicine · Sep 2013
Letter Randomized Controlled TrialArginine administration to critically ill patients with a low nitric oxide fraction in the airways: a pilot study.