Journal of intensive care medicine
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J Intensive Care Med · Jan 2011
Randomized Controlled TrialCURB-65, PSI, and APACHE II to assess mortality risk in patients with severe sepsis and community acquired pneumonia in PROWESS.
Patients with community-acquired pneumonia (CAP) comprised 35.6% of the overall phase 3 Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study and 33.1% of the placebo arm. We investigated the use of CURB-65, the Pneumonia Severity Index (PSI), and Acute Physiology and Chronic Health Evaluation II (APACHE II) prediction scores to identify the CAP population from the PROWESS placebo arm at the greatest mortality risk. ⋯ Despite early diagnosis and appropriate antibiotic therapy, conventionally treated CAP with PSI = 5, CURB-65 3, or APACHE II 25 has an unacceptably high mortality. In this study, PSI, CURB-65, and APACHE II scoring systems perform similarly in predicting the 28-day and in-hospital mortality; however, differences in the categorization of severe CAP were observed and there was a significant mortality in patients with a CURB-65 <3 and PSI <5.
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J Intensive Care Med · Mar 2009
Randomized Controlled TrialThe effects of ventilatory mode on lung aeration assessed with computer tomography: a randomized controlled study.
Maintenance of spontaneous breathing superimposed on mechanical ventilation is suggested to improve gas exchange in patients with acute lung injury. The aim of this study was to evaluate the long-term effects of airway pressure release ventilation with maintained unsupported spontaneous breathing (APRV) and synchronized intermittent mandatory ventilation with pressure support (SIMV) on the amount of lung collapse in acute lung injury patients. ⋯ The change in the amount of nonaerated lung was comparable between groups; 14.7% (3.8-17.4) in APRV group (n = 13) and 9.6% (-1.4 to 18.62) in the SIMV group (n = 10), (P = .65, difference in mean 4.9%, 95% confidence interval -9.0% to 19.0%). The effects of APRV and SIMV on lung aeration are similar after 7 days of mechanical ventilation.
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J Intensive Care Med · Jan 2009
Randomized Controlled TrialA new immunomodulatory therapy for severe sepsis: Ulinastatin Plus Thymosin {alpha} 1.
To study the effect of immunomodulatory therapy with ulinastatin plus thymosin alpha( 1) on septic patients. ⋯ Combined immunomodulatory therapy with ulinastatin plus thymosin alpha(1) appears to yield improved survival for patients with sepsis; this finding should be verified in larger clinical trials.
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J Intensive Care Med · Sep 2003
Randomized Controlled Trial Clinical TrialA prospective evaluation of the 1-hour decision point for admission versus discharge in acute asthma.
Study objectives were to evaluate the 1-hour decision point for discharge or admission for acute asthma; to compare this decision point to the admission recommendations of the Expert Panel Report 2 (EPR-2) guidelines; to develop a model for predicting need for admission in acute asthma. The design used was a prospective preinterventional and postinterventional comparison. The setting was a university hospital emergency department. ⋯ No absolute value of peak flow or FEV(1) reliably predicts need for hospital admission. The EPR-2 guideline thresholds for admission are barely adequate as outcome predictors. A clinical model is proposed that may allow more accurate outcome prediction.
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J Intensive Care Med · Jan 2003
Randomized Controlled Trial Multicenter Study Clinical TrialThe role of the alpha2-adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit.
Dexmedetomidine was evaluated for sedation of 401 post-surgical patients in this double-blind, randomized, placebo-controlled, multicenter trial. Dexmedetomidine or saline was started on arrival in the intensive care unit (ICU) (1.0 mcg/kg for 10 minutes), then titrated at 0.2 to 0.7 mcg/kg/h to effect. Patients could be given propofol if necessary. ⋯ The majority of dexmedetomidine patients maintained blood pressures within normal range, without rebound. Hypertension, atelectasis, and rigors occurred more frequently in the control group, while hypotension and bradycardia occurred more frequently in the dexmedetomidine group. Preoperative cardiovascular conditions were not risk factors for dexmedetomidine patients.