Journal of critical care
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Journal of critical care · Dec 2008
ReviewImportant issues in the design and reporting of clinical trials in severe sepsis and acute lung injury.
Severe sepsis and acute lung injury are challenging diagnoses as they relate to designing and reporting of clinical trials. The limited success in bringing forward new therapies in these areas is likely proof of that premise. The ability to use preclinical and phase I and II trial data to predict which patients and which dosing regimens are more likely to benefit is perhaps the greatest challenge. ⋯ Conflict of interest issues which rested dormantly for years are now at the forefront of discussion, and journal editorial board responsibility in this area is being recognized. Protocols may also help reduce heterogeneity of treatment across centers in clinical trials. This article reviews many of the problems encountered in clinical trial design and reporting and offers a perspective on dealing with them to the betterment of a clinical trial.
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Journal of critical care · Dec 2008
Hemodynamics and metabolic studies on septic shock in patients with acute liver failure.
Acute liver failure is often accompanied by hyperdynamic circulation, which is also a characteristic of septic shock. Pre-existing acute liver failure may worsen the hemodynamic impairment and prognosis in sepsis. ⋯ In patients with acute liver failure, septic shock was characterized by an accentuated hyperdynamic circulation, hyperlactatemia and an augmented renin-angiotensin-aldosterone system activity. Pre-existing liver failure has a significant impact on the disease severity of septic shock and portends a grave prognosis.
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Journal of critical care · Dec 2008
Effect of corticosteroids on arginine vasopressin-containing vasopressor therapy for septic shock: a case control study.
Studies showing corticosteroids decrease time to shock reversal in septic shock did not include arginine vasopressin, which also may reduce the duration of catecholamine therapy. Thus, the effect of corticosteroids on vasopressin-containing vasopressor regimens is unknown. We designed this study to evaluate the effect of corticosteroids on time to vasopressin-containing vasopressor withdrawal and the proportion of patients alive without vasopressors at day 7. ⋯ Although corticosteroids did not improve the time to withdrawal of vasopressin-containing vasopressor therapy they significantly increased the proportion of patients alive without vasopressors at day 7.
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Journal of critical care · Dec 2008
Respiratory failure in chronic obstructive pulmonary disease after extubation: value of expiratory flow limitation and airway occlusion pressure after 0.1 second (P0.1).
The aim of this study was to confirm the ability of the airway occlusion pressure after 0.1 second (P0.1) recorded after extubation to define chronic obstructive pulmonary disease (COPD) patients with a high risk of postextubation respiratory failure and to evaluate the role of the expiratory flow limitation (EFL) in these patients. ⋯ Bedside evaluation of EFL and P0.1 helps to define COPD patients at high risk for postextubation respiratory failure. Extubation failure in COPD was associated with higher EFL.