Journal of critical care
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Journal of critical care · Oct 2014
Review Meta Analysis Comparative StudyDo the observational studies using propensity score analysis agree with randomized controlled trials in the area of sepsis?
Sepsis is a leading cause of mortality and morbidity in the intensive care unit, and many studies have been conducted aiming to improve its outcome. Randomized controlled trials (RCTs) and observational studies using propensity score (PS) method are commonly used for this purpose. However, the agreement between these two major methodological designs has never been investigated in this specific area. The present study aimed to compare the effect sizes between RCTs and PS-based studies. ⋯ Our study shows that PS studies tend to report larger treatment effect than RCTs in the field of sepsis, indicating the difference between efficacy trials and effectiveness studies.
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Journal of critical care · Oct 2014
Review Meta AnalysisMortality benefit of vasopressor and inotropic agents in septic shock: A Bayesian network meta-analysis of randomized controlled trials.
The choice of vasopressor in septic shock has been a matter of debate. The purpose of this study was to systematically review overall evidence of vasopressor and inotropic agents in septic shock using a Bayesian network meta-analysis. ⋯ Our results support the use of NE with or without low-dose vasopressin as the first-line vasopressor therapy in septic shock. No concrete evidence exists to support the use of EPI over dopamine as the second-line agent or the addition of an inotropic agent.
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Journal of critical care · Oct 2014
Randomized Controlled Trial Multicenter StudyClonidine in the sedation of mechanically ventilated children: A pilot randomized trial.
Clonidine is often used as a sedative in critically ill children, but its effectiveness has not been evaluated in a large, rigorous randomized controlled trial. Our objectives in this pilot trial were to assess the feasibility of a larger trial with respect to (1) effective screening, (2) recruitment, (3) timely drug administration, and (4) protocol adherence. ⋯ This pilot trial demonstrated feasibility of a larger randomized controlled trial. Some important challenges emerged, allowing refinement of the study protocol and enrolment estimates. We recommend that future trials capitalize on the experience gained and use these results to design a larger trial focusing on clinically important outcomes.
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Journal of critical care · Oct 2014
Randomized Controlled TrialThe effect of Na-selenite treatment on the oxidative stress-antioxidants balance of multiple organ failure.
Our study tested the hypothesis that sodium (Na)-selenite expression treatment can reduce oxidative stress and increase plasma antioxidants, whereas modulating white blood cell antigen expression in severe sepsis. Selenite is a well known cofactor of glutathione peroxidases and other antioxidant enzymes; therefore, one may expect an antioxidant effect of treatment. ⋯ Although our Na-selenite treatment regime successfully restored the selenium deficiency of severe septic patients, antioxidant and white blood cell antigen expression modulating effect of the therapy was not observed in our patient group.
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Journal of critical care · Oct 2014
ReviewRisks of nonsteroidal antiinflammatory drugs in undiagnosed intensive care unit pneumococcal pneumonia: Younger and more severely affected patients.
The purpose of this study is to investigate whether exposure to nonsteroidal antiinflammatory drugs (NSAIDs) at the early stage of severe pneumococcal community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission may affect its presentation and outcome. ⋯ We report as severe pneumococcal pneumonia in young and healthy patients exposed to NSAIDs as in older, more comorbid, and nonexposed ones. Nonsteroidal antiinflammatory drug use may mask initial symptoms and delay antimicrobial therapy, thus predisposing to worse outcomes.