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
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
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
Review Case ReportsElectroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit-Five cases and a review.
Delirium in the intensive care unit (ICU) is conventionally treated pharmacologically but can progress into a protracted state refractory to medical treatment--a potentially life-threatening condition in itself. ⋯ Although controversial, ECT is nevertheless recognized as an efficient and safe treatment for various psychiatric illnesses including delirium. Considering the significantly increased mortality and severe cognitive decline associated with delirium in the ICU, we find ECT to be a valuable treatment option for this vulnerable patient population. It can be considered when agitation cannot be controlled with medical treatment, when agitation and delirium make weaning impossible, or prolonged deep sedation the only alternative.
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Journal of critical care · Oct 2014
Observational StudyDiagnostic accuracy of central venous saturation in estimating mixed venous saturation is proportional to cardiac performance among cardiac surgical patients.
Advanced hemodynamic monitoring in cardiac surgery translates into improvement in outcomes. We evaluated the relationship between central venous (ScvO2) and mixed venous (SvO2) saturations over the early postoperative period. The adequacy of their interchangeability was tested in patients with varying degrees of cardiac performance. ⋯ The diagnostic accuracy of ScvO2 for estimating SvO2 is proportional to cardiac performance. A negative SvO2-ScvO2 gradient at T2 correlated with inotropic support requirement, higher operative risk score, age, lactate level, and duration of cardiopulmonary bypass.