Journal of critical care
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Journal of critical care · Jun 2021
Balanced crystalloids versus saline in critically ill adults with low plasma bicarbonate: A secondary analysis of a clinical trial.
We aimed to determine if balanced crystalloids compared with saline improve outcomes in critically ill adults admitted with low plasma bicarbonate. ⋯ Among critically ill adults presenting to the Emergency Department, initial plasma bicarbonate concentration does not appear to be a useful marker to guide the selection of balanced crystalloid versus saline.
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Journal of critical care · Jun 2021
Clinical trial registry searches are under-utilized in systematic reviews from critical care journals: A bibliometric analysis.
Publication bias has a significant impact on the results of systematic reviews. Clinical trial registry searches, which include unpublished research, should be conducted when performing systematic reviews to reduce publication bias. We aimed to analyze the use of clinical trial registry searches in critical care systematic reviews. ⋯ The omission of relevant, unpublished clinical trial results may be negatively impacting the accuracy of critical care systematic reviews. We recommend all systematic reviewers conduct clinical trial registry searches to reduce publication bias.
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Journal of critical care · Jun 2021
Multicenter StudyAssessment of fluid resuscitation on time to hemodynamic stability in obese patients with septic shock.
Assess time to hemodynamic stability (HDS) in obese patients with septic shock who received <30 vs. ≥30 ml/kg of initial fluid resuscitation based on actual body weight (ABW). ⋯ Obese patients given ≥30 ml/kg based on ABW had a shorter time to HDS and a lower risk of in-hospital death. Exploratory results suggest improved outcomes resuscitating by ABW vs. IBW; ABW showed no strong benefit over AdjBW. Further prospective studies are needed to confirm the optimal fluid dosing in obese patients.
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Journal of critical care · Jun 2021
Sustained low-efficiency dialysis with regional citrate anticoagulation in critically ill patients with COVID-19 associated AKI: A pilot study.
Acute Kidney Injury (AKI) is a frequent complication in critically ill patients with Coronavirus disease 2019 (COVID-19), and it has been associated with worse clinical outcomes, especially when Kidney Replacement Therapy (KRT) is required. A condition of hypercoagulability has been frequently reported in COVID-19 patients, and this very fact may complicate KRT management. Sustained Low Efficiency Dialysis (SLED) is a hybrid dialysis modality increasingly used in critically ill patients since it allows to maintain acceptable hemodynamic stability and to overcome the increased clotting risk of the extracorporeal circuit, especially when Regional Citrate Anticoagulation (RCA) protocols are applied. ⋯ Finally, RCA, as compared with heparin-based protocols, does not further increase the already high hemorrhagic risk of patients with AKI. Based on these premises, we performed a pilot study on the clinical management of critically ill patients with COVID-19 associated AKI who underwent SLED with a simplified RCA protocol. Low circuit clotting rates were observed, as well as adequate KRT duration was achieved in most cases, without any relevant metabolic complication nor worsening of hemodynamic status.
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Journal of critical care · Jun 2021
Implementation of lung protective ventilation order to improve adherence to low tidal volume ventilation: A RE-AIM evaluation.
Lung protective ventilation (LPV), defined as a tidal volume (Vt) ≤8 cc/kg of predicted body weight, reduces ventilator-induced lung injury but is applied inconsistently. ⋯ We designed and implemented an LPV order that sustainably improved LPV adherence across diverse ICUs.