Journal of critical care
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Journal of critical care · Aug 2023
Multicenter StudyLow dose vs high dose tocilizumab in COVID-19 patients with hypoxemic respiratory failure.
Tocilizumab has been shown to decrease mortality when used concomitantly with steroids in COVID-19 with 8 mg/kg (max 800 mg) being the standard dose. Our study sought to assess whether a low dose (400 mg) shows similar benefit compared to a high dose for COVID patients concurrently on the same median dose of steroids. ⋯ Compared to low dose tocilizumab, the high dose did not provide additional efficacy and mortality benefit but resulted in higher fungal and viral infections. This study illustrates that low dose tocilizumab can be an alternative to high dose during a drug shortage of tocilizumab without compensating for efficacy and safety, conserving resources for more patients.
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Journal of critical care · Aug 2023
Randomized Controlled Trial Multicenter StudySafety, tolerability, pharmacokinetics, and efficacy of kukoamine B in patients with sepsis: A randomized phase IIa trial.
To evaluate the safety, tolerability, pharmacokinetics, and efficacy of kukoamine B (KB), an alkaloid compound with high affinity for both lipopolysaccharide (LPS) and oligodeoxynucle-otides containing CpG motifs (CpG DNA), in patients with sepsis-induced organ failure. ⋯ In patients with sepsis-induced organ failure, KB was safe and well tolerated. Further investigation is warranted.
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Journal of critical care · Jun 2023
Multicenter StudyDefinitions, rates and associated mortality of ICU-acquired pneumonia: A multicenter cohort study.
We aimed to analyze intensive care unit (ICU)-acquired pneumonia according to 7 definitions, estimating associated hospital mortality. ⋯ Rates of ICU-acquired pneumonia vary by definition and are associated with differential increased risk of death.
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Journal of critical care · Apr 2023
Multicenter StudyInstitution-free days after critical illness: A multicenter retrospective study.
Patient-centered outcomes beyond mortality such as institution-free days (IFD) are becoming increasingly relevant in critical care trials. ⋯ IFD is a simple, easily measurable patient-centered outcome that varies depending on the definition used. Patient input should be sought to define the optimum definition and clinical use of IFD.
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Journal of critical care · Feb 2023
Multicenter Study Observational StudyDetermining respiratory rate using measured expiratory time constant: A prospective observational study.
Potential negative implications associated with high respiratory rate (RR) are intrinsic positive end-expiratory pressure (PEEPi) generation, cardiovascular depression and possibly ventilator induced lung injury. Despite these negative consequences, optimal RR remains largely unknown. We hypothesized that without consideration of dynamics of lung emptying (i.e., the expiratory time constant [RCEXP]) clinician settings of RR may exceed the frequency needed for optimal lung emptying. ⋯ Use of RRP based on measured RCEXP revealed that the clinician-set RR exceeded that predicted by RCEXP in the majority of patients. Measuring RCEXP appears to be a useful variable for adjusting the RR during mandatory mechanical ventilation.