Critical care medicine
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Critical care medicine · Mar 2007
Multicenter StudyAssessing contemporary intensive care unit outcome: an updated Mortality Probability Admission Model (MPM0-III).
To update the Mortality Probability Model at intensive care unit (ICU) admission (MPM0-II) using contemporary data. ⋯ MPM0-II risk factors remain relevant in predicting ICU outcome, but the 1993 model significantly overpredicts mortality in contemporary practice. With the advantage of a much larger sample size and the addition of new variables and interaction effects, MPM0-III provides more accurate comparisons of actual vs. expected ICU outcomes.
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Critical care medicine · Mar 2007
Review Case ReportsNoninvasive positive pressure ventilation in critical and palliative care settings: understanding the goals of therapy.
Although noninvasive positive pressure ventilation (NPPV) is a widely accepted treatment for some patients with acute respiratory failure, the use of NPPV in patients who have decided to forego endotracheal intubation is controversial. Therefore, the Society of Critical Care Medicine charged this Task Force with developing an approach for considering use of NPPV for patients who choose to forego endotracheal intubation. ⋯ This Task Force suggests an approach to use of NPPV for patients and families who choose to forego endotracheal intubation. NPPV should be applied after careful discussion of the goals of care, with explicit parameters for success and failure, by experienced personnel, and in appropriate healthcare settings. Future studies are needed to evaluate the clinical outcomes of using NPPV for patients who choose to forego endotracheal intubation and to examine the perspectives of patients, families, and clinicians on use of NPPV in these contexts.
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Critical care medicine · Mar 2007
Inhibitor kappaB-alpha haplotype GTC is associated with susceptibility to acute respiratory distress syndrome in Caucasians.
The nuclear factor (NF)-kappaB regulates inflammatory responses and plays important roles in the pathogenesis of acute respiratory distress syndrome (ARDS). Inhibitor kappaB-alpha (NFKBIA) inhibits NF-kappaB and controls its activities. The objective was to determine whether polymorphisms in NFKBIA gene would be associated with ARDS development. ⋯ The haplotype GTC of NFKBIA gene is associated with higher risk of ARDS in Caucasians, particularly in male patients and in patients with direct lung injury.
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Critical care medicine · Mar 2007
Randomized, controlled trials as minimal risk: an ethical analysis.
We aim to clarify the circumstances in which randomized, controlled trials should be designated as minimal risk, allowing institutional review boards to approve their conduct with a waiver of informed consent if obtaining informed consent is not feasible. ⋯ In determining whether an randomized, controlled trial should be designated as minimal risk, the potential sources of risk that must be considered are as follows: physical risk from study treatments, the loss of individualized care, risk from nontherapeutic components of the research protocol, and the psychological impact of participation, particularly if the research takes place without informed consent in an emergency setting. The risks of research participation should be considered in comparison with the risk of nonparticipation; e.g., the risks specific to research participation should be considered separately from the risks inherent in treatment of the potential research participant's underling condition. Participation in an randomized, controlled trial may pose no more than minimal risk when: 1) genuine clinical equipoise exists; 2) all of the treatment options included in the research study fall within the current standard of care; 3) there is no currently available treatment with a more favorable risk-benefit profile than the treatments included in the study; 4) the nontherapeutic components of the research are safely under the minimal risk threshold; and 5) the research protocol provides sufficient latitude for treating physicians to individualize care when appropriate. The potential for research participation to have a negative psychological impact on participants or their families should be considered in risk assessment. The requirement for informed consent should only be waived to the extent necessary, and opportunities for the research participant or surrogate to decide whether to participate in the research should be maximized.