Critical care medicine
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Critical care medicine · May 2014
Navigating the Institutional Review Board Approval Process in a Multicenter Observational Critical Care Study.
To characterize variation in the institutional review board application process of a multicenter, observational critical care study. ⋯ In a multicenter, observational critical care study, significant variation was observed between sites in all aspects of the institutional review board evaluation and approval process. The level of difficulty was significantly higher for less experienced investigators with a trend toward longer time to institutional review board approval. Variation in institutional review board interpretation of waiver of informed consent regulations was cited as a major barrier to approval.
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Critical care medicine · May 2014
Comparative StudyA Cost-Effectiveness Analysis of Postoperative Goal-Directed Therapy for High-Risk Surgical Patients.
Patients undergoing major surgery are at high risk of increased postoperative morbidity and mortality. Goal-directed therapy has been shown to improve outcomes when commenced in the early postoperative period, yet the economic impact remains unclear. The aim of our study was to assess the cost effectiveness of goal-directed therapy as part of postoperative management. ⋯ The implementation of goal-directed therapy is both clinical and cost-effective. Additional implementation expenditures can be offset by savings due to reduced costs accrued from a reduction in complication rates and hospital length of stay. We conclude that goal-directed therapy provides significant benefits with respect to clinical and financial outcomes.
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Critical care medicine · May 2014
Observational StudyThe Effects of Different IV Fat Emulsions on Clinical Outcomes in Critically Ill Patients.
To examine the effects of different IV fat emulsions on clinical outcomes in critically ill patients. ⋯ Use of alternative IV fat emulsions in parenteral nutrition, particularly olive and fish oil, was associated with improved clinical outcomes.
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Critical care medicine · May 2014
Small-Volume 7.5% NaCl Adenosine, Lidocaine, and Mg2+ Has Multiple Benefits During Hypotensive and Blood Resuscitation in the Pig Following Severe Blood Loss: Rat to Pig Translation.
Currently, there is no effective small-volume fluid for traumatic hemorrhagic shock. Our objective was to translate small-volume 7.5% NaCl adenosine, lidocaine, and Mg hypotensive fluid resuscitation from the rat to the pig. ⋯ Small-volume resuscitation with 7.5% NaCl + adenosine, lidocaine, and Mg/adenosine and lidocaine provided superior cardiovascular, acid-base, metabolic, and renal recoveries following severe hemorrhagic shock in the pig compared with 7.5% NaCl alone.
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Critical care medicine · May 2014
Deletion of Soluble Epoxide Hydrolase Attenuates Cardiac Hypertrophy via Down-Regulation of Cardiac Fibroblasts-Derived Fibroblast Growth Factor-2.
Inhibition of soluble epoxide hydrolase (Ephx2) has been shown to play a protective role in cardiac hypertrophy, but the mechanism is not fully understood. We tested the hypothesis that deletion of soluble epoxide hydrolase attenuates cardiac hypertrophy via down-regulation of cardiac fibroblasts-derived fibroblast growth factor-2. ⋯ Our present data demonstrated that deletion of soluble epoxide hydrolase prevented cardiac hypertrophy not only directly to cardiomyocytes but also to cardiac fibroblasts by reducing expression of fibroblast growth factor-2.