Critical care medicine
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Critical care medicine · Dec 2019
Randomized Controlled Trial Comparative StudyVasopressin Versus Norepinephrine for the Management of Septic Shock in Cancer Patients: The VANCS II Randomized Clinical Trial.
Previous trials suggest that vasopressin may improve outcomes in patients with vasodilatory shock. The aim of this study was to evaluate whether vasopressin could be superior to norepinephrine to improve outcomes in cancer patients with septic shock. ⋯ In cancer patients with septic shock, vasopressin as first-line vasopressor therapy was not superior to norepinephrine in reducing 28-day mortality rate.
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Critical care medicine · Dec 2019
Randomized Controlled TrialEarly Palliative Care Consultation in the Medical ICU: A Cluster Randomized Crossover Trial.
To assess the impact of early triggered palliative care consultation on the outcomes of high-risk ICU patients. ⋯ Early triggered palliative care consultation was associated with greater transition to do-not-resuscitate/do-not-intubate and to hospice care, as well as decreased ICU and post-ICU healthcare resource utilization. Our study suggests that routine palliative care consultation may positively impact the care of high risk, critically ill patients.
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Critical care medicine · Dec 2019
Randomized Controlled TrialRamelteon for Prevention of Postoperative Delirium: A Randomized Controlled Trial in Patients Undergoing Elective Pulmonary Thromboendarterectomy.
To assess the efficacy of ramelteon in preventing delirium, an acute neuropsychiatric condition associated with increased morbidity and mortality, in the perioperative, ICU setting. ⋯ Ramelteon 8 mg did not prevent postoperative delirium in patients admitted for elective cardiac surgery.
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Critical care medicine · Dec 2019
Randomized Controlled TrialInsights Into a "Negative" ICU Trial Derived From Gene Expression Profiling.
Randomized controlled trials in the ICU often fail to show differences in endpoints between groups. We sought to explore reasons for this at a molecular level by analyzing transcriptomic data from a recent negative trial. Our objectives were to determine if randomization successfully balanced transcriptomic features between groups, to assess transcriptomic heterogeneity among the study subjects included, and to determine if the study drug had any effect at the gene expression level. ⋯ In this clinical trial, transcriptomic data provided a useful complement to clinical data, suggesting that the reasons for the negative result were less likely related to the biological efficacy of the study drug, and may instead have been related to poor sensitivity of the clinical outcomes. In larger studies, transcriptomics may also prove useful in predicting response to treatment.