American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Apr 2019
Determinants of Intensive Care Unit Telemedicine Effectiveness: An Ethnographic Study.
Telemedicine is an increasingly common care delivery strategy in the ICU. However, ICU telemedicine programs vary widely in their clinical effectiveness, with some studies showing a large mortality benefit and others showing no benefit or even harm. ⋯ The effectiveness of ICU telemedicine programs may be influenced by several potentially modifiable factors within the domains of leadership, perceived value, and organizational structure.
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Am. J. Respir. Crit. Care Med. · Apr 2019
Randomized Controlled TrialTranscriptomic Signatures in Sepsis and a Differential Response to Steroids: From the VANISH Randomized Trial.
There remains uncertainty about the role of corticosteroids in sepsis with clear beneficial effects on shock duration, but conflicting survival effects. Two transcriptomic sepsis response signatures (SRSs) have been identified. SRS1 is relatively immunosuppressed, whereas SRS2 is relatively immunocompetent. ⋯ Transcriptomic profile at onset of septic shock was associated with response to corticosteroids. Those with the immunocompetent SRS2 endotype had significantly higher mortality when given corticosteroids compared with placebo. Clinical trial registered with www.clinicaltrials.gov (ISRCTN 20769191).