Critical care : the official journal of the Critical Care Forum
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The present review introduces the general philosophy behind hypothesis (significance) testing and calculation of P values. Guidelines for the interpretation of P values are also provided in the context of a published example, along with some of the common pitfalls. Examples of specific statistical tests will be covered in future reviews.
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Randomized Controlled Trial Clinical Trial
Physiological-dose steroid therapy in sepsis [ISRCTN36253388].
The aim of the study was to assess the prognostic importance of basal cortisol concentrations and cortisol response to corticotropin, and to determine the effects of physiological dose steroid therapy on mortality in patients with sepsis. ⋯ There was a trend towards a decrease in the mortality rates of the patients with sepsis who received physiological-dose steroid therapy. In the advancing process from sepsis to septic shock, adrenal insufficiency was not frequent as supposed. There was a trend (that did not reach significance) towards a decrease in the mortality rates of the patients with sepsis who received physiological-dose steroid therapy.
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In order to evaluate the complications and risk factors associated with peripheral arterial catheters used for haemodynamic monitoring, we reviewed the literature published from 1978 to 2001. We closely examined the three most commonly used arterial cannulation sites. ⋯ Major complications occurred in fewer than 1% of the cases, and rates were similar for the radial, femoral and axillary arteries. We conclude that arterial cannulation is a safe procedure.
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Measuring cardiac output is of paramount importance in the management of critically ill patients in the intensive care unit and of 'high risk' surgical patients in the operating room. Alternatives to thermodilution are now available and are gaining acceptance among practitioners who have been trained almost exclusively in the use of the pulmonary artery catheter. ⋯ No single method stands out or renders the others obsolete. By making cardiac output easily measurable, however, these techniques should all contribute to improvement in haemodynamic management.
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Based on several recently completed randomized controlled trials, cortisol replacement is likely to become a standard of care for vasopressor dependent septic shock. Further studies are needed in order to accomplish whether this treatment should be limited to patients with a blunted cortisol response to corticotrophin. Similarly, in patients with severe sepsis who do not need vasopressors, the benefit/risk ratio of cortisol replacement remains to be assessed.