Critical care : the official journal of the Critical Care Forum
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Comparative Study
Landmark survival as an end-point for trials in critically ill patients--comparison of alternative durations of follow-up: an exploratory analysis.
Interventional ICU trials have followed up patients for variable duration. However, the optimal duration of follow-up for the determination of mortality endpoint in such trials is uncertain. We aimed to determine the most logical and practical mortality end-point in clinical trials of critically ill patients. ⋯ A minimum of 90 days follow-up is necessary to fully capture the mortality effect of sepsis and community acquired pneumonia. A shorter period of follow-up time may be sufficient for non-operative trauma.
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Great variability exists in data collection and coding of variables in studies on traumatic brain injury (TBI). This confounds comparison of results and analysis of data across studies. The difficulties in performing a meta-analysis of individual patient data were recently illustrated in the IMPACT project (International Mission on Prognosis and Clinical Trial Design in TBI): merging data from 11 studies involved over 10 person years of work. ⋯ Recommendations hereto have been proposed by an interagency initiative in the US. These proposals deserve to be taken forward at an international level. This initiative may well constitute one of the most important steps forwards, paving the road for harvesting successful results in the near future.
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Comparative Study
Comparison between Flotrac-Vigileo and Bioreactance, a totally noninvasive method for cardiac output monitoring.
This study was designed to compare the clinical acceptability of two cardiac output (CO) monitoring systems: a pulse wave contour-based system (FloTrac-Vigileo) and a bioreactance-based system (NICOM), using continuous thermodilution (PAC-CCO) as a reference method. ⋯ This study showed that the NICOM and Vigileo devices have similar monitoring capabilities in post-operative cardiac surgery patients.
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Oxygen is one of the most commonly used therapeutic agents. Injudicious use of oxygen at high partial pressures (hyperoxia) for unproven indications, its known toxic potential, and the acknowledged roles of reactive oxygen species in tissue injury led to skepticism regarding its use. ⋯ Data on regional hemodynamic effects of hyperoxia and recent compelling evidence on its anti-inflammatory actions incited a surge of interest in the potential therapeutic effects of hyperoxia in myocardial revascularization and protection, in traumatic and nontraumatic ischemicanoxic brain insults, and in prevention of surgical site infections and in alleviation of septic and nonseptic local and systemic inflammatory responses. Although the margin of safety between effective and potentially toxic doses of oxygen is relatively narrow, the ability to carefully control its dose, meticulous adherence to currently accepted therapeutic protocols, and individually tailored treatment regimens make it a cost-effective safe drug.
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Comparative Study
Pumpless extracorporeal interventional lung assist in patients with acute respiratory distress syndrome: a prospective pilot study.
Pumpless interventional lung assist (iLA) is used in patients with acute respiratory distress syndrome (ARDS) aimed at improving extracorporeal gas exchange with a membrane integrated in a passive arteriovenous shunt. In previous studies, feasibility and safety of the iLA system was demonstrated, but no survival benefit was observed. In the present pilot study we tested the hypothesis that timely initiation of iLA using clear algorithms and an improved cannulation technique will positively influence complication rates and management of lung protective ventilation. ⋯ The use of an indication algorithm for iLA in early ARDS, combined with a refined application technique was associated with efficient carbon dioxide removal and a reduced incidence of adverse events. iLA could serve as an extracorporeal assist to support mechanical ventilation by enabling low tidal volume and a reduced inspiratory plateau pressure.