Articles: critical-illness.
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Randomized Controlled Trial Multicenter Study
Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial.
Evidence demonstrates that providing nutritional support to intensive care unit (ICU) patients within 24 hours of ICU admission reduces mortality. However, early feeding is not universally practiced. Changing practice in complex multidisciplinary environments is difficult. Evidence supporting whether guidelines can improve ICU feeding practices and patient outcomes is contradictory. ⋯ Using a multifaceted practice change strategy, ICUs successfully developed and introduced an evidence-based nutritional support guideline that promoted earlier feeding and greater nutritional adequacy. However, use of the guideline did not improve clinical outcomes. Trial Registration anzctr.org.au Identifier: ACTRN12608000407392.
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Critical care medicine · Dec 2008
Randomized Controlled Trial Comparative StudyIntensive versus conventional insulin therapy: a randomized controlled trial in medical and surgical critically ill patients.
The role of intensive insulin therapy in medical surgical intensive care patients remains unclear. The objective of this study was to examine the effect of intensive insulin therapy on mortality in medical surgical intensive care unit patients. ⋯ Intensive insulin therapy was not associated with improved survival among medical surgical intensive care unit patients and was associated with increased occurrence of hypoglycemia. Based on these results, we do not advocate universal application of intensive insulin therapy in intensive care unit patients.
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Randomized Controlled Trial Comparative Study
Noninvasive Doppler ultrasonography for assessing cardiac function: can it replace the Swan-Ganz catheter?
Cardiac function, including cardiac index (CI), traditionally has been measured by a pulmonary artery catheter (PAC). A noninvasive alternative for measuring cardiac function would offer obvious advantages. ⋯ Doppler UTS correlates well with PAC measurements of CI. This noninvasive modality is an accurate and safe alternative to PAC.
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Randomized Controlled Trial
Tolerability and safety of olive oil-based lipid emulsion in critically ill neonates: a blinded randomized trial.
We assessed the safety and tolerability of an olive oil-based lipid emulsion compared with a soybean-based lipid emulsion in critically ill neonates. ⋯ The OO-based emulsion (ClinOleic) was well tolerated in critically ill neonates. Differences in plasma phospholipids at day 5 reflected the fatty acid composition of the administered emulsion. No significant differences in plasma F(2)-isoprostane levels were detected after 5 d of lipid administration.
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Intensive care medicine · Nov 2008
Randomized Controlled Trial Comparative StudyProportional assist ventilation with load-adjustable gain factors in critically ill patients: comparison with pressure support.
It is not known if proportional assist ventilation with load-adjustable gain factors (PAV+) may be used as a mode of support in critically ill patients. The aim of this study was to examine the effectiveness of sustained use of PAV+ in critically ill patients and compare it with pressure support ventilation (PS). ⋯ PAV+ may be used as a useful mode of support in critically ill patients. Compared to PS, PAV+ increases the probability of remaining on spontaneous breathing, while it considerably reduces the incidence of patient-ventilator asynchronies.