Articles: critical-illness.
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Randomized Controlled Trial
Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients.
An acute disease is regularly associated with inflammation, decreased food intake, and low physical activity; the consequence is loss of muscle mass. However, the restoration of muscle tissue is problematic, especially in older patients. Loss of muscle mass leads to further decrease of physical activity which leads, together with recurring disease, to the progressive muscle mass loss accompanied by loss of self-sufficiency. Early nutrition support and physical activity could reverse this situation. Therefore, the aim of this study was to determine whether an active approach based on early nutritional therapy and exercise would influence the development of sarcopenia and impaired self-sufficiency during acute illness. ⋯ The early nutritional intervention together with early rehabilitation preserves muscle mass and independence in ill older patients hospitalized because of acute disease.
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Health Technol Assess · Dec 2014
Randomized Controlled Trial Multicenter Study Comparative StudyProspective multicentre randomised, double-blind, equivalence study comparing clonidine and midazolam as intravenous sedative agents in critically ill children: the SLEEPS (Safety profiLe, Efficacy and Equivalence in Paediatric intensive care Sedation) study.
Children in paediatric intensive care units (PICUs) require analgesia and sedation but both undersedation and oversedation can be harmful. ⋯ Clonidine is an alternative to midazolam. Our trial-based economic evaluation suggests that clonidine is likely to be a cost-effective sedative agent in the PICU in comparison with midazolam (probability of cost-effectiveness exceeds 50%). Rebound hypertension did not appear to be a significant problem with clonidine but, owing to its effects on heart rate, specific cardiovascular attention needs to be taken during the loading and early infusion phase. Neither drug in combination with morphine provided ideal sedation, suggesting that in unparalysed patients a third background agent is necessary. The disappointing recruitment rates reflect a reluctance of parents to provide consent when established on a sedation regimen, and reluctance of clinicians to allow sedation to be studied in unstable critically ill children. Future studies will require less exacting protocols allowing enhanced recruitment.
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Randomized Controlled Trial
The CALORIES trial: statistical analysis plan.
The CALORIES trial is a pragmatic, open, multicentre, randomised controlled trial (RCT) of the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral route compared with early nutritional support via the enteral route in unplanned admissions to adult general critical care units (CCUs) in the United Kingdom. The trial derives from the need for a large, pragmatic RCT to determine the optimal route of delivery for early nutritional support in the critically ill. ⋯ In keeping with best trial practice, we have developed, described and published a statistical analysis plan for the CALORIES trial and are placing it in the public domain before inspecting data from the trial.
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Randomized Controlled Trial Multicenter Study
"Do not resuscitate" decisions in acute respiratory distress syndrome. A secondary analysis of clinical trial data.
Factors and outcomes associated with end-of-life decision-making among patients during clinical trials in the intensive care unit are unclear. ⋯ The vast majority of deaths among clinical trial patients with ARDS were preceded by a DNR order. Unlike other studies of end-of-life decision-making in the intensive care unit, nearly all patients who became DNR died. The impact of variation of practice in end-of-life decision-making during clinical trials warrants further study.
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Eur Arch Otorhinolaryngol · Nov 2014
Randomized Controlled Trial Observational StudyAcute and long-term dysphagia in critically ill patients with severe sepsis: results of a prospective controlled observational study.
Dysphagia is a major risk factor for morbidity and mortality in critically ill patients treated in intensive care units (ICUs). Structured otorhinolaryngological data on dysphagia in ICU survivors with severe sepsis are missing. In a prospective study, 30 ICU patients with severe sepsis and thirty without sepsis as control group were examined using bedside fiberoptic endoscopic evaluation of swallowing after 14 days in the ICU (T1) and 4 months after onset of critical illness (T2). ⋯ Multivariate analysis revealed tracheostomy at T1 as independent risk factor for severe dysphagia at T2 (p = 0.030). Severe sepsis appears to be a relevant risk factor for long-term dysphagia. An otorhinolaryngological evaluation of dysphagia at ICU discharge is mandatory for survivors of severe critical illness to plan specific swallowing rehabilitation programs.