Articles: critical-illness.
-
Randomized Controlled Trial
Incidence of aspiration and gastrointestinal complications in critically ill patients using continuous versus bolus infusion of enteral nutrition: a pseudo-randomised controlled trial.
Enteral nutrition (EN) for the critically ill and mechanically ventilated patients can be administered either via the continuous or bolus methods. However, there is insufficient evidence supporting which of these methods may have a lower risk of aspiration and gastrointestinal (GI) complications. This study was conducted in order to identify the incidence of aspiration and GI complications using continuous enteral nutrition (CEN) and bolus enteral nutrition (BEN) in critically ill patients at the Rafik Hariri University Hospital (RHUH), Beirut, Lebanon. ⋯ CEN versus BEN methods did not affect the incidence of aspiration, HGRV, vomiting or diarrhoea. However, the incidence of constipation was significantly greater in patients receiving CEN.
-
Randomized Controlled Trial Multicenter Study Comparative Study
Trial of the route of early nutritional support in critically ill adults.
Uncertainty exists about the most effective route for delivery of early nutritional support in critically ill adults. We hypothesized that delivery through the parenteral route is superior to that through the enteral route. ⋯ We found no significant difference in 30-day mortality associated with the route of delivery of early nutritional support in critically ill adults. (Funded by the United Kingdom National Institute for Health Research; CALORIES Current Controlled Trials number, ISRCTN17386141.).
-
Randomized Controlled Trial
A randomized clinical trial for the timing of tracheotomy in critically ill patients: factors precluding inclusion in a single center study.
We investigated the potential benefits of early tracheotomy performed before day eight of mechanical ventilation (MV) compared with late tracheotomy (from day 14 if it still indicated) in reducing mortality, days of MV, days of sedation and ICU length of stay (LOS). ⋯ This study shows that early tracheotomy reduces the days of sedation in patients undergoing MV, but was underpowered to prove any other benefit. In those patients selected by their attending physicians as potential candidates for a tracheotomy, an early procedure can lessen the days of MV, the days of sedation and LOS. However, the imprecision of physicians to select patients who will require prolonged MV challenges the potential benefits of early tracheotomy.
-
Randomized Controlled Trial
Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial.
Low vitamin D status is linked to increased mortality and morbidity in patients who are critically ill. It is unknown if this association is causal. ⋯ Among critically ill patients with vitamin D deficiency, administration of high-dose vitamin D3 compared with placebo did not reduce hospital length of stay, hospital mortality, or 6-month mortality. Lower hospital mortality was observed in the severe vitamin D deficiency subgroup, but this finding should be considered hypothesis generating and requires further study.
-
Int. J. Antimicrob. Agents · Oct 2014
Randomized Controlled Trial Comparative StudyPharmacokinetics of imipenem in critically ill patients during empirical treatment of nosocomial pneumonia: a comparison of 0.5-h and 3-h infusions.
In critically ill patients, pathophysiological changes alter the pharmacokinetics of antibiotics. Imipenem exhibits primarily time-dependent killing. Its administration by prolonged infusion may increase the time for which its plasma concentration exceeds the minimum inhibitory concentrations (MICs) of suspected pathogens. ⋯ The study included 22 patients. Whilst no significant differences were found between both groups for %fT>MIC, %fT>4×MIC was 87.4±12.19%, 68.6±15.08%, 47.31±6.64% and 27.81±9.52% of the 8-h interval in the short infusion group for MICs of 0.5, 1, 2 and 4mg/L, respectively, and 85.15±17.57%, 53.14±27.27%, 13.55±24.47% and 0±0% of the 6-h interval for the extended infusion group. In conclusion, administration of 0.5g of imipenem by a 3-h infusion every 6h does not provide sufficient drug concentrations to treat infections caused by pathogens with a MIC of ≥2mg/L.