Intensive care medicine
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Intensive care medicine · Jan 2012
Early peak temperature and mortality in critically ill patients with or without infection.
We evaluated the independent association between peak temperature in the first 24 h after ICU admission and in-hospital mortality according to whether there was an admission diagnosis of infection using a database of admissions to 129 ICUs in Australia and New Zealand (ANZ) (n = 269,078). Subsequently, we sought to confirm or refute the ANZ database findings using a validation cohort of admissions to 201 ICUs in the UK (n = 366,973). ⋯ Elevated peak temperature in the first 24 h in ICU is associated with decreased in-hospital mortality in critically ill patients with an infection; randomised trials are needed to determine whether controlling fever increases mortality in such patients.
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Intensive care medicine · Jan 2012
ReviewEfficacy and safety of regional citrate anticoagulation in critically ill patients undergoing continuous renal replacement therapy.
Regional citrate anticoagulation (RCA) is an attractive anticoagulation mode in continuous renal replacement therapy (CRRT) because it restricts the anticoagulatory effect to the extracorporeal circuit. In recent years, several randomized controlled trials have been conducted to investigate its superiority over other anticoagulation modes. Thus, we performed a systematic review of available evidence on the efficacy and safety of RCA. ⋯ RCA is effective in maintaining circuit patency and reducing the risk of bleeding, and thus can be recommended for CRRT if and when metabolic monitoring is adequate and the protocol is followed. However, the safety of citrate in patients with liver failure cannot be concluded from current analysis. The metabolic stability can be easily controlled during RCA. Survival benefit from RCA is still controversial due to limited evidence.
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Intensive care medicine · Jan 2012
Effect of changes over time in the performance of a customized SAPS-II model on the quality of care assessment.
The aim of our study was to explore, using an innovative method, the effect of temporal changes in the mortality prediction performance of an existing model on the quality of care assessment. The prognostic model (rSAPS-II) was a recalibrated Simplified Acute Physiology Score-II model developed for very elderly Intensive Care Unit (ICU) patients. ⋯ Variability over time may markedly vary among different performance measures, and infrequent model recalibration can result in improper assessment of the quality of care in many hospitals. We stress the importance of the timely recalibration and repeated validation of prognostic models over time.
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Intensive care medicine · Jan 2012
Review Meta AnalysisVasopressin for treatment of vasodilatory shock: an ESICM systematic review and meta-analysis.
To examine the benefits and risks of vasopressin or its analog terlipressin for patients with vasodilatory shock. ⋯ Overall, use of vasopressin or terlipressin did not produce any survival benefit in the short term in patients with vasodilatory shock. Physicians may value the sparing effects of vasopressin/terlipressin on norepinephrine requirement given its apparent safe profile.
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Intensive care medicine · Jan 2012
Randomized Controlled Trial Multicenter StudyDesigning and conducting a randomized trial for pandemic critical illness: the 2009 H1N1 influenza pandemic.
To analyze the hurdles in implementing a randomized trial of corticosteroids for severe 2009 H1N1 influenza infections. ⋯ This report highlights the main hurdles in implementing a randomized trial for a pandemic critical illness and proposes solutions for future trials.