Intensive care medicine
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Intensive care medicine · Mar 2015
Randomized Controlled Trial Comparative StudyEffectiveness of treatment based on PiCCO parameters in critically ill patients with septic shock and/or acute respiratory distress syndrome: a randomized controlled trial.
To compare treatment based on either PiCCO-derived physiological values or central venous pressure (CVP) monitoring, we performed a prospective randomized controlled trial with group sequential analysis. ⋯ On the basis of our study, PICCO-based fluid management does not improve outcome when compared to CVP-based fluid management.
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Intensive care medicine · Mar 2015
Multicenter Study Observational StudyDiagnostic yield and safety of CT scans in ICU.
Critically ill patients often require CT scans. Adverse events (AE) can occur during intra-hospital transport (IHT). The aim of this prospective study was to determine the diagnostic and therapeutic yield and the safety of CT scans in ICU patients. ⋯ The CT scan as a diagnostic procedure invalidated a diagnostic hypothesis and led to a therapeutic change in more than half of the cases.
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Intensive care medicine · Mar 2015
Plasma soluble thrombomodulin levels are associated with mortality in the acute respiratory distress syndrome.
Thombomodulin (TM) is an activator of protein C and a biomarker for endothelial injury. We hypothesized that (1) elevated plasma levels would be associated with clinical outcomes and (2) polymorphisms in the TM gene would be associated with plasma levels. ⋯ Higher plasma sTM levels are associated with increased mortality in ARDS. The lack of association between the sTM levels and genetic variants suggests that the increased levels of sTM may reflect severity of endothelial damage rather than genetic heterogeneity. These findings underscore the importance of endothelial injury in ARDS pathogenesis and suggest that, in combination with clinical markers, sTM could contribute to risk stratification.
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Intensive care medicine · Mar 2015
Comparative StudyComparison of different equations to assess glomerular filtration in critically ill patients.
To evaluate equations for estimation of glomerular filtration rate (GFR) and measured urinary creatinine clearance, compared to measured GFR in critically ill patients. ⋯ In this cohort of patients, estimates of GFR had low accuracy and precision. Cystatin C based formulas, especially CKD-EPIcr-cys, showed limited bias; however, the accuracy and precision of these estimates were still insufficient. Measured urinary creatinine clearance overestimates GFR, but may provide a cheap alternative, when this is taken into account.