Intensive care medicine
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Intensive care medicine · Nov 2018
Randomized Controlled TrialSmall volume resuscitation with 20% albumin in intensive care: physiological effects : The SWIPE randomised clinical trial.
Why this is interesting...
In many ways, human albumin might be the perfect colloid fluid – and concentrated 20% albumin could be the ideal resuscitation fluid in the critical care setting, where fluid overload is otherwise a common consequence. Because of its high relative concentration, the intravascular expansion effect of 20% albumin is roughly double its infused volume, unlike 4% or 5% albumin.
In the SWIPE trial Mårtensson et al showed that even in the leaky-capillary state of critical illness, resuscitation with 20% albumin decreased fluid needs, lessened positive fluid-balance states, and was not associated with harm when compared to 4-5% albumin.
What did they do?
This was a well designed multicentre trial across three adult Australian & UK ICUs. 321 patients were randomized to either 20% or 4-5% albumin resuscitation during their first 48h in ICU.
Bottom line:
Probably the most important takeaway is simply that resuscitation with 20% albumin is practical and results in no patient harm compared with 4-5%. The 576mL median lower difference in fluid balance is unlikely alone to be dramatically consequential.
Nonetheless an important first step before larger studies can look at morbidity and mortality outcomes.
Cautiously note though that for logistic reasons the trial was open label, so treating clinicians were well aware of which fluid they were using. Additionally, they were given free reign to choose additional resuscitation fluids (crystalloid or synthetic colloid) as the clinical situation required.
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Intensive care medicine · Nov 2018
Randomized Controlled Trial Multicenter Study Comparative StudyTerlipressin versus norepinephrine as infusion in patients with septic shock: a multicentre, randomised, double-blinded trial.
Recent clinical data suggest that terlipressin, a vasopressin analogue, may be more beneficial in septic shock patients than catecholamines. However, terlipressin's effect on mortality is unknown. We set out to ascertain the efficacy and safety of continuous terlipressin infusion compared with norepinephrine (NE) in patients with septic shock. ⋯ In this multicentre, randomised, double-blinded trial, we observed no difference in mortality between terlipressin and NE infusion in patients with septic shock. Patients in the terlipressin group had a higher number of serious adverse events.
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Intensive care medicine · Nov 2018
Case ReportsAn unexpected blood thief: the subacute presentation of a spontaneous Ilio-iliac arterio-venous fistula.
Abstract
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Intensive care medicine · Nov 2018
Multicenter Study Observational StudyEarly PREdiction of sepsis using leukocyte surface biomarkers: the ExPRES-sepsis cohort study.
Reliable biomarkers for predicting subsequent sepsis among patients with suspected acute infection are lacking. In patients presenting to emergency departments (EDs) with suspected acute infection, we aimed to evaluate the reliability and discriminant ability of 47 leukocyte biomarkers as predictors of sepsis (Sequential Organ Failure Assessment score ≥ 2 at 24 h and/or 72 h following ED presentation). ⋯ NCT02188992.
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Intensive care medicine · Nov 2018
Randomized Controlled Trial Multicenter StudyA multicentre randomized pilot trial on the effectiveness of different levels of cooling in comatose survivors of out-of-hospital cardiac arrest: the FROST-I trial.
To obtain initial data on the effect of different levels of targeted temperature management (TTM) in out-of-hospital cardiac arrest (OHCA). ⋯ ClinicalTrials.gov unique identifier: NCT02035839 ( http://clinicaltrials.gov ).