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
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 ).
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Intensive care medicine · Nov 2018
Randomized Controlled TrialLatent class analysis of ARDS subphenotypes: a secondary analysis of the statins for acutely injured lungs from sepsis (SAILS) study.
Using latent class analysis (LCA), we have consistently identified two distinct subphenotypes in four randomized controlled trial cohorts of ARDS. One subphenotype has hyper-inflammatory characteristics and is associated with worse clinical outcomes. Further, within three negative clinical trials, we observed differential treatment response by subphenotype to randomly assigned interventions. The main purpose of this study was to identify ARDS subphenotypes in a contemporary NHLBI Network trial of infection-associated ARDS (SAILS) using LCA and to test for differential treatment response to rosuvastatin therapy in the subphenotypes. ⋯ LCA using a two-subphenotype model best described the SAILS population. The subphenotypes have features consistent with those previously reported in four other cohorts. Addition of new class-defining variables in the LCA model did not yield additional subphenotypes. No treatment effect was observed with rosuvastatin. These findings further validate the presence of two subphenotypes and demonstrate their utility for patient stratification in ARDS.
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Intensive care medicine · Nov 2018
Randomized Controlled TrialSafety and tolerability of a single administration of AR-301, a human monoclonal antibody, in ICU patients with severe pneumonia caused by Staphylococcus aureus: first-in-human trial.
Hospital-acquired bacterial pneumonia (HABP) is a critical concern in hospitals with ventilator-associated bacterial pneumonia (VABP) remaining the most common infection in the ICU, often due to Staphylococcus aureus, an increasingly difficult to treat pathogen. Anti-infective monoclonal antibodies (mAb) may provide new, promising treatment options. This randomized, double-blinded, placebo-controlled study aimed at assessing the safety and pharmacokinetics of AR-301, an S. aureus alpha toxin-neutralizing mAb, and exploring its clinical and microbiologic outcomes when used adjunctively with standard-of-care antibiotics. ⋯ Adjunctive treatment of severe S. aureus HABP with anti-staphylococcal mAbs appears feasible and suggests some clinical benefits, but larger randomized studies are needed to better define its safety and efficacy.