The International journal of artificial organs
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Randomized Controlled Trial Comparative Study
A pilot study of high-adsorption hemofiltration in human septic shock.
To compare the hemodynamic and biological effects of high-adsorption continuous veno-venous hemofiltration (CVVH) with standard CVVH in septic shock. ⋯ High-adsorption CVVH appears more effective than standard CVVH in decreasing noradrenaline requirements and plasma concentrations of cytokines in septic shock patients.
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This short review paper addresses a recently published study on the controversy concerning the type of renal replacement therapy (RRT) used in ICU. It proposes a somewhat different point of view regarding this study, based on the numerous problems that have been identified with it. Indeed, given these shortcomings, the study conclusions are somewhat misleading and are not effectively supported by the trial data. ⋯ This may answer many of the outstanding issues and provide a balanced opinion about this study and its real importance in ICU practice. Finally, this study does not have the scientific power (as explained by the accompanying editorial by Kellum) to put an end to the ICU controversy regarding the choice of RRT in acute renal failure while in ICU. Therefore, there is an urgent need for a better designed study regarding this controversy.
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To assess the clinical sensitivity of causes of death, concomitant diseases and postoperative complications including thromboembolic events in ECMO patients. ⋯ In ECMO patients major discrepancies between clinical and post-mortem examination were found. The true incidence of thromboembolic events is highly underestimated by clinical evaluation.
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There is limited information about renal recovery to independence from renal replacement therapy (RRT) and about factors associated with its occurrence after severe acute renal failure (ARF). ⋯ The majority of severe ARF patients who survive their acute illness are independent of RRT by 90 days. Male sex and a diagnosis of septic shock are independently associated with recovery while a greater co-morbidity score and a higher serum creatinine prior to RRT are predictive of non-recovery.
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The aim of the work was to develop and to evaluate the clinical efficiency of a mobile telecare system implementing teleconsultations based on the continuous transmission of patient-collected data directly to the physician and to the clinic. The developed TeleMed system consists of the patients' and the diabetologist's mobile units, the diabetologist's clinic and home workstations and the clinical server. The evaluation of the system was performed on a group of 13 newly diagnosed type 1 diabetic patients, during a single-arm study with 3-days run-in period, including a one-day intensive educational program, and 3-week study period, when the intensive insulin treatment was conducted without visits of patients to the clinic. ⋯ The TeleMed facilitates not only efficient realization of the intensive insulin treatment but also successful remote patient training and education. No formal patient satisfaction study was done. However, some of the findings indicate that the application of the developed system increases patient self-confidence and quality of life.