Journal of critical care
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Journal of critical care · Dec 2016
Randomized Controlled TrialA 4-arm randomized controlled pilot trial of innovative solutions for jugular central venous access device securement in 221 cardiac surgical patients.
To improve jugular central venous access device (CVAD) securement, prevent CVAD failure (composite: dislodgement, occlusion, breakage, local or bloodstream infection), and assess subsequent trial feasibility. ⋯ Jugular CVAD securement is challenging in postcardiac surgical patients who are coagulopathic and mobilized early. TA+SPU was ineffective for CVAD securement and is not recommended. Suture + TA+SPU appeared promising, with zero CVAD failure observed. Future trials should resolve uncertainty about the comparative effect of suture + TA+SPU, suture + AD, and SSD+SPU vs suture + BPU.
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Journal of critical care · Dec 2016
ReviewRecirculation in venovenous extracorporeal membrane oxygenation.
Despite the increasing use of venovenous extracorporeal membrane oxygenation (ECMO) to treat severe respiratory failure, recirculation remains a common complication that may result in severe hypoxemia and end-organ damage. The present review, therefore, examines updated evidence for the causes, measurement, and management of recirculation. Six electronic databases were searched from their dates of inception to January 2016, and 38 relevant studies were selected for analysis. ⋯ Although cannula configuration appears to be a key contributor to recirculation in addition to factors such as ECMO flow rate, there are insufficient comparative clinical studies to recommend an optimal cannulation technique for minimizing recirculation. Existing evidence suggests that the dual-lumen cannula may have a low recirculation fraction, but only if correctly positioned. This review underscores the need for more robust clinical and laboratory studies to effectively evaluate and address the persistent problem of recirculation.
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Journal of critical care · Dec 2016
Randomized Controlled TrialThe efficacy and safety of antithrombin and recombinant human thrombomodulin combination therapy in patients with severe sepsis and disseminated intravascular coagulation.
Recombinant human thrombomodulin (rhTM) is often used concomitantly with antithrombin (AT) to treat disseminated intravascular coagulation (DIC). This observational study aimed to investigate the efficacy and safety of AT+rhTM combination therapy. ⋯ Compared with AT monotherapy, combination therapy with AT and rhTM may be more effective in improving platelet counts and D-dimer levels, as well as reducing mortality, in patients with severe sepsis-associated DIC.