Journal of critical care
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Journal of critical care · Oct 2018
Days alive and free as an alternative to a mortality outcome in pivotal vasopressor and septic shock trials.
RCTs in septic shock negative for mortality may show organ dysfunction benefits. We hypothesized that RCTs in septic shock show significant differences between treatment groups in organ support despite no mortality differences. ⋯ Differences between treatment groups in organ dysfunction in RCTs in septic shock occur despite lack of mortality differences depending on calculation method. If standardized and validated further, DAF could become the primary endpoint of RCTs in septic shock.
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Journal of critical care · Oct 2018
Comparative StudyGlycocalyx biomarker syndecan-1 is a stronger predictor of respiratory failure in patients with sepsis due to pneumonia, compared to endocan.
Endocan, a component of the endothelial glycocalyx (EG), has been linked with respiratory failure in sepsis. This study explored the temporal patterns of three EG biomarkers, including endocan, and their relationships with inflammation and respiratory failure. ⋯ Syndecan-1, but not endocan, was associated with neutrophil activation and was the best EG biomarker predictor of adverse clinical outcomes.
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Critical illnesses are a major cause of morbidity and mortality in The Gambia, yet national data on critical care capacity is lacking. ⋯ The Gambia has a very low ICU bed capacity and lacks the human resources and equipment necessary to diagnose and treat the large number of critically ill patients admitted to public hospitals in the country.
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Journal of critical care · Oct 2018
Six subphenotypes in septic shock: Latent class analysis of the PROWESS Shock study.
Septic shock is a highly heterogeneous condition which is part of the challenge in its diagnosis and treatment. In this study we aim to identify clinically relevant subphenotypes of septic shock using a novel statistic al approach. ⋯ LCA appears to be an applicable statistical tool in analysing a heterogenous clinical cohort of septic shock. The results may lead to a better understanding of septic shock complexity and form a basis for considering targeted therapies and selecting patients for future clinical trials.
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Journal of critical care · Oct 2018
Combined vitamin C, hydrocortisone, and thiamine therapy for patients with severe pneumonia who were admitted to the intensive care unit: Propensity score-based analysis of a before-after cohort study.
To evaluate the efficacy of combined vitamin C, hydrocortisone, and thiamine in patients with severe pneumonia. ⋯ Combined vitamin C, hydrocortisone, and thiamine therapy may benefit patients with severe pneumonia.