Journal of critical care
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Journal of critical care · Aug 2021
Meta AnalysisRenal replacement therapy modality in critically ill patients with acute kidney injury - A network meta-analysis of randomized controlled trials.
This network meta-analysis aims to compare the efficacy and safety of various renal replacement therapy (RRT) modalities in critically ill patients with acute kidney injury (AKI). ⋯ No superiority of one particular RRT modality over another in terms of renal recovery and short-term mortality in critically ill patients with AKI. PD exhibited worse fluid removal and better safety in the prevention of hypotension than the extracorporeal modalities.
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Journal of critical care · Aug 2021
Intra-abdominal hypertension and hypoxic respiratory failure together predict adverse outcome - A sub-analysis of a prospective cohort.
To assess whether the combination of intra-abdominal hypertension (IAH, intra-abdominal pressure ≥ 12 mmHg) and hypoxic respiratory failure (HRF, PaO2/FiO2 ratio < 300 mmHg) in patients receiving invasive ventilation is an independent risk factor for 90- and 28-day mortality as well as ICU- and ventilation-free days. ⋯ In our sub-analysis, the combination of IAH and HRF was not independently associated with 90-day mortality but independently increased the odds of 28-day mortality, and reduced the number of ICU- and ventilation-free days.
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Journal of critical care · Aug 2021
Positive end-expiratory pressure in COVID-19-related ARDS: Do not forget the airway closure.
Airway closure is a physiological phenomenon in which the distal airways are obstructed when the airway pressure drops below the airway opening pressure. We assessed this phenomenon in 27 patients with coronavirus disease 2019-related acute respiratory distress syndrome. ⋯ The median airway opening pressure was 8 cmH2O (interquartile range, 7-10), with a maximum value of 17 cmH2O. Three patients had a baseline positive end-expiratory pressure lower than the airway opening pressure.
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Journal of critical care · Aug 2021
Association of intranasal desmopressin therapy with overcorrection of severe hyponatremia: A retrospective, propensity score-based, single-center cohort study.
Severe hyponatremia, defined as serum sodium concentration ([sNa]) ≤ 120 mEq/L, requires aggressive treatment to prevent potentially fatal cerebral edema, seizures, and other sequelae, but overcorrection can also result in life-threatening cerebral hemorrhage and demyelination. We compared the safety and efficacy of nasal desmopressin to conventional management for the prevention of [sNa] overcorrection. ⋯ Intranasal desmopressin therapy increased the safe correction of severe hyponatremia. Large prospective trials are warranted to confirm this result.
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Journal of critical care · Aug 2021
High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study.
Hemoadsorption with CytoSorb® offers a possible therapeutic approach in septic shock, but modes of application and dosing are still undetermined. ⋯ The application of CytoSorb® seems to be effective in various conditions of septic shock. In a cohort of most severely ill patients the observed mortality was lower than predicted and decreased linearly with blood purification volumes inadvertently exceeding 6 l/kg BW. These results suggest that hemoadsorption might improve survival provided that the applied dose is high enough.