Journal of critical care
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Journal of critical care · Jun 2020
ReviewClinical utility of midodrine and methylene blue as catecholamine-sparing agents in intensive care unit patients with shock.
Shock is common in the intensive care unit, affecting up to one third of patients. Treatment of shock is centered upon managing hypotension and ensuring adequate perfusion via administration of fluids and catecholamine vasopressors. Due to the risks associated with catecholamine vasopressors, interest has grown in using catecholamine-sparing agents such as midodrine and methylene blue. ⋯ Examples of search terms included "midodrine", "methylene blue", "critically ill", "shock", and "catecholamine-sparing." Several studies have evaluated their use in patients with shock and found potential benefits in terms of causing significant elevations in blood pressure and hastening catecholamine vasopressor discontinuation with few adverse effects; however, robust evidence is lacking for these off-label indications. Because of the variety of dosing strategies used and the incongruences between patient populations, it is also challenging to define finite recommendations. This review aims to summarize current evidence for the use of midodrine and methylene blue as catecholamine-sparing agents in critically ill patients with resolving or refractory shock.
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Journal of critical care · Jun 2020
A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19.
COVID-19 (coronavirus disease 2019) is a public health emergency of international concern. As of this time, there is no known effective pharmaceutical treatment, although it is much needed for patient contracting the severe form of the disease. The aim of this systematic review was to summarize the evidence regarding chloroquine for the treatment of COVID-19. ⋯ There is rationale, pre-clinical evidence of effectiveness and evidence of safety from long-time clinical use for other indications to justify clinical research on chloroquine in patients with COVID-19. However, clinical use should either adhere to the Monitored Emergency Use of Unregistered Interventions (MEURI) framework or be ethically approved as a trial as stated by the World Health Organization. Safety data and data from high-quality clinical trials are urgently needed.
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Journal of critical care · Jun 2020
One-year survival in patients with solid tumours discharged alive from the intensive care unit after unplanned admission: A retrospective study.
Outcomes in cancer patients after unplanned ICU admission was reassessed. ⋯ Among the factors associated with one-year mortality after ICU discharge, the possibility of receiving oncologic treatment after ICU discharge seems crucial.
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To determine if baseline lipid levels contribute to the relationship between lipid levels during sepsis and outcomes. ⋯ Baseline lipid values, particularly triglyceride concentrations, are associated with hospital mortality in septic patients.
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Journal of critical care · Jun 2020
Observational StudyHigh serum substance P levels and mortality after malignant middle cerebral artery infarction.
Previously our team found higher serum substance P concentrations at day 1 of a malignant middle cerebral artery infarction (MMCAI) in non-surviving than in surviving patients. Thus, the objective of this study was to determine whether serum substance P levels during the first week of MMCAI could predict mortality. ⋯ The two new findings of our study are that non-surviving MMCAI patients showed higher serum substance P levels at day 1, 4 and 8 than surviving, and that those levels could predict 30-day mortality.