Critical care medicine
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Critical care medicine · Mar 2005
ReviewPrognostic determinants of acute respiratory distress syndrome in adults: impact on clinical trial design.
The objective of this study was to review known clinical predictors and biologic markers of adverse clinical outcomes in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) that might be used as selection criteria in clinical trials of novel therapies for ALI/ARDS. ⋯ The design of clinical trials for new therapies for ALI and ARDS is a complex problem that ultimately will have a major impact on both trial outcome and generalizability. A number of clinical factors and biologic markers can be used to differentiate groups of patients at highest risk for adverse clinical outcomes. Whether enriching study populations with these sicker patients will increase or decrease the likelihood of a treatment effect for a given therapy is unknown.
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Critical care medicine · Mar 2005
Randomized Controlled Trial Clinical TrialA controlled trial of smart infusion pumps to improve medication safety in critically ill patients.
Intravenous medications are vital during inpatient management. Errors associated with the administration of medications through intravenous infusion pumps to critically ill patients can result in adverse drug events. We sought to assess the impact of smart pumps with integrated decision support software on the incidence and nature of medication errors and adverse drug events. ⋯ Intravenous medication errors and adverse drug events were frequent and could be detected using smart pumps. We found no measurable impact on the serious medication error rate, likely in part due to poor compliance. Although smart pumps have great promise, technological and nursing behavioral factors must be addressed if these pumps are to achieve their potential for improving medication safety.
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Critical care medicine · Mar 2005
Randomized Controlled Trial Clinical TrialModulation of asymmetric dimethylarginine in critically ill patients receiving intensive insulin treatment: a possible explanation of reduced morbidity and mortality?
Asymmetric dimethylarginine, which inhibits production of nitric oxide, has been shown to be a strong and independent predictor of mortality in critically ill patients with clinical evidence of organ dysfunction. Interestingly, intensive insulin therapy in critically ill patients improved morbidity and mortality, but the exact mechanisms by which these beneficial effects are brought about remain unknown. Therefore, we aimed to investigate whether modulation of asymmetric dimethylarginine concentrations by intensive insulin therapy is involved in these effects. ⋯ Modulation of asymmetric dimethylarginine concentration by insulin at least partly explains the beneficial effects found in critically ill patients receiving intensive insulin therapy.
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Critical care medicine · Mar 2005
Review Comparative StudyProtocols for lung protective ventilation.
Protocols have a well-established role in clinical research and are increasingly being used to direct routine clinical care. In this article, we review the differing goals of research and clinical protocols and outline the similar process for their development. We use the mechanical ventilation protocol of the ARDS Network trial comparing small with traditional tidal volumes as an example. As a starting point for debate, we also suggest guiding principles and specific components of a protocol for high-frequency oscillatory ventilation.
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Critical care medicine · Mar 2005
Randomized Controlled Trial Clinical TrialEffect of hypertonic saline dextran on acid-base balance in patients undergoing surgery of abdominal aortic aneurysm.
To evaluate the magnitude and cause of metabolic acidosis after infusion of 7.5% sodium chloride 6% dextran 70. ⋯ Both the intravenous administration of 7.5% sodium chloride and the conventional fluid regimen with saline-based 6% hydroxyethyl starch solution resulted in a metabolic acidosis of equal extent. This suggests dilution of plasma buffers or a decrease in strong ion difference to be the primary cause of metabolic acidosis.