Crit Care Resusc
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The Crystalloid versus Hydroxyethyl Starch Trial (CHEST) and the Scandinavian Starch in Severe Sepsis/ Septic Shock (6S) trial reported that 6% hydroxyethyl starch (HES) is associated with increased use of renal replacement therapy and death in critically ill patients. Data collection was harmonised between the two trials in order to facilitate a preplanned individual patient data meta-analysis (IPDMA) of patients with severe sepsis. ⋯ We developed a preanalysis SAP to combine data on patients with severe sepsis from the 6S trial and the CHEST. Prepublication of our SAP will reduce the risk of bias in the reporting of the results and improve confidence in the estimates of effects, allowing comparisons with conventional meta-analyses and assisting in the translation of research findings into clinical practice.
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Multicenter Study
Sodium administration in critically ill paediatric patients in Australia and New Zealand: a multicentre point prevalence study.
Dysnatraemia and a positive fluid balance are associated with poor outcomes in paediatric intensive care units (PICUs). Our objective was to determine sodium intake and the total daily fluid balance in children in the PICU. ⋯ Daily sodium intake in children in the PICU is high. The contributions of maintenance and bolus intravenous fluids (most commonly as 0.9% sodium chloride), drug infusions and boluses, including antibiotics, and enteral feeds, are significant.
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Randomized Controlled Trial
Randomised trial of software algorithm driven regional citrate anticoagulation versus heparin in continuous renal replacement therapy: the Filter Life in Renal Replacement Therapy pilot trial.
The effectiveness of continuous renal replacement therapy (CRRT) increases when unplanned circuit failure is prevented. Adequate anticoagulation is an important component. Although heparin is the predominating anticoagulant, calcium chelation with citrate is an alternative, but systemic calcium monitoring and supplementation increase the complexity of CRRT. We assessed efficacy and safety of citrate delivery via integrated software algorithms against an established regional heparin protocol. ⋯ Although the per-protocol results favoured citrate when it was actually delivered, the significant crossover between treatment arms hampered more definitive conclusions. Until further studies support improved patient outcomes, increased complexity and complications suggest that anticoagulation choice be made using patient-specific indications.
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To develop methods for distinguishing patients with in-hospital cardiac arrest (IHCA) from patients with out-of-hospital cardiac arrest (OHCA) in routinely collected intensive care unit registry data, and to explore the utility of the methods for describing trends in adult ICU cardiac arrest (CA) admissions and outcomes. ⋯ Use of routinely collected registry data uncovered important trends in adult ICU admission and survival rates for patients with IHCA and OHCA. The improved survival rates and increased number of admissions to tertiary centres requires further study to understand mechanisms and related factors.
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To compare the admission characteristics, discharge destination and mortality of patients reviewed by the rapid response team (RRT) for deterioration with those of other hospital patients; and to determine the association between RRT review for deterioration and mortality. ⋯ Patients reviewed for deterioration were older and had greater comorbidity than patients the RRT was not called to review. RRT review for deterioration was an independent risk factor for mortality.