Crit Care Resusc
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Randomized Controlled Trial Multicenter Study
A cluster randomised, crossover, registry-embedded clinical trial of proton pump inhibitors versus histamine-2 receptor blockers for ulcer prophylaxis therapy in the intensive care unit (PEPTIC study): study protocol.
The balance of risks and benefits with using proton pump inhibitors (PPIs) versus histamine-2 receptor blockers (H2RB) for stress ulcer prophylaxis in patients who are invasively ventilated in the intensive care unit (ICU) is uncertain. ⋯ The PEPTIC study will compare the effect on in-hospital mortality of implementing, at the level of the ICU, the use of PPI as the preferred agent for stress ulcer prophylaxis in mechanically ventilated adults in the ICU with using H2RB as the preferred agent.
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Randomized Controlled Trial
Fluid resuscitation associated with elevated angiopoietin-2 and length of mechanical ventilation after cardiac surgery.
Fluid restriction in patients with acute respiratory distress syndrome increases ventilator-free days while lowering plasma angiopoietin-2 (Ang-2), a marker of pulmonary endothelial injury. We hypothesised that fluid resuscitation may lead to endothelial injury after cardiac surgery and analysed Ang-2, angiopoietin-1 (Ang-1) and phospholipase A2 (PLA2) levels and the impact of fluid management on ventilation time. ⋯ ACTRN12612000754842.
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Magnesium therapy may reduce the risk of atrial fibrillation after cardiac surgery. However, studies are heterogeneous in relation to dosage and method of delivery and no studies have directly compared the biochemical effect of different delivery strategies. ⋯ The strategy of a 10 mmol magnesium bolus followed by a continuous infusion over 12 hours achieved a more sustained and moderately elevated magnesium concentration in comparison to a single 20 mmol bolus, despite increased urinary losses of magnesium. Further studies are required to assess a more extended continuous infusion.
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Extracorporeal membrane oxygenation (ECMO) is a promising adjunct to cardiopulmonary resuscitation (CPR) in refractory cardiac arrest (CA). Factors associated with outcome are incompletely characterised. The aim of our study was to identify pre-ECMO factors associated with in-hospital mortality after extracorporeal CPR (ECPR). ⋯ Following ECPR, the factors most strongly associated with mortality were ongoing CPR at the time of ECMO initiation and arrest to ECMO cannulation time. Interventions aimed at reducing time to ECMO initiation may lead to improved outcomes.
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There has recently been a surge of interest in intravenous (IV) vitamin C as a potential therapy in intensive care unit (ICU) patients, particularly in those with septic shock. Establishing the safety and efficacy of IV vitamin C therapy through rigorously conducted randomised controlled trials is a priority. A key logistical issue for such trials is to establish the stability of IV vitamin C solutions prepared for infusion ahead of time. Accordingly, we aimed to assess the stability of IV vitamin C solutions over time using doses of vitamin C from previous pilot trials. ⋯ Our findings suggest that vitamin C solutions of 1.5 g per 50 mL of 0.9% saline and 2.5 g per 50 mL of D5W remain stable for up to 96 hours and do not need to be protected from light.