Crit Care Resusc
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Randomized Controlled Trial Multicenter Study
The NICE-SUGAR (Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation) Study: statistical analysis plan.
The Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) Study is the largest study to date of glycaemic control in critically ill patients. ⋯ We have developed a pre-determined statistical analysis plan for the NICE-SUGAR Study. This plan will be followed to avoid analysis bias arising from prior knowledge of the study findings.
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Albumin has been used for volume resuscitation and supplementation in critically ill patients for over 50 years. While regarded as a "gold standard" colloid solution, albumin is associated with substantial cost, and questions have been raised about its safety and efficacy. A large-scale randomised controlled trial (the Saline vs. ⋯ Similarly, there is no substantive evidence to justify the use of hyperoncotic albumin solutions for resuscitation or supplementation in critically ill patients. Albumin is a safe and effective resuscitation solution in critically ill patients without traumatic brain injury. However, the acquisition costs of albumin and synthetic colloids are more than those of crystalloids, and, as yet, colloids have not been proven to confer substantive benefits over crystalloids such as saline.
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To determine whether hyperglycaemia is associated with prolongation of the corrected QT (QTc) interval on the electrocardiogram (ECG) in critically ill patients. ⋯ There was a moderate, significant correlation between QTc and BGL. Patients with a QTc > 0.44 s had higher BGL, APACHE II score and mortality. BGL was an independent predictor of QTc duration, but neither BGL nor QTc were independent predictors of mortality in this study.
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To determine whether operators with less than 3 months' formal anaesthesiology training have higher rates of complications when performing endotracheal intubation (ETI) in the intensive care unit than operators with longer formal anaesthesiology training. ⋯ ETIs performed in the ICU where the initial operator has less than 3 months' formal training in anaesthesiology appear not to be associated with more complications. However, this may be attributable to less experienced operators having more assistance and supervision, and to patient selection.
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To assess outcomes in patients with spinal cord injury (SCI) and a tracheostomy tube (TT), before and after the introduction of a tracheostomy review and management service (TRAMS) for ward-based patients. ⋯ Implementing a tracheostomy review and management service improved outcomes for SCI patients: they left acute care sooner, spoke sooner, and the TT was removed earlier, with associated cost savings.