Crit Care Resusc
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Near-infrared spectroscopy (NIRS) has been used in clinical practice to assess regional cerebral tissue oxygen saturation (StcO2). There is no evidence whether repeated use of the same sensor affects StcO2 measurements. We aimed to assess whether there was a significant systematic decrease or increase in StcO2 when NIRS sensors were reused. ⋯ Repeated use of NIRS sensors measured StcO2 in different individuals for up to 10 days. There were no significant, systematic, persistent or progressive changes in StcO2 with extended use over time. Our findings suggest that StcO2 does not change with sensor reuse for up to 10 days.
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The search for biomarkers has been described as a dismal patchwork of fragmented research. We review biomarkers in sepsis in the critically ill in terms of conventional single circulating proteins. Despite sepsis biomarker publications trebling over the past 6 years, currently only one, procalcitonin, has materialised promise. ⋯ The standing of gene signatures in the paradigmatic discipline, breast cancer, is described. Uncertainties in the understanding of the sepsis process are documented - the dissociation between blood and tissue element activity, or compartmentalisation. The paradox of the active search for gene signatures to refine the sepsis phenotype and discover target subtypes for new therapies in the absence of such therapies is presented.
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Randomized Controlled Trial Multicenter Study
Study protocol for the Augmented versus Routine Approach to Giving Energy Trial (TARGET).
Nutrition is routinely provided to critically ill patients who are mechanically ventilated and remain in the intensive care unit for more than a few days. Nasogastric feeding, which is standard practice for patients who are unable to tolerate oral nutrition, typically delivers less than 60% of the recommended energy requirements. It remains uncertain whether the delivery of about 100% of the recommended energy goals via the enteral route will affect survival and other important clinical outcomes. ⋯ The results of this trial are expected to determine whether increased energy delivery, using an energy-dense formula can improve clinically meaningful outcomes, including survival.
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Randomized Controlled Trial
Proportional assist ventilation versus pressure support ventilation in weaning ventilation: a pilot randomised controlled trial.
Proportional assist ventilation with load-adjustable gain factors (PAV+) is a mode of ventilation that provides assistance in proportion to patient effort. This may have physiological and clinical advantages when compared with pressure support ventilation (PSV). Our objective was to compare these two modes in patients being weaned from mechanical ventilation. ⋯ Both modes of ventilation were comparable in time to liberation from the ventilator.