collection
https://read.qxmd.com/read/32678530/dexamethasone-in-hospitalized-patients-with-covid-19
#21
RANDOMIZED CONTROLLED TRIAL
Peter Horby, Wei Shen Lim, Jonathan R Emberson, Marion Mafham, Jennifer L Bell, Louise Linsell, Natalie Staplin, Christopher Brightling, Andrew Ustianowski, Einas Elmahi, Benjamin Prudon, Christopher Green, Timothy Felton, David Chadwick, Kanchan Rege, Christopher Fegan, Lucy C Chappell, Saul N Faust, Thomas Jaki, Katie Jeffery, Alan Montgomery, Kathryn Rowan, Edmund Juszczak, J Kenneth Baillie, Richard Haynes, Martin J Landray
BACKGROUND: Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. METHODS: In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone...
February 25, 2021: New England Journal of Medicine
https://read.qxmd.com/read/33031764/lopinavir-ritonavir-in-patients-admitted-to-hospital-with-covid-19-recovery-a-randomised-controlled-open-label-platform-trial
#22
RANDOMIZED CONTROLLED TRIAL
(no author information available yet)
BACKGROUND: Lopinavir-ritonavir has been proposed as a treatment for COVID-19 on the basis of in vitro activity, preclinical studies, and observational studies. Here, we report the results of a randomised trial to assess whether lopinavir-ritonavir improves outcomes in patients admitted to hospital with COVID-19. METHODS: In this randomised, controlled, open-label, platform trial, a range of possible treatments was compared with usual care in patients admitted to hospital with COVID-19...
October 24, 2020: Lancet
https://read.qxmd.com/read/33933206/tocilizumab-in-patients-admitted-to-hospital-with-covid-19-recovery-a-randomised-controlled-open-label-platform-trial
#23
RANDOMIZED CONTROLLED TRIAL
(no author information available yet)
BACKGROUND: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. METHODS: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg-800 mg (depending on weight) given intravenously...
May 1, 2021: Lancet
https://read.qxmd.com/read/34000257/convalescent-plasma-in-patients-admitted-to-hospital-with-covid-19-recovery-a-randomised-controlled-open-label-platform-trial
#24
RANDOMIZED CONTROLLED TRIAL
(no author information available yet)
BACKGROUND: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. METHODS: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK...
May 29, 2021: Lancet
https://read.qxmd.com/read/33545096/azithromycin-in-patients-admitted-to-hospital-with-covid-19-recovery-a-randomised-controlled-open-label-platform-trial
#25
RANDOMIZED CONTROLLED TRIAL
(no author information available yet)
BACKGROUND: Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19. METHODS: In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK...
February 13, 2021: Lancet
https://read.qxmd.com/read/31574228/effects-of-a-resuscitation-strategy-targeting-peripheral-perfusion-status-versus-serum-lactate-levels-among-patients-with-septic-shock-a-bayesian-reanalysis-of-the-andromeda-shock-trial
#26
COMPARATIVE STUDY
Fernando G Zampieri, Lucas P Damiani, Jan Bakker, Gustavo A Ospina-Tascón, Ricardo Castro, Alexandre B Cavalcanti, Glenn Hernandez
Rationale: A recent randomized controlled trial showed that a peripheral perfusion-guided resuscitation strategy was associated with lower mortality and less organ dysfunction when compared with lactate-guided resuscitation strategy in patients with septic shock, but the difference in the primary outcome, 28-day mortality, did not reach the proposed statistical significance threshold ( P  = 0.06). We tested different analytic methods to aid in the interpretation of these results. Objectives: To reassess the results of the ANDROMEDA-SHOCK trial using both Bayesian and frequentist frameworks...
February 15, 2020: American Journal of Respiratory and Critical Care Medicine
https://read.qxmd.com/read/34186011/the-dethroning-of-6-ml-kg-as-the-go-to-setting-in-acute-respiratory-distress-syndrome
#27
LETTER
Martin J Tobin
No abstract text is available yet for this article.
October 1, 2021: American Journal of Respiratory and Critical Care Medicine
https://read.qxmd.com/read/34151633/outcomes-of-barotrauma-in-critically-ill-covid-19-patients-with-severe-pneumonia
#28
JOURNAL ARTICLE
Victor P Gazivoda, Mudathir Ibrahim, Aaron Kangas-Dick, Arony Sun, Michael Silver, Ory Wiesel
BACKGROUND: Pneumomediastinum and pneumothorax are complications which may be associated with barotrauma in mechanically ventilated patients. The current literature demonstrates unclear outcomes regarding barotrauma in critically ill patients with severe COVID-19. The purpose of this study was to examine the incidence of barotrauma in patients with severe COVID-19 pneumonia and its influence on survival. STUDY DESIGN AND METHODS: A retrospective cohort study was performed from March 18, 2020 to May 5, 2020, with follow-up through June 18, 2020, encompassing critically ill intubated patients admitted for COVID-19 pneumonia at an academic tertiary care hospital in Brooklyn, New York...
October 2021: Journal of Intensive Care Medicine
https://read.qxmd.com/read/34145166/ivermectin-for-prevention-and-treatment-of-covid-19-infection-a-systematic-review-meta-analysis-and-trial-sequential-analysis-to-inform-clinical-guidelines
#29
JOURNAL ARTICLE
Andrew Bryant, Theresa A Lawrie, Therese Dowswell, Edmund J Fordham, Scott Mitchell, Sarah R Hill, Tony C Tham
BACKGROUND: Repurposed medicines may have a role against the SARS-CoV-2 virus. The antiparasitic ivermectin, with antiviral and anti-inflammatory properties, has now been tested in numerous clinical trials. AREAS OF UNCERTAINTY: We assessed the efficacy of ivermectin treatment in reducing mortality, in secondary outcomes, and in chemoprophylaxis, among people with, or at high risk of, COVID-19 infection. DATA SOURCES: We searched bibliographic databases up to April 25, 2021...
June 21, 2021: American Journal of Therapeutics
https://read.qxmd.com/read/31397716/one-year-outcomes-following-tracheostomy-for-acute-respiratory-failure
#30
JOURNAL ARTICLE
Anuj B Mehta, Allan J Walkey, Douglas Curran-Everett, Ivor S Douglas
OBJECTIVES: Tracheostomy utilization has dramatically increased recently. Large gaps exist between expected and actual outcomes resulting in significant decisional conflict and regret. We determined 1-year patient outcomes and healthcare utilization following tracheostomy to aid in decision-making and resource allocation. DESIGN: Retrospective cohort study. SETTING: All California hospital discharges from 2012 to 2013 with follow-up through 2014...
November 2019: Critical Care Medicine
https://read.qxmd.com/read/22080643/a-multicenter-mortality-prediction-model-for-patients-receiving-prolonged-mechanical-ventilation
#31
MULTICENTER STUDY
Shannon S Carson, Jeremy M Kahn, Catherine L Hough, Eric J Seeley, Douglas B White, Ivor S Douglas, Christopher E Cox, Ellen Caldwell, Shrikant I Bangdiwala, Joanne M Garrett, Gordon D Rubenfeld
OBJECTIVE: Significant deficiencies exist in the communication of prognosis for patients requiring prolonged mechanical ventilation after acute illness, in part because of clinician uncertainty about long-term outcomes. We sought to refine a mortality prediction model for patients requiring prolonged ventilation using a multicentered study design. DESIGN: Cohort study. SETTING: Five geographically diverse tertiary care medical centers in the United States (California, Colorado, North Carolina, Pennsylvania, and Washington)...
April 2012: Critical Care Medicine
https://read.qxmd.com/read/33818614/tocilizumab-in-treatment-for-patients-with-covid-19
#32
COMMENT
Chengliang Yang, Mingyao Liu
No abstract text is available yet for this article.
July 1, 2021: JAMA Internal Medicine
https://read.qxmd.com/read/33750093/variability-in-the-hemodynamic-response-to-fluid-bolus-in-pediatric-septic-shock
#33
JOURNAL ARTICLE
Suchitra Ranjit, Rajeswari Natraj, Niranjan Kissoon, Ravi R Thiagarajan, Balasubramaniam Ramakrishnan, M Ignacio Monge García
OBJECTIVES: Fluid boluses are commonly administered to improve the cardiac output and tissue oxygen delivery in pediatric septic shock. The objective of this study is to evaluate the effect of an early fluid bolus administered to children with septic shock on the cardiac index and mean arterial pressure, as well as on the hemodynamic response and its relationship with outcome. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS: We prospectively collected hemodynamic data from children with septic shock presenting to the emergency department or the PICU who received a fluid bolus (10 mL/kg of Ringers Lactate over 30 min)...
August 1, 2021: Pediatric Critical Care Medicine
https://read.qxmd.com/read/33657830/invasive-management-of-acute-myocardial-infarction-complicated-by-cardiogenic-shock-a-scientific-statement-from-the-american-heart-association
#34
REVIEW
Timothy D Henry, Matthew I Tomey, Jacqueline E Tamis-Holland, Holger Thiele, Sunil V Rao, Venu Menon, Deborah G Klein, Yoshifumi Naka, Ileana L Piña, Navin K Kapur, George D Dangas
Cardiogenic shock (CS) remains the most common cause of mortality in patients with acute myocardial infarction. The SHOCK trial (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) demonstrated a survival benefit with early revascularization in patients with CS complicating acute myocardial infarction (AMICS) 20 years ago. After an initial improvement in mortality related to revascularization, mortality rates have plateaued. A recent Society of Coronary Angiography and Interventions classification scheme was developed to address the wide range of CS presentations...
April 13, 2021: Circulation
https://read.qxmd.com/read/33644843/the-surviving-sepsis-campaign-fluid-resuscitation-and-vasopressor-therapy-research-priorities-in-adult-patients
#35
REVIEW
Ishaq Lat, Craig M Coopersmith, Daniel De Backer, Craig M Coopersmith
OBJECTIVE: To expand upon the priorities of fluid resuscitation and vasopressor therapy research priorities identified by a group of experts assigned by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. DATA SOURCES: Original paper and literature search. STUDY SELECTION: Several members of the original task force with expertise specific to the area of fluid resuscitation and vasopressor therapy. DATA EXTRACTION: None...
March 1, 2021: Intensive Care Medicine Experimental
https://read.qxmd.com/read/33175277/pulmonary-infections-complicating-ards
#36
REVIEW
Charles-Edouard Luyt, Lila Bouadma, Andrew Conway Morris, Jayesh A Dhanani, Marin Kollef, Jeffrey Lipman, Ignacio Martin-Loeches, Saad Nseir, Otavio T Ranzani, Antoine Roquilly, Matthieu Schmidt, Antoni Torres, Jean-François Timsit
Pulmonary infection is one of the main complications occurring in patients suffering from acute respiratory distress syndrome (ARDS). Besides traditional risk factors, dysregulation of lung immune defenses and microbiota may play an important role in ARDS patients. Prone positioning does not seem to be associated with a higher risk of pulmonary infection. Although bacteria associated with ventilator-associated pneumonia (VAP) in ARDS patients are similar to those in patients without ARDS, atypical pathogens (Aspergillus, herpes simplex virus and cytomegalovirus) may also be responsible for infection in ARDS patients...
December 2020: Intensive Care Medicine
https://read.qxmd.com/read/33367994/prone-positioning-for-ards-patients-tips-for-preparation-and-use-during-the-covid-19-pandemic
#37
REVIEW
Ken Kuljit S Parhar, Danny J Zuege, Karen Shariff, Gwen Knight, Sean M Bagshaw
Many patients with coronavirus disease (COVID-19) will develop acute respiratory distress syndrome (ARDS). Prone positioning is an important non-pharmacologic strategy that should be considered for all invasively ventilated patients with moderate to severe ARDS (including those with COVID-19). Prone positioning offers several physiologic and clinical benefits, including improving hypoxemia, matching ventilation with perfusion, reducing regional hyperinflation, and improving survival. To safely offer prone positioning, appropriate training, simulation, and health system planning should be undertaken...
April 2021: Canadian Journal of Anaesthesia
https://read.qxmd.com/read/33285372/icu-acquired-hypernatremia-treated-by-enteral-free-water-a-retrospective-cohort-study
#38
JOURNAL ARTICLE
Elisabeth A J de Vos, Peter H J van der Voort
PURPOSE: ICU acquired hypernatremia (IAH) is associated with increased morbidity and mortality, however treatment remains controversial. This study aims to determine the effect of enteral free water suppletion in patients with IAH. MATERIALS AND METHODS: Retrospective single center study in a tertiary ICU. INCLUSION CRITERIA: patients with IAH and treatment with enteral free water. EXCLUSION CRITERIA: patients with renal replacement therapy, diabetic ketoacidosis or hyperosmolar hyperglycaemic state...
April 2021: Journal of Critical Care
https://read.qxmd.com/read/33196136/a-clinical-librarian-in-a-hospital-critical-care-unit-may-generate-a-positive-return-on-investment
#39
JOURNAL ARTICLE
Ned Hartfiel, Girendra Sadera, Victoria Treadway, Catherine Lawrence, Rhiannon Tudor Edwards
BACKGROUND: Timely information provided by clinical librarians can contribute to outcomes such as improved patient care and time savings for hospital staff. What is unknown is the return on investment (ROI) of a clinical librarian on a critical care unit. OBJECTIVE: The aim of this study was to assess the ROI, from the employer perspective, of placing a clinical librarian in a critical care unit in a large UK acute hospital. METHODS: Using a mixed methods approach, ROI was estimated by comparing the total costs with the total monetised benefits of implementing the clinical librarian intervention...
June 2021: Health Information and Libraries Journal
https://read.qxmd.com/read/32409703/diabetic-ketoacidosis
#40
REVIEW
Ketan K Dhatariya, Nicole S Glaser, Ethel Codner, Guillermo E Umpierrez
Diabetic ketoacidosis (DKA) is the most common acute hyperglycaemic emergency in people with diabetes mellitus. A diagnosis of DKA is confirmed when all of the three criteria are present - 'D', either elevated blood glucose levels or a family history of diabetes mellitus; 'K', the presence of high urinary or blood ketoacids; and 'A', a high anion gap metabolic acidosis. Early diagnosis and management are paramount to improve patient outcomes. The mainstays of treatment include restoration of circulating volume, insulin therapy, electrolyte replacement and treatment of any underlying precipitating event...
May 14, 2020: Nature Reviews. Disease Primers
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