Tag: trial

Upvote Story 4
Statistically significant results in anesthesia and critical care randomized controlled trials are often fragile, and study conclusions are frequently affected by spin. Routine calculation of the Fragility Index in medical literature may allow for better understanding of trials and therefore enhance the quality of reporting. We identified 166 eligible randomized controlled trials with a median sample size of 207 patients (interquartile range, 109–497). The median... Read More | Comment
Upvote Story 5
Among ICU nurses, an intervention that included education, role-play, and debriefing resulted in a lower prevalence of job strain at 6 months compared with nurses who did not undergo this program. Further research is needed to understand which components of the program may have contributed to this result and to evaluate whether this program is cost-effective. Among 198 ICU nurses who were randomized (95 aged... Read More | Comment
Upvote Story 20
Vitamin C, angiotensin-II, and methylene blue are emerging options on the cutting edge of refractory septic shock treatment that require more investigation, but nevertheless appear promising, Rishi Rattan, MD, said at the annual clinical congress of the American College of Surgeons. Trials evaluating vitamin C in this setting have demonstrated a large mortality impact with an absence of side effects, according to Dr. Rattan, a... Read More | Comment
Upvote Story 9
Intravenous caffeine is able to accelerate emergence from isoflurane anesthesia in healthy males without any apparent adverse effects. All randomized participants were included in the analysis. The mean time to emergence with saline was 16.5 ± 3.9 (SD) min compared to 9.6 ± 5.1 (SD) min with caffeine (P = 0.002), a difference of 6.9 min (99% CI, 1.8 to 12), a 42% reduction. Participants emerged at a higher expired... Read More | Comment
Upvote Story 15
In this multicentre study, we could not demonstrate any difference between Lp299 and CHX used in oral care procedures regarding their impact on colonisation with emerging potentially pathogenic enteric bacteria in the oropharynx and trachea. Potentially pathogenic enteric bacteria not present at inclusion were identified in oropharyngeal samples from 29 patients in the CHX group and in 31 samples in the probiotic group. One hundred... Read More | Comment
Upvote Story 6
Recently the MINDS-USA trial evaluated the use of haloperidol or ziprasidone for delirium in critical illness. Before jumping into the results of this study, it will help to establish a couple of foundational principles. Overall, antipsychotics don’t reverse the underlying pathophysiologic causes of delirium. However, antipsychotics can be useful to alleviate symptoms of agitation and insomnia, allowing the patient to be managed safely while delirium... Read More | Comment
Upvote Story 6
Functional status and chronic health status are important baseline characteristics of critically ill patients. The assessment of frailty on admission to the intensive care unit (ICU) may provide objective, prognostic information on baseline health. To determine the impact of frailty on the outcome of critically ill patients, we performed a systematic review and meta-analysis comparing clinical outcomes in frail and non-frail patients admitted to ICU.... Read More | Comment
Upvote Story 6
Dexmedetomidine is associated with less delirium than benzodiazepines, and better sleep architecture than either benzodiazepines or propofol; its effect on delirium and sleep when administered at night to patients requiring sedation remains unclear. Nocturnal administration of low-dose dexmedetomidine in critically ill adults reduces the incidence of delirium during the ICU stay; patient-reported sleep quality appears unchanged. Nocturnal dexmedetomidine was associated with a greater proportion of... Read More | Comment
Upvote Story 4
Patients who develop vasodilatory shock, particularly when caused by an inflammatory condition like sepsis or pancreatitis, have evidence of significant endothelial injury as manifested by coagulation disorders and increased capillary permeability. Endothelial injury during shock may lead to ACE defects, which in turn may cause an increase in vasodilatory mediators that are normally metabolized by ACE and a relative or absolute decrease in ANG-2. These... Read More | Comment
Upvote Story 15
It seems like every week there’s another publicized instance of our impending replacement by artificial intelligence. Big Data, they say, is going to free us of the cognitive burdens of complex thought while maximizing healthcare outcomes. This latest entry is the “AI Clinician”, which has been created as a demonstration for the treatment of sepsis. Or, rather more narrowly, the AI Clinician tries to prescribe... Read More | Comment
Upvote Story 4
A novel drug is showing promise for helping improve cognition in patients with mild to moderate Alzheimer’s disease (AD), according to new topline results. A phase 3 trial of more than 800 patients showed that those who were randomly assigned to receive oral GV-971 (Green Valley Pharmaceutical Co, China) met the primary endpoint of significant change from baseline to week 36 on the 12-item cognitive... Read More | Comment
Upvote Story 7
It is a longstanding cultural norm to provide supplemental oxygen to sick patients regardless of their blood oxygen saturation. A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in hospital. Patients randomised to liberal oxygen therapy were more likely to die (risk ratio 1.21 (95% confidence interval 1.03 to 1.43)). The increase in mortality was highest... Read More | Comment
Upvote Story 6
Critical illness can disrupt local and systemic mechanisms that protect against upper gastrointestinal bleeding, a condition that may be associated with increased mortality, particularly among patients receiving extracorporeal life support. On the basis of randomized trials performed over a period of 40 years,3 most guidelines recommend preventive therapy with either histamine H2–receptor antagonists or proton-pump inhibitors (PPIs) for patients in the intensive care unit (ICU)... Read More | Comment
Upvote Story 5
“There is no mortality benefit for that.” How many times have you heard that? The implication is usually the same: that intervention is a waste of time. A smart, evidence-based clinician wouldn’t bother with it. But, what does it actually mean if there is no proven mortality benefit? Several factors conspire to make it nearly impossible to prove mortality benefit in critical care: Mortality is... Read More | Comment
Upvote Story 4
Perhaps the most vexing problem in a patient in an intensive care unit (ICU) is an unexpected change in mental status. Historically, “acute encephalopathy” was the term used to encompass such alterations, but “delirium” is now used to describe this state. The Oxford English Dictionary defines delirium as “an acutely disturbed state of mind characterized by restlessness, illusions, and incoherence that are occurring in intoxication,... Read More | Comment