Tag: trial

Effect of an automated notification system for deteriorating ward patients on clinical outcomes

We performed a prospective before-and-after study in all patients admitted to two clinical ward areas in a district general hospital in the UK. We examined the effect on clinical outcomes of deploying an electronic automated... read more

The Confusion Assessment Method for the ICU-7 Delirium Severity Scale

Delirium severity is independently associated with longer hospital stays, nursing home placement, and death in patients outside the ICU. Delirium severity in the ICU is not routinely measured because the available instruments... read more

Which position is safest for central line placement: subclavian, jugular, femoral?

Where to place a central venous catheter is a decision driven mainly by individual experience and preference. The limited evidence available has not established any site as superior; the subclavian position has been reported... read more

Comparison of Alveolar Recruitment Strategies for Preventing Postoperative Pulmonary Complications

This randomized clinical trial compares the effects of adding an intensive vs moderate alveolar recruitment strategy to protective ventilation on the number and severity of pulmonary complications following cardiac surgery.... read more

Family Responses to Prognostic Information in Chronic Critical Illness

Prognostic disclosure by skilled clinician communicators evokes a repertoire of responses from surrogates for the chronically critically ill. Recognition of these response patterns may help all clinicians better communicate... read more

Pre-hospital therapeutic hypothermia: The RINSE trial

Therapeutic hypothermia has had a bit of a rollercoaster ride over the last few years. It was all the rage following three small trials, which initially suggested a significant benefit from cooling patients to 33C following... read more

Meta-analysis confirms EGDT for sepsis is unhelpful and wasteful (PRISM)

Three large, well-conducted randomized trials around the world (ProCESS, ARISE, and ProMISe) all agreed: use of early goal-directed therapy (EGDT) for sepsis does not improve mortality or any other important clinical outcome.... read more

The Case for CRISPR-Cas9

Few techniques in the history of modern science have made as large an impact in as short a time as CRISPR-Cas9. Only a few years after the technique was first described, its inventors are predicted to be on the shortlist... read more

Mechanical Ventilation: Which Patients Benefit from High PEEP?

Among patients with hypoxaemia after cardiac surgery, the use of an intensive alveolar recruitment strategy compared with a moderate recruitment strategy resulted in less severe pulmonary complications during the hospital... read more

Vitamin C and the Ethics of Borrowing data

I was recently amazed to be engaged in a Twitter kerfuffle which generated more than 10,000 Impressions within 24 hours. Passions were running high, libellous comments were being broadcast, and old friendships seemed to be... read more

Clinical review: The ABC of weaning failure

About 20% to 30% of patients are difficult to wean from invasive mechanical ventilation. The pathophysiology of difficult weaning is complex. Accordingly, determining the reason for difficult weaning and subsequently developing... read more

Vitamin D and outcomes in adult critically ill patients

In critically ill patients, vitamin D administration might be associated with a reduction in mortality without significant adverse events. A large multicenter randomized trial should conclusively confirm these findings. Seven... read more

What’s new in the extracorporeal treatment of sepsis?

Clinical research has shown that endotoxin is indeed circulating in the blood of up to 50% of sepsis shock patients and associated with impaired clinical outcome. In view of the pivotal role of endotoxin in sepsis patients,... read more

Efficacy of Oral Risperidone, Haloperidol, or Placebo for Symptoms of Delirium Among Patients in Palliative Care

In patients receiving palliative care, individualized management of delirium precipitants and supportive strategies result in lower scores and shorter duration of target distressing delirium symptoms than when risperidone... read more

Moderate Exercise and Oxygen Consumption in Hypertrophic Cardiomyopathy

This randomized clinical trial assesses whether moderate-intensity exercise training, compared with usual activity, improves exercise capacity in adults with hypertrophic cardiomyopathy. During a 5-year period, 728 adult... read more

The ICM research agenda on ICU-acquired weakness

Intensive care unit (ICU)-acquired weakness (ICUAW) develops as a complication of critical illness and may represent the extreme end of a spectrum of weakness that begins with any serious illness regardless of care location.... read more

Mechanical Thrombectomy for Acute Ischemic Stroke

Coutinho et al have performed a timely post hoc analysis consisting of a patient population from 2 large, prospective, core laboratory–adjudicated trials: Solitaire With the Intention for Thrombectomy (SWIFT) and Solitaire... read more

Ratio-based Transfusion and Non-trauma Patients

Researchers at Massachusetts General Hospital (MGH) urge caution in adopting ratio-based transfusion - a practice previously studied only in patients with severe traumatic injuries - in non-trauma patients. Their study published... read more

Meta-Analysis of Therapeutic Hypothermia for Traumatic Brain Injury in Adult and Pediatric Patients

Therapeutic hypothermia is a likely beneficial treatment following TBI in adults, improving both neurologic outcomes and decreasing mortality rates. Our work suggests that the optimal management strategy to improve both morbidity... read more

Opening pressures and atelectrauma in ARDS

Data show that the prerequisites of the open lung strategy are not satisfied using PEEP up to 15 cmH2O and plateau pressure up to 30 cmH2O. For an effective open lung strategy, higher pressures are required. Therefore,... read more

Care that Matters: Quality Measurement and Health Care

Barry Saver and colleagues caution against the use of process and performance metrics as health care quality measures in the United States. There is limited evidence that many "quality" measures - including those... read more

Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin

Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin: a subgroup analysis of SOCRATES, a randomised, double-blind, controlled trial. In this prespecified... read more