scholarly journals Comparison of published guidelines for management of coagulopathy and thrombosis in critically ill patients with COVID 19: implications for clinical practice and future investigations

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Adam Flaczyk ◽  
Rachel P. Rosovsky ◽  
Clay T. Reed ◽  
Brittany K. Bankhead-Kendall ◽  
Edward A. Bittner ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Anticoagulation Management ◽  
Randomized Controlled Clinical Trials ◽  
Increased Risk ◽  
Individualized Approach

Abstract Critically ill patients with COVID-19 are at increased risk for thrombotic complications which has led to an intense debate surrounding their anticoagulation management. In the absence of data from randomized controlled clinical trials, a number of consensus guidelines and recommendations have been published to facilitate clinical decision-making on this issue. However, substantive differences exist between these guidelines which can be difficult for clinicians. This review briefly summarizes the major societal guidelines and compares their similarities and differences. A common theme in all of the recommendations is to take an individualized approach to patient management and a call for prospective randomized clinical trials to address important anticoagulation issues in this population.

Impact of lung ultrasound on clinical decision making in critically ill patients

2013 ◽  
Vol 40 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Nektaria Xirouchaki ◽  
Eumorfia Kondili ◽  
George Prinianakis ◽  
Polychronis Malliotakis ◽  
Dimitrios Georgopoulos
Keyword(s):  
Decision Making ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Clinical Decision

scholarly journals Lung Ultrasound in COVID-19 pandemic: Why? How? And When?

2020 ◽  
pp. 3-12
Author(s):  
Khrystyna Pronyuk ◽  
Andriy Vysotskyi
Keyword(s):  
Critically Ill ◽  
Computer Tomography ◽  
Critically Ill Patients ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Clinical Decision ◽  
X Rays ◽  
Lung Involvement ◽  
X Ray ◽  
Chest X Ray

During COVID-19 pandemic Lung ultrasound has rapidly become a tool for diagnosis and monitoring of lung involvement and it’s severity. Accurate evaluation of lung pathologic entities at the bedside, especially in critically ill patients, and those on mechanical ventilation, remains problematic. CT should not be frequently repeated and is not available everywhere, especially for critically ill patients. Limitations of bedside chest X-ray have been well described and lead to poor-quality X-ray films with low sensitivity.The lung ultrasound has been shown to be a useful tool in intensive care patients with adult respiratory distress syndrome (ARDS) and can be used forassessing severity of lung involvement in COVID-19. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. There have been shown that lung ultrasound can predict the deterioration of the patient's conditionand can be used for risk stratification and clinical decision making, reducethe use of both chest x‐rays and computer tomography, what is very important especially in limited resources settings.

The Design of Randomized Clinical Trials in Critically Ill Patients

CHEST Journal ◽  
2002 ◽  
Vol 121 (4) ◽  
pp. 1290-1300 ◽  
Author(s):  
Paul C. Hébert ◽  
Deborah J. Cook ◽  
George Wells ◽  
John Marshall
Keyword(s):  
Clinical Trials ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomized Clinical Trials

scholarly journals Pediatric Index of Mortality 3 score as a predictor for the outcomes of critically ill patients

2020 ◽  
Vol 60 (6) ◽  
pp. 328-33
Author(s):  
Gusti Ayu Nyoman Yulia Sitta Dewi ◽  
Dyah Kanya Wati ◽  
Made Gede Dwi Lingga Utama ◽  
Ketut Suarta Suarta ◽  
I Wayan Darma Artana ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Decision Making ◽  
Significant Risk ◽  
Bivariate Analysis ◽  
Good Ability ◽  
Increased Risk ◽  
Pediatric Index Of Mortality

Background The ability to predict mortality in critically ill patients is important for assessing patient prognosis, evaluating therapy, and assessing intensive care unit quality. The Pediatric Index of Mortality (PIM) 3 is a scoring system to predict outcomes in order to assist clinical decision-making. Objective To assess the ability of PIM 3 to predict outcomes of critically ill PICU patients.Methods This prospective cohort study included 150 children aged 1 month to 18 years who were admitted to the pediatric intensive care unit (PICU), Sanglah Hospital, Denpasar, Bali. Subjects were grouped into two based on ROC curve PIM score ≥48 and <48. The PIM 3 score was consisted of 10 variables, with a re-diagnosis classification of the PIM 2 score. Bivariate analysis was conducted to both groups to find the distribution of mortality in both groups, followed by homogenity test on variables gender, age, nutritional status, lenght of stay and mechanical ventilation. Variables which made the cut on bivariate test were included in multivariate analysis.Results The optimal PIM 3 score limit in predicting mortality was ≥48, with area under the curve (AUC) 76% (95%CI 0.69 to 0.85). Multivariate analysis revealed a 2.48 times increased risk to mortality in patients with PIM 3 score ≥48 (95%CI 1.6 to 3.7). In addition, PICU length of stay ≤7 days was a significant risk factor for mortality. Conclusion The PIM 3 has a good ability to predict the outcome of critically ill PICU patients. Critically ill patients with PIM 3 score ≥48 have a higher risk of mortality compared to those with PIM 3 < 48.

scholarly journals Hygiene protocols for the treatment of denture-related stomatitis: local and systemic parameters analysis - a randomized, double-blind trial protocol

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Adriana B. Ribeiro ◽  
Camila B. de Araújo ◽  
Luiz Eduardo V. Silva ◽  
Rubens Fazan-Junior ◽  
Helio C. Salgado ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Complex Structure ◽  
Material Design ◽  
Clinical Decision ◽  
Sodium Hypochlorite Solution ◽  
Oral Diseases ◽  
Double Blind ◽  
Lactose Monohydrate

Abstract Background Denture-related stomatitis (DS) is chronic multifactorial inflammation, strongly related to the presence of the biofilm that is the complex structure formed by microorganisms held together by a mucus-like matrix of carbohydrate that adheres to different surfaces, including the denture surface. DS has recently been correlated with deleterious cardiovascular alterations. The potential effect of hygiene protocols in the control of DS and randomized clinical trials that address this oral condition with cardiovascular complications are important in clinical decision-making. Material/design A clinical trial, randomized, double-blind, and with parallel groups, will be conducted in Brazil The sample will consist of 100 patients without teeth in both arches, users of at least maxillary complete dentures, and diagnosed with DS, who will be allocated to groups (n = 25 per group) according to the different hygiene protocols: (1) brushing of the palate and immersion of the prosthesis in 0.25% sodium hypochlorite solution (positive control); (2) brushing of the palate and immersion of the prosthesis in 0.15% triclosan solution; (3) brushing of the palate and immersion of the prosthesis in lactose monohydrate; or (4) brushing the palate with citric acid and immersing the prosthesis in lactose monohydrate. The response variables will be heart rate variability and alteration of blood pressure (systemic level), remission of DS, removal of biofilm, reduction of microbial load (colony-forming units (CFU)), mouth and prosthesis odor level, expression of MUC1, proinflammatory cytokines, C-reactive protein (CRP), viscosity, pH and salivary flow (locally); patient-centred qualitative analysis will also be undertaken. Measurements will be performed at baseline and 10 days after the interventions. The results obtained will be statistically analyzed as pertinent, with a level of significance of 0.05. Discussion This study will provide a guideline for clinical practice regarding the use of hygiene protocols in the treatment of oral diseases (DS) mediated by biofilm. Also, it may provide evidence of correlation of oral manifestation with cardiac risk. Trial registration Brazilian Registry of Clinical Trials, RBR-4hhwjb. Registered on 9 November 2018.

Use And Influence Of Lung Ultrasound On Clinical Decision Making In Critically Ill Patients

2010 ◽  
Author(s):  
Nektaria Xirouchaki ◽  
Maria Plataki ◽  
DHMHTRHS BABALIS ◽  
LEFTERIS MAGKANAS ◽  
VAGGELIS KANIARIS ◽  
...  
Keyword(s):  
Decision Making ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Clinical Decision
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