scholarly journals Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Raphaël Cinotti ◽  
Jean-Baptiste Lascarrou ◽  
Marie-Ange Azais ◽  
Gwenhaël Colin ◽  
Jean-Pierre Quenot ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Fluid Balance ◽  
Fluid Overload ◽  
Invasive Mechanical Ventilation ◽  
Randomized Controlled Study ◽  
Secondary Outcome ◽  
Controlled Study ◽  
Control Group ◽  
Randomized Controlled ◽  
Single Blind

Abstract Background Fluid overload has been associated with increased morbidity and mortality in critically ill patients. The goal of this study was to assess the efficacy and safety of a diuretic strategy to overcome positive fluid balance in patients on invasive mechanical ventilation. Methods Design: Multicenter, single-blind, randomized-controlled study. Patients were randomized into a diuretic (furosemide) or a control group. Patients were eligible in case of fluid overload defined as in-ICU weight increase ≥ 3%, invasive mechanical ventilation (FiO2 ≤ 60% and PEEP ≤ 10 cm H2O on inclusion) and hemodynamic stabilization. The primary outcome was fluid balance, defined as weight variation from reference weight to successful extubation. The main secondary outcome was the safety of diuretic. Results 171 patients were randomized. After 5 exclusions, 166 patients were included in the analysis: 77 in the diuretic and 89 in the control group. Fluid balance was 1.4 [− 2.5 to 4.5] kg in the diuretic and 6.4 [0.5–11.2] kg in the control group (p < 0.001). In the multiple imputation analysis, fluid balance was significantly decreased in the diuretic group (mean difference = − 4.8 95% CI [− 7.3 to − 2.5], p < 0.001). Eleven (14%) patients died in the diuretic group and 16 (18%) patients in the control group (p = 0.5). There was a worsening of Acute Kidney Injury in 67 (75.3%) patients of the control group versus 46 (59.7%) patients in the diuretic group (p = 0.03). Conclusions In this multicenter randomized-controlled study, protocolized diuretic therapy reduced fluid accumulation in patients receiving mechanical ventilation and was well tolerated with a favorable safety profile. Trial registration NCT 02345681, Registered January 26 2015, Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT02345681?term=02345681&draw=2&rank=1.

Sequential Non-Invasive Following Short-Term Invasive Mechanical Ventilation in the Treatment of Tuberculosis with Respiratory Failure: A Randomized Controlled Study

2021 ◽  
Author(s):  
Nai-Min Kang ◽  
Nan Zhang ◽  
Bao-Jian Luo ◽  
En-Dong Wu ◽  
Jian-Quan Shi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Randomized Controlled Study ◽  
Arterial Oxygen ◽  
Controlled Study ◽  
Invasive Ventilation ◽  
Ventilation Time ◽  
Non Invasive ◽  
Randomized Controlled

Abstract Background: Invasive and non-invasive mechanical ventilation (MV) have been combined as sequential MV (SMV) in the treatment of respiratory failure. However, the effectiveness remains unclear. Here, we performed a randomized controlled study to assess the efficacy and safety of SMV in the treatment of tuberculosis with respiratory failure.Methods. Forty-four tuberculosis patients diagnosed with respiratory failure were randomly divided into SMV group (n=24) and conventional MV (CMV) group (n=20). Initially, the patients in both groups received invasive positive pressure ventilation (IPPV). When the patients' conditions were relieved, the ventilation modality in SMV group was switched to oronasal face continuous positive airway pressure (CPAP) until weaning. Results. After treatment, the patients in SMV group had similar respiratory rate, heart rate, oxygenation index, alveolo-arterial oxygen partial pressure difference (A-aDO2), blood pH, PaCO2 to those in CMV group (all P value>0.05). There was no significant difference in ventilation time and ICU stay between the two groups (P>0.05), but SMV group significantly reduced the time of invasive ventilation (mean difference (MD):-36.2 hrs,95% confidence interval (CI):-53.6,-18.8 hrs,P<0.001). SMV group also reduced the incidence of ventilator-associated pneumonia (VAP;relative risk (RR):0.44,95% CI:0.24,0.83,P=0.006) and atelectasis (RR:0.49,95% CI:0.24,1.00,P=0.040). Conclusions. SMV was effective in treating tuberculosis with respiratory failure. It showed advantages in reducing invasive ventilation time and ventilator-associated adverse events.

scholarly journals Sequential non-invasive following short-term invasive mechanical ventilation in the treatment of tuberculosis with respiratory failure: a randomized controlled study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nai-Min Kang ◽  
Nan Zhang ◽  
Bao-Jian Luo ◽  
En-Dong Wu ◽  
Jian-Quan Shi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Invasive Ventilation ◽  
Ventilation Time ◽  
Non Invasive ◽  
Randomized Controlled

Abstract Background Invasive and non-invasive mechanical ventilation (MV) have been combined as sequential MV in the treatment of respiratory failure. However, the effectiveness remains unclear. Here, we performed a randomized controlled study to assess the efficacy and safety of sequential MV in the treatment of tuberculosis with respiratory failure. Methods Forty-four tuberculosis patients diagnosed with respiratory failure were randomly divided into sequential MV group (n = 24) and conventional MV group (n = 20). Initially, the patients in both groups received invasive positive pressure ventilation. When the patients' conditions were relieved, the ventilation modality in sequential MV group was switched to oronasal face mask continuous positive airway pressure until weaning. Results After treatment, the patients in sequential MV group had similar respiratory rate, heart rate, oxygenation index, alveolo-arterial oxygen partial pressure difference (A-aDO2), blood pH, PaCO2 to those in conventional MV group (all P value > 0.05). There was no significant difference in ventilation time and ICU stay between the two groups (P > 0.05), but sequential MV group significantly reduced the time of invasive ventilation (mean difference (MD): − 36.2 h, 95% confidence interval (CI) − 53.6, − 18.8 h, P < 0.001). Sequential MV group also reduced the incidence of ventilator-associated pneumonia (VAP; relative risk (RR): 0.44, 95% CI 0.24, 0.83, P = 0.006) and atelectasis (RR:0.49, 95% CI 0.24,1.00, P = 0.040). Conclusions Sequential MV was effective in treating tuberculosis with respiratory failure. It showed advantages in reducing invasive ventilation time and ventilator-associated adverse events. Registration number for clinical trial Chinese Clinical Trial Registry ChiCTR2000032311, April 21st, 2020

scholarly journals Tofacitinib versus standard of care treatment in patients with COVID-19: a multicenter non-randomized controlled study

2021 ◽  
Author(s):  
Sergey Moiseev ◽  
Nikolay Bulanov ◽  
Anastasiia Zykova ◽  
Michail Brovko ◽  
Pavel Novikov ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Oxygen Saturation ◽  
Cox Regression ◽  
Invasive Mechanical Ventilation ◽  
Standard Of Care ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Cox Regression Analysis ◽  
Randomized Controlled ◽  
Standard Of Care Treatment

This non-randomized controlled study aimed to assess the efficacy of tofacitinib in reducing the risk of invasive mechanical ventilation or death in patients with COVID-19. Patients with COVID-19 associated with reduced oxygen saturation, increased C-reactive protein (≥50 mg/L), and/or persisting fever were recruited. Tofacitinib was administered in addition to standard of care therapy. Study outcomes were evaluated separately in the groups of patients with oxygen saturation at rest ≤93% and >93%. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox regression analysis adjusted for inverse propensity score weighting. Overall, 384 patients with COVID-19 (212 males; median age 60 years) were included in our study and were treated with tofactinib (n=131) or standard of care alone (n=253). The percentages of patients who started mechanical ventilation or died during hospitalization in the tofacitinib and control groups were 12.5% (9/72) vs. 14.1% (26/185) among patients who required respiratory support (HR 0.92, 95% CI 0.33-2.56), and 1.7% (1/59) vs. 4.4% (3/68) in those with normal oxygen saturation (HR 0.83; 95 CI 0.07-9.44). Tofacitinib did not reduce the risk of invasive mechanical ventilation or death in patients with COVID-19, although the analysis of these outcomes favored tofacitinib.

scholarly journals Effect of Tourniquet Use in Ankle Arthroscopic Surgery on Postoperative Recovery: A Prospective Non- Randomized Controlled Study

2020 ◽  
Author(s):  
Tingting Huang ◽  
Haixiao Liu ◽  
Yuezheng Hu ◽  
Xinxian Xu
Keyword(s):  
Functional Outcome ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Arthroscopic Surgery ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Control Group ◽  
Complication Rates ◽  
Randomized Controlled ◽  
The Mean

Abstract The aim of this prospective non- randomized controlled study was to explore the effect of tourniquet use on joint swelling, pain, functional outcome, and tourniquet- related ischemia- reperfusion injury (IRI) during ankle arthroscopic surgery.52 patients who received ankle arthroscopy were allocated to had the procedure done with the tourniquet inflated (the Control group, n= 27) or without the tourniquet inflated (the NT group, n= 25). The main outcome measures were: (1) The amount of swelling of the ankle; (2) Pain as measured by a visual analog scale (VAS); (3) The levels of MDA, IMA,TOS, TAS and OSI at 10 min before incision (T1)，after the completion of surgery (T2), and 30 min after tourniquet deflation (T3); (4) The functional outcome as measured by American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score; (5) The rate of complication. All patients were reviewed at a mean follow- up of 14.2 months (range, 12- 19 months). The mean circumferences of the ankle in the NT group were significantly lower than those in the Control group on postoperative day 2 and 5 (p<0.05). The mean level of VAS in the Control group was significantly higher on postoperative day 2 (p<0.05). The outcomes of AOFAS ankle hindfoot score were comparable between groups postoperatively (p>0.05). The levels of MDA, IMA, TOS and OSI were all significantly lower in the NT group compared at T2 and T3 (p<0.05), and the level of TAS was significantly lower in the NT group at T3 (p<0.05). The complication rates of two groups were comparable (p>0.05).With the use of tourniquet during ankle arthroscopic surgery, there was increased joint swelling and pain postoperatively, and a trend toward increased levels of MDA, IMA, TOS, TAS and OSI intraoperatively. Thus, we do not recommend using a tourniquet in this type of procedure.

scholarly journals Effectiveness of ultrasound guided ethanol motor points block in reduction of spasticity and improvement of upper limb function in hemiplegic patients: a randomized controlled study

2020 ◽  
Vol 7 (9) ◽  
pp. 1409
Author(s):  
Sreejith C. ◽  
Akoijam Joy Singh ◽  
Longjam Nilachandra Singh ◽  
Kanti Rajkumari ◽  
Margaret Chabungbam ◽  
...  
Keyword(s):  
Upper Limb ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Control Group ◽  
Ultrasound Guided ◽  
Limb Function ◽  
Ethanol Injection ◽  
Randomized Controlled ◽  
Upper Limb Function ◽  
Group A

Background: Stroke is the third leading cause of disability in general population commonly causing upper motor neuron syndrome complications like spasticity, which is more common in upper limb. Ethanol injection into spastic muscle is an emerging effective treatment in the spasticity management. Ethanol causes selective destruction of nerve fibers through denaturation of protein.Methods: A randomized controlled study was conducted for a period of 2 years from March 2018 on sixty-eight hemiplegic patients to assess the effectiveness of ethanol muscle block in reduction of spasticity and improvement in functional ability. The patients were allocated into two groups (Group A and B). Group A received ultrasound guided intramuscular ethanol injection along with range of motion (ROM) exercises and wrist hand orthosis (WHO) and Group B received ROM exercises and WHO. The outcomes were measured by modified ashworth scale (MAS) for spasticity and modified version of motor assessment scale for functional improvement.Results: Intervention group showed significant improvement in spasticity shown by reduction of MAS of elbow flexors from 3 at baseline to 1.15±0.3 at 12 weeks as compared to control group with 3 at baseline to 1.76±0.5 at 12 weeks (p<0.05). Upper limb function scale of study group improved from 1.5±0.8 to 3.0±0.6 at 12 weeks compared to control group 1.3±0.8 to 2.8±0.6 (p<0.05).Conclusions: It can thus be concluded that intramuscular injection of ethanol accompanied by wrist hand orthosis have beneficial effect on improvement of spasticity and upper limb function.

Early Use of Sarilumab in Patients Hospitalised with COVID-19 Pneumonia and Features of Systemic Inflammation.

2021 ◽  
Author(s):  
Nicolás Merchante ◽  
Sheila Cárcel ◽  
José Carlos Garrido-Gracia ◽  
Marta Trigo-Rodríguez ◽  
María Ángeles Esteban Moreno ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Systemic Inflammation ◽  
Primary Outcome ◽  
Invasive Mechanical Ventilation ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Open Label ◽  
Randomized Controlled ◽  
Subcutaneous Dose ◽  
Early Use

In this phase II, open-label, randomized, controlled clinical trial of 115 patients hospitalized with COVID-19 and systemic inflammation, early use of sarilumab was associated with a low risk of acute respiratory distress syndrome requiring high-flow devices or mechanical ventilation. Objective: To investigate the efficacy and safety of early treatment with sarilumab, added to standard of care (SOC), in hospitalised adults with COVID-19. Methods: Phase II, open-label, randomized, controlled clinical trial of hospitalised patients with COVID-19 pneumonia and interleukin (IL)-6 levels ≥ 40 pg/mL and/or D-dimer > 1500 ng/mL. Participants were randomized (1:1:1) to receive SOC (control group), SOC plus a single subcutaneous dose of sarilumab 200 mg (Sarilumab-200) or SOC plus a single subcutaneous dose of sarilumab 400 mg (Sarilumab-400). The primary outcome variable was the development of acute respiratory distress syndrome (ARDS) requiring high-flow nasal oxygenation (HFNO), non-invasive mechanical ventilation (NIMV) or invasive mechanical ventilation (IMV) at day 28. Results: One-hundred and fifteen participants (control group, n = 39; Sarilumab-200, n = 37; Sarilumab-400, n = 39) were included. At randomization, 104 (90%) patients had supplemental oxygen and 103 (90%) received corticosteroids. Eleven (28%) patients in the control group, ten (27%) in Sarilumab-200 and five (13%) in Sarilumab-400 developed the primary outcome (hazard ratio [95% CI] of Sarilumab-400 vs control group: 0.41 [0.14-1.18]; p=0.09). Seven (6%) patients died: three in the control group and four in Sarilumab-200. There were no deaths in Sarilumab-400 (p = 0.079, log-rank test for comparisons with the control group). Conclusion: In patients recently hospitalised with COVID-19 pneumonia and features of systemic inflammation, early IL-6 blockade with a single dose of sarilumab 400 mg was safe and associated with a trend for better outcomes.

scholarly journals Evaluating a combined bowel preparation for small-bowel capsule endoscopy: a prospective randomized–controlled study

2019 ◽  
Vol 8 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Stephanie L Hansel ◽  
Joseph A Murray ◽  
Jeffrey A Alexander ◽  
David H Bruining ◽  
Mark V Larson ◽  
...  
Keyword(s):  
Small Bowel ◽  
Capsule Endoscopy ◽  
Bowel Preparation ◽  
Diagnostic Yield ◽  
Completion Rate ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Control Group ◽  
Randomized Controlled ◽  
Significant Difference

Abstract Background Capsule endoscopy (CE) is frequently hindered by intra-luminal debris. Our aim was to determine whether a combination bowel preparation would improve small-bowel visualization, diagnostic yield, and the completion rate of CE. Methods Single-blind, prospective randomized–controlled study of outpatients scheduled for CE. Bowel-preparation subjects ingested 2 L of polyethylene glycol solution the night prior to CE, 5 mL simethicone and 5 mg metoclopramide 20 minutes prior to CE and laid in the right lateral position 30 minutes after swallowing CE. Controls had no solid food after 7 p.m. the night prior to CE and no liquids 4 hours prior to CE. Participants completed a satisfaction survey. Capsule readers completed a small-bowel-visualization assessment. Results Fifty patients were prospectively enrolled (56% female) with a median age of 54.4 years and 44 completed the study (23 patients in the control group and 21 in the preparation group). There was no significant difference between groups on quartile-based small-bowel visualization (all P &gt; 0.05). There was no significant difference between groups in diagnostic yield (P = 0.69), mean gastric (P = 0.10) or small-bowel transit time (P = 0.89). The small-bowel completion rate was significantly higher in the preparation group (100% vs 78%; P = 0.02). Bowel-preparation subjects reported significantly more discomfort than controls (62% vs 17%; P = 0.01). Conclusions Combined bowel preparation did not improve small-bowel visualization but did significantly increase patient discomfort. The CE completion rate improved in the preparation group but the diagnostic yield was unaffected. Based on our findings, a bowel preparation prior to CE does not appear to improve CE performance and results in decreased patient satisfaction (ClinicalTrials.gov, No. NCT01243736).

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