scholarly journals Critical Care Ultrasound Oriented Shock Treatment in Intensive Care Unit: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Wanhong Yin ◽  
Yao Qin ◽  
Tongjuan Zou ◽  
Xueying Zeng ◽  
Yi Li ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Standard Care ◽  
Controlled Trial ◽  
Shock Treatment ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Critical Care Ultrasound

Abstract Objective: To determine whether our established Pathophysiology and etiology treatment for shock based on critical ultrasonography (PESCUS) workflow is superior to standard care in the setting of Intensive Care Unit (ICU). Materials and Methods: This is a prospective randomized controlled study. Critically ill adult shock patients were assigned to critical care ultrasound oriented treatment (CUOT) group who received treatment designed for different phases of shock guided by PESCUS workflow or standard care (SC) group who received standard care without treatment guided by PESCUS workflow.Results: Of the 147 enrolled patients, 77 were assigned to the CUOT group and 70 to the SC group. There were no significant difference between the two groups at baseline. The ICU mortality in CUOT group was significantly lower (29.9% vs. 45.7%, P=0.047). The CUOT group received significantly less fluid than SC group in the stabilization and de-escalation phases. The median duration of stabilization and de-escalation phase of shock in CUOT group was 35.0 [IQR 19.3-59.8] hours compared with 60.0[IQR 24.0-78.0] hours in SC group, p=0.024). Conclusions: Our study suggests utilization of PESCUS workflow can potentially improve ICU outcome in shock patient and avoid unnecessary fluid overload during shock recovery phase. Trial registration: Critical Care Ultrasound Oriented Shock Treatment in ICU, (28/03/2017) NCT03093987，Registered, Retrospectively registered .

scholarly journals Effectiveness of Kangaroo Mother Care by Role-Playing Method on Mother’s Resilience and Breastfeeding Self-Efficacy in Neonatal Intensive Care Unit, a Randomized Controlled Trial

2021 ◽  
Author(s):  
fateme mohammadi ◽  
Behnaz Basiri ◽  
Majid Barati ◽  
Salman Khazaei ◽  
Seyedeh Zahra Masoumi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Self Efficacy ◽  
Neonatal Intensive Care ◽  
Controlled Trial ◽  
Role Playing ◽  
Kangaroo Mother Care ◽  
Randomized Controlled ◽  
Significant Difference

Abstract Background The purpose of the study is to evaluate the effectiveness of kangaroo mother care by role-playing method on mother’s resilience and breastfeeding self-efficacy in neonatal intensive care unit. Methods In this one-blind a randomized controlled trial,78 mothers of infants admitted to neonatal intensive care unit were randomly assigned into two groups: role-playing method (n = 39), routine method (n = 39). The mothers of the intervention group were trained individually in two 30-minute sessions. After training, mothers performed kangaroo mother Care for their infants three times a day and each time 30 min for 7 days. Mothers in the control group received routine embrace care training (booklet training). Questionnaires were collected before the intervention, one day after and one week after intervention. Data analyses were conducted using SPSS version 22. Results mother’s resilience and breastfeeding self-efficacy in the study groups was significant at the end of the two among groups. Funding demonstrated a statistically significant difference in the score of the resilience (P = < 0.001) and breastfeeding self-efficacy (P = < 0.001) in the each group one day and one week after performing the intervention. In addition, revealed a statistically significant difference between the both groups in of resilience score(P < 0.01) and breastfeeding self-efficacy (P < 0.01) one day and one week after performing the intervention (P < 0.01), So that the role playing method was more effective than the routine method (booklet training). Conclusion Training kangaroo mother care by role-playing and routine methods were both effective in mother’s resilience and breastfeeding self-efficacy, but role-playing method was More effective and can be recommended role playing and routine methods as therapeutic care methods in clinical settings at the beginning of the admission of infants in the neonatal intensive care unit to improve mother’s resilience and breastfeeding self-efficacy.

scholarly journals Standard Care Versus Awake Prone Position in Adult Nonintubated Patients With Acute Hypoxemic Respiratory Failure Secondary to COVID-19 Infection—A Multicenter Feasibility Randomized Controlled Trial

2021 ◽  
pp. 088506662110144
Author(s):  
Devachandran Jayakumar ◽  
Pratheema Ramachandran, DNB ◽  
Ebenezer Rabindrarajan, DNB ◽  
Bharath Kumar Tirupakuzhi Vijayaraghavan, MD ◽  
Nagarajan Ramakrishnan, AB ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Prone Position ◽  
Feasibility Study ◽  
Standard Care ◽  
Controlled Trial ◽  
Prone Positioning ◽  
Hypoxemic Respiratory Failure ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Hypoxic Respiratory Failure

Rationale: The feasibility and safety of awake prone positioning and its impact on outcomes in non-intubated patients with acute respiratory distress syndrome secondary to COVID-19 is unknown. Results of the observational studies published during this pandemic have been conflicting. In this context, we conducted a multi-center, parallel group, randomized controlled feasibility study on awake prone positioning in non-intubated patients with COVID-19 pneumonia requiring supplemental oxygen. Methods: 60 patients with acute hypoxic respiratory failure secondary to COVID-19 pneumonia requiring 4 or more liters of oxygen to maintain a saturation of ≥92% were recruited in this study. Thirty patients each were randomized to either standard care or awake prone group. Patients randomized to the prone group were encouraged to self-prone for at least 6 hours a day. The primary outcome was the proportion of patients adhering to the protocol in each group. Results: In the prone group, 43% (13 out of 30) of patients were able to self-prone for 6 or more hours a day. In the supine group, 47% (14 out of 30) were completely supine and 53% spent some hours in the prone position, but none exceeded 6 hours. There was no significant difference in any of the secondary outcomes between the 2 groups and there were no adverse events. Conclusions: Awake prone positioning in non-intubated patients with acute hypoxic respiratory failure is feasible and safe under clinical trial conditions. The results of our feasibility study will potentially help in the design of larger definitive trials to address this key knowledge gap.

Effect of Albumin Addition to Cardiopulmonary Bypass Prime on Outcomes in Children Undergoing Open-Heart Surgery (EACPO Study)—A Randomized Controlled Trial

2020 ◽  
pp. 215013512095908
Author(s):  
Abdul Rauf ◽  
Reena K. Joshi ◽  
Neeraj Aggarwal ◽  
Mridul Agarwal ◽  
Manendra Kumar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Controlled Study ◽  
Risk Category ◽  
Open Heart ◽  
Oncotic Pressure ◽  
Randomized Controlled

Background: There is a paucity of literature regarding the association of high oncotic priming solutions for pediatric cardiopulmonary bypass (CPB) and outcomes, and no consensus exists regarding the composition of optimal CPB priming solution. This study aimed to examine the impact of high oncotic pressure priming by the addition of 20% human albumin on outcomes. Methods: Double-blinded, randomized controlled study was done in the pediatric cardiac intensive care unit of a tertiary care hospital. Consecutive children with congenital heart diseases admitted for open-heart surgery were randomized into two groups, where the study group received an additional 20% albumin to conventional blood prime before CPB initiation. Results: We enrolled 39 children in the high oncotic prime (added albumin) group and 37 children in the conventional prime group. In the first 24-hour postoperative period, children in the albumin group had significantly lower occurrence of hypotension (28.2% vs 54%, P = .02), requirement of fluid boluses (25.6% vs 54%, P = .006), and lactate clearance time (6 vs 9 hours, P < .001). Albumin group also had significantly higher platelet count (×103/µL) at 24 hours (112 vs 91, P = .02). There was no significant difference in intra-CPB hemodynamic parameters and incidence of acute kidney injury. In subgroup analysis based on risk category, significantly decreased intensive care unit stay (4 vs 5 days, P = .04) and hospital stay (5 vs 7 days, P = .002) were found in the albumin group in low-risk category. Conclusion: High oncotic pressure CPB prime using albumin addition might be beneficial over conventional blood prime, and our study does provide a rationale for further studies.

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