Adding procalcitonin-guided therapy to standard care did not reduce mortality in critically ill patients

2012 ◽  
Vol 156 (4) ◽  
pp. JC2
Author(s):  
Henry S. Sacks
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Guided Therapy

scholarly journals Relaxation for Critically ill Patient Outcomes andStress-coping Enhancement (REPOSE): a protocol for a pilot randomised trial of an integrative intervention to improve critically ill patients’ delirium and related outcomes

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023961
Author(s):  
Elizabeth D E Papathanassoglou ◽  
Yoanna Skrobik ◽  
Kathleen Hegadoren ◽  
Patrica Thompson ◽  
Henry Thomas Stelfox ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Patient Outcomes ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Control Group ◽  
Moderate Pressure ◽  
Icu Discharge ◽  
Integrative Intervention

IntroductionDelirium is a common complication of critical illness, associated with negative patient outcomes. Preventive or therapeutic interventions are mostly ineffective. Although relaxation-inducing approaches may benefit critically ill patients, no well-designed studies target delirium prevention as a primary outcome. The objective of this study is to assess feasibility and treatment effect estimates of a multimodal integrative intervention incorporating relaxation, guided imagery and moderate pressure touch massage for prevention of critical illness delirium and for related outcomes.Methods and analysisRandomised, controlled, single-blinded trial with two parallel groups (1:1 allocation: intervention and standard care) and stratified randomisation (age (18–64 years and ≥65 years) and presence of trauma) with blocking, involving 104 patients with Intensive Care Delirium Screening Checklist (ICDSC): 0–3 recruited from two academic intensive care units (ICUs). Intervention group participants receive the intervention in addition to standard care for up to five consecutive days (or until transfer/discharge); control group participants receive standard care and a sham intervention. We will assess predefined feasibility outcomes, that is, recruitment rates and protocol adherence. The primary clinical outcome is incidence of delirium (ICDSC ≥4). Secondary outcomes include pain scores, inflammatory biomarkers, heart rate variability, stress and quality of life (6 weeks and 4 months) post-ICU discharge. Feasibility measures will be analysed descriptively, and outcomes will be analysed longitudinally. Estimates of effects will be calculated.Ethics and disseminationThe study has received approval from the Human Research Ethics Board, University of Alberta. Results will inform the design of a future multicentre trial.Trial registration numberNCT02905812; Pre-results.

A pilot feasibility trial of allocation of freshest available red blood cells versus standard care in critically ill patients

Transfusion ◽  
2011 ◽  
Vol 52 (6) ◽  
pp. 1196-1202 ◽  
Author(s):  
Cecile Aubron ◽  
Gillian Syres ◽  
Alistair Nichol ◽  
Michael Bailey ◽  
Jasmin Board ◽  
...  
Keyword(s):  
Red Blood Cells ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Cells ◽  
Standard Care ◽  
Feasibility Trial

scholarly journals A Randomized, Single-blind, Group sequential, Active-controlled Study to evaluate the clinical efficacy and safety of α-Lipoic acid for critically ill patients with coronavirus disease 2019(COVID-19)

2020 ◽  
Author(s):  
Ming Zhong ◽  
Aijun Sun ◽  
Ting Xiao ◽  
Ge Yao ◽  
Ling Sang ◽  
...  
Keyword(s):  
Placebo Group ◽  
Critically Ill ◽  
Lipoic Acid ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Efficacy And Safety ◽  
Group Sequential ◽  
All Cause Mortality ◽  
Single Blind

AbstractObjectTo evaluate the clinical efficacy and safety of α-Lipoic acid (ALA) for critically ill patients with coronavirus disease 2019 (COVID-19).MethodsA randomized, single-blind, group sequential, active-controlled trial was performed at JinYinTan Hospital, Wuhan, China. Between February 2020 and March 2020, 17 patients with critically ill COVID-19 were enrolled in our study. Eligible patients were randomly assigned in a 1:1 ratio to receive either ALA (1200 mg/d, intravenous infusion) once daily plus standard care or standard care plus equal volume saline infusion (placebo) for 7 days. All patients were monitored within the 7 days therapy and followed up to day 30 after therapy. The primary outcome of this study was the Sequential Organ Failure Estimate (SOFA) score, and the secondary outcome was the all-cause mortality within 30 days.ResultNine patients were randomized to placebo group and 8 patients were randomized to ALA group. SOFA score was similar at baseline, increased from 4.3 to 6.0 in the placebo group and increased from 3.8 to 4.0 in the ALA group (P=0.36) after 7 days. The 30-day all-cause mortality tended to be lower in the ALA group (3/8, 37.5%) compared to that in the placebo group (7/9, 77.8%, P=0.09).ConclusionIn our study, ALA use is associated with lower SOFA score increase and lower 30-day all-cause mortality as compared with the placebo group. Although the mortality rate was two-folds higher in placebo group than in ALA group, only borderline statistical difference was evidenced due to the limited patient number. Future studies with larger patient cohort are warranted to validate the role of ALA in critically ill patients with COVID-19.

scholarly journals Carbapenem Therapeutic Drug Monitoring in Critically Ill Adult Patients and Clinical Outcomes: A Systematic Review with Meta-Analysis

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 177
Author(s):  
Sharon Lechtig-Wasserman ◽  
Hans Liebisch-Rey ◽  
Nicolas Diaz-Pinilla ◽  
Jhosep Blanco ◽  
Yuli-Viviana Fuentes-Barreiro ◽  
...  
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Antimicrobial Resistance ◽  
Critically Ill ◽  
Drug Monitoring ◽  
Critically Ill Patients ◽  
Clinical Cure ◽  
Standard Care ◽  
Plasma Concentrations ◽  
Therapeutic Drug ◽  
Secondary Outcomes

Drug monitoring is one strategy of antibiotic stewardship to face antimicrobial resistance. This strategy could have a determinant role in critically ill patients treated with carbapenems to overcome pharmacokinetic variability, reduce the risk of subtherapeutic dosage or toxicity, and reduce the risks inherent to treatment. However, the effectiveness of therapeutic drug monitoring (TDM) is unknown. This paper aims to identify TDM effectiveness in critically ill patients treated with carbapenems. English and ClinicalTrials.gov databases were searched to identify relevant studies evaluating carbapenem TDM. Randomized controlled trials (RCTs) and comparative cohort studies were selected for inclusion if they compared carbapenem TDM to standard care in adult critically ill or sepsis/septic shock patients. The primary outcome was mortality. Secondary outcomes included morbidity, clinical cure, microbiological eradication, antimicrobial resistance, drug-related side effects, and achievement of target plasma concentrations. Overall, performing carbapenem TDM was not associated with a decrease in mortality. However, it could be evidence for a relationship with clinical cure as well as target attainment. Some studies found favorable outcomes related to clinical and microbiological responses, such as lower procalcitonin levels at the end of the monitored therapy compared to standard care. For the primary and secondary outcomes analyzed, strong evidence was not identified, which could be due to the size, risk of bias, and design of selected studies.

scholarly journals Management of Critically Ill Patients with COVID-19: What We Learned and What We Do

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Ata Mahmoodpoor ◽  
Kamran Shadvar ◽  
Ali Akbar Ghamari ◽  
Mojtaba Mohammadzadeh Lameh ◽  
Roghayeh Asghari Ardebili ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Diagnosis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Clinical Course ◽  
Diagnosis And Treatment ◽  
To Receive

: There are many unknown questions and puzzle pieces that should describe the clinical course of COVID-19 and its complications, especially ARDS. We provide the initial immediate surge response to allow every patient in need of an ICU bed to receive one. Till our knowledge is improved, the most important intervention in the treatment of critically ill patients with COVID-19 seems to be the level of standard care and appropriate and early diagnosis and treatment. It seems that each center should have its protocol on the management of critically ill COVID-19 patients regarding prevention, diagnosis, and treatment. This treatment should now be performed regardless of the reason which lies behind the pathophysiology of this disease, which is yet unknown. In this report, we share our experience in the management of critically ill COVID-19 patients during the 2 months in our intensive care unit.

scholarly journals Interest of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial.

2020 ◽  
Author(s):  
sigismond lasocki ◽  
Pierre ASFAR ◽  
Samir JABER ◽  
Martine FERRANDIERE ◽  
Thomas KERFORNE ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Critically Ill ◽  
Primary Endpoint ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Intravenous Iron ◽  
Icu Stay ◽  
Icu Discharge ◽  
Prolonged Icu Stay ◽  
One Year

Abstract Background: Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnosed in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods: In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm patients were treated with intravenous iron (1g of ferric carboxymaltose) when hepcidin was <20 μg/l and with intravenous iron and erythropoietin for 20≤ hepcidin <41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ICU discharge (post-ICU LOS). Secondary endpoints were day 15 anemia, day 30 fatigue, day-90 mortality and one-year survival. Results: Of 405 randomized patients, 399 were analyzed (201 in intervention and 198 in control arm). 220(55%) had ID at discharge (i.e. an hepcidin <41 μg/l). Primary endpoint was not different (medians(IQR) post-ICU LOS 33(13;90) vs 33(11;90) days for intervention and control respectively, median difference -1(-3;1) days, p=0.78). D90 mortality was significantly lower in the intervention arm (16(8%) vs 33(16.6%) deaths, absolute risk difference -8.7 (-15.1 to -2.3)%, p=0.008, OR 95%IC, 0.46, 0.22 to 0.94, p=0.035) and one-year survival was improved (p =0.0394). Conclusion: Treatment of ID diagnosed according to hepcidin levels did not reduce the post-ICU LOS, but may reduce the long-term mortality in critically ill patients about to be discharged after a prolonged stay.

Association of systemic secondary brain insults and outcome in patients with convulsive status epilepticus

Neurology ◽  
2020 ◽  
Vol 95 (18) ◽  
pp. e2529-e2541
Author(s):  
Candice Fontaine ◽  
Virginie Lemiale ◽  
Matthieu Resche-Rigon ◽  
Maleka Schenck ◽  
Jonathan Chelly ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Therapeutic Hypothermia ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Controlled Trial ◽  
Convulsive Status Epilepticus ◽  
Open Label ◽  
Arterial Blood ◽  
Brain Insults

ObjectiveTo evaluate the association between systemic factors (mean arterial blood pressure, arterial partial pressures of carbon dioxide and oxygen, body temperature, natremia, and glycemia) on day 1 and neurologic outcomes 90 days after convulsive status epilepticus.MethodsThis was a post hoc analysis of the Evaluation of Therapeutic Hypothermia in Convulsive Status Epilepticus in Adults in Intensive Care (HYBERNATUS) multicenter open-label controlled trial, which randomized 270 critically ill patients with convulsive status epilepticus requiring mechanical ventilation to therapeutic hypothermia (32°C–34°C for 24 hours) plus standard care or standard care alone between March 2011 and January 2015. The primary endpoint was a Glasgow Outcome Scale score of 5, defining a favorable outcome, 90 days after convulsive status epilepticus.ResultsThe 172 men and 93 women had a median age of 57 years (45–68 years). Among them, 130 (49%) had a history of epilepsy, and 59 (29%) had a primary brain insult. Convulsive status epilepticus was refractory in 86 (32%) patients, and total seizure duration was 67 minutes (35–120 minutes). The 90-day outcome was unfavorable in 126 (48%) patients. In multivariate analysis, none of the systemic secondary brain insults were associated with outcome; achieving an unfavorable outcome was associated with age >65 years (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.20–3.85; p = 0.01), refractory convulsive status epilepticus (OR 2.00, 95% CI 1.04–3.85; p = 0.04), primary brain insult (OR 2.00, 95% CI 1.02–4.00; p = 0.047), and no bystander-witnessed seizure onset (OR 2.49, 95% CI 1.05–5.59; p = 0.04).ConclusionsIn our population, systemic secondary brain insults were not associated with outcome in critically ill patients with convulsive status epilepticus.ClinicalTrials.gov identifierNCT01359332.

scholarly journals Impact of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial.

2020 ◽  
Author(s):  
sigismond lasocki ◽  
Pierre ASFAR ◽  
Samir JABER ◽  
Martine FERRANDIERE ◽  
Thomas KERFORNE ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Critically Ill ◽  
Primary Endpoint ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Intravenous Iron ◽  
Icu Stay ◽  
Icu Discharge ◽  
Prolonged Icu Stay ◽  
One Year

Abstract Background: Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnosed in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods: In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm patients were treated with intravenous iron (1g of ferric carboxymaltose) when hepcidin was <20 μg/l and with intravenous iron and erythropoietin for 20≤ hepcidin <41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ICU discharge (post-ICU LOS). Secondary endpoints were day 15 anemia, day 30 fatigue, day-90 mortality and one-year survival. Results: Of 405 randomized patients, 399 were analyzed (201 in intervention and 198 in control arm). 220(55%) had ID at discharge (i.e. an hepcidin <41 μg/l). Primary endpoint was not different (medians(IQR) post-ICU LOS 33(13;90) vs33(11;90) days for intervention and control respectively, median difference -1(-3;1) days, p=0.78). D90 mortality was significantly lower in intervention arm (16(8%) vs 33(16.6%) deaths, absolute risk difference -8.7 (-15.1 to -2.3)%, p=0.008, OR 95%IC, 0.46, 0.22 to 0.94, p=0.035) and one-year survival was improved (p =0.04). Conclusion: Treatment of ID diagnosed according to hepcidin levels did not reduce the post-ICU LOS, but was associated with a significant reduction in D90 mortality and with improved 1-year survival in critically ill patients about to be discharged after a prolonged stay.

Sign in / Sign up

Export Citation Format

Share Document