First selection of FREE ACCESS articles just for you!
These articles have been personally selected by Intensive Care Medicine's editorial team and made available for FREE ACCESS until the end of September 2016! Enjoy all of these great articles below:
A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators. D. C. Angus, A. E. Barnato, D. Bell et al.
- The meta-analysis of all published randomised clinical trials of EGDT does not show improved survival for patients randomised to receive EGDT compared to usual care or to less invasive alternative haemodynamic resuscitation protocols. EGDT is, however, associated with increased admission to ICU.
Accuracy of LightCycler® SeptiFast for the detection and identification of pathogens in the blood of patients with suspected sepsis: a systematic review and meta-analysis. Paul Dark, Bronagh Blackwood, Simon Gates et al.
- This comprehensive systematic review included 41 studies reporting on a total of 10,493 SeptiFast tests when compared with blood culture. SeptiFast appears to have higher specificity than sensitivity, but deficiencies in study quality are likely to render this body of work unreliable. It remains difficult to make firm recommendations about the likely clinical utility of SeptiFast in the setting of suspected sepsis.
Asynchronies during mechanical ventilation are associated with mortality. Lluís Blanch, Ana Villagra, Bernat Sales et al.
- Patient–ventilator asynchronies (i.e. ineffective inspiratory efforts during expiration, double-triggering, aborted inspirations, short cycling, and prolonged cycling) occur frequently around the clock and in the most common modes of mechanical ventilation. The asynchrony index (defined as the number of asynchronous events divided by the total number of ventilator cycles and IEE multiplied by 100) is associated with mortality. Further studies should determine whether asynchronies are a marker for or a cause of mortality.
Chloride-liberal vs. chloride-restrictive intravenous fluid administration and acute kidney injury: an extended analysis. Nor’azim Mohd Yunos, Rinaldo Bellomo, Neil Glassford et al.
- The restriction of chloride content in intravenous fluids has recently been shown to decrease the incidence of acute kidney injury. This study extended a previous observation to 12 months and found the positive renal outcomes persisted even after doubling the observation period. Chloride restriction is feasible and safe and excess chloride administration may adversely affect renal function.
Cost awareness of physicians in intensive care units: a multicentric national study. Romain Hernu, Martin Cour, Sylvie de la Salle et al.
- Nowadays, incorporating cost-consciousness into our daily practice is unavoidable. In this study, junior and senior physicians in 99 French intensive care units were asked, by questionnaire, to estimate the true hospital costs of 46 selected prescriptions commonly used in critical care practice. It was found that ICU physicians have a poor awareness of prescriptions costs, especially with regards to high-cost drugs. Considerable emphasis and effort are still required to integrate the cost-containment problem into the daily prescriptions in ICUs.
Diagnostic accuracy of SeptiFast multi-pathogen real-time PCR in the setting of suspected healthcare-associated bloodstream infection. Geoffrey Warhurst, Satanayarana Maddi, Graham Dunn et al.
- The study reports a phase III diagnostic accuracy study of SeptiFast real-time PCR in the setting of healthcare associated infection in critical care. The main finding was that when compared with blood culture, SeptiFast is likely to have limited utility for the diagnosis of bloodstream infection despite its potential to deliver results more rapidly.
Diastolic dysfunction and mortality in septic patients: a systematic review and meta-analysis. Filippo Sanfilippo, Carlos Corredor, Nick Fletcher et al.
- Conflicting evidence regarding the effects of diastolic dysfunction on the mortality of septic patients exists. This systematic review and meta-analysis found that diastolic dysfunction is very common in patients with severe sepsis and septic shock and it is associated with mortality. Systolic dysfunction was less common and not significantly associated with mortality in septic patients.
Effectiveness of treatment based on PiCCO parameters in critically ill patients with septic shock and/or acute respiratory distress syndrome: a randomised controlled trial. Zhongheng Zhang , Hongying Ni, Zhixian Qian
- The optimisation of volume status is the cornerstone of the management of critically ill patients. This randomised controlled trial provides no evidence that treatment based on the use of PiCCO will benefit critically ill patients with septic shock and/or ARDS when compared to CVP-based fluid management.