Abstract:
PURPOSE OF REVIEW:To review the challenges and limitations of randomized clinical trials in acute respiratory distress syndrome, with special emphasis on those pertaining to ventilatory management. RECENT FINDINGS:Superbly executed randomized trials of ventilatory strategy have garnered deserved attention from the critical care community and yet have illustrated the limitations of our current approach to clinical research in this area. Inexact definitions, incomplete mechanistic understanding of complex pathophysiology, inappropriate outcome variables, diverse therapeutic environments, lengthy data acquisition time and ethical constraints on trial design limit the applicability of randomized control trial methodology to acute respiratory distress syndrome and acute lung injury. As yet, clinical practice does not seem to have been greatly impacted by the implications of completed randomized controlled trials per se. Recent issues, both ethical and interpretive, regarding control group participants have raised troubling and theoretically important issues that are yet to be fully resolved. SUMMARY:Without tighter definitions of the condition under treatment, more specific targets for interventions to act upon, stratification that recognizes key interactive elements, and cointerventions based on better mechanistic understanding, randomized controlled trials of new drugs, ventilatory strategy, and other management approaches in acute respiratory distress syndrome are likely to remain a blunt instrument for investigation. As valuable as they are for calling important therapeutic principles to attention and for helping to suggest general guidelines for care, the limitations of randomized controlled trials for treating the individual with acute respiratory distress syndrome must be acknowledged.
journal_name
Curr Opin Crit Carejournal_title
Current opinion in critical careauthors
Marini JJdoi
10.1097/01.ccx.0000198996.22072.4akeywords:
subject
Has Abstractpub_date
2006-02-01 00:00:00pages
25-31issue
1eissn
1070-5295issn
1531-7072pii
00075198-200602000-00007journal_volume
12pub_type
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journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e32814b040c
更新日期:2007-06-01 00:00:00
abstract:PURPOSE OF REVIEW:We report on recent advances and achievements on the use of extracorporeal gas exchange for long-term application in the therapy of critically ill patients with various forms of respiratory failure. RECENT FINDINGS:The most important results regarding the use of extracorporeal gas exchange are expect...
journal_title:Current opinion in critical care
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doi:10.1097/MCC.0b013e3283220e1f
更新日期:2009-02-01 00:00:00
abstract:PURPOSE OF REVIEW:To provide an update on the progress of the multicenter, randomized, controlled trial of corticosteroids after significant head injury (CRASH). RECENT FINDINGS:After a successful pilot phase, the main phase of the CRASH Trial began in March 2001. By June 2002, 107 hospitals from 31 countries were par...
journal_title:Current opinion in critical care
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00075198-200304000-00003
更新日期:2003-04-01 00:00:00
abstract::Intra-abdominal infection continues to pose a significant threat to critically ill patients in the year 2000. A review of the current literature reveals that despite remarkable developments in critical care medicine and extensive study of patients with tertiary peritonitis, the associated mortality rate remains nearly...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
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journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000205
更新日期:2015-06-01 00:00:00
abstract:PURPOSE OF REVIEW:There is significant controversy for perioperative fluid management. This review discusses the evidence from clinical studies, basic research, and systematic reviews to provide a summary of the current best practice in this area. RECENT FINDINGS:Recent evidence has challenged the long-held contention...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e3283632f1f
更新日期:2013-08-01 00:00:00
abstract::The introduction of mechanical ventilation in the intensive care unit environment had the merit of putting a potent life-saving tool in the physicians' hands in a number of situations; however, like most sophisticated technologies, it can cause severe side effects and eventually increase mortality if improperly applie...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200102000-00007
更新日期:2001-02-01 00:00:00
abstract:PURPOSE OF REVIEW:Survival of critically ill patients is frequently associated with significant functional impairment and reduced health-related quality of life. Early rehabilitation of ICU patients has recently been identified as an important focus for interdisciplinary ICU teams. However, the amount of rehabilitation...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
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更新日期:2012-10-01 00:00:00
abstract:PURPOSE OF REVIEW:Blunt cerebrovascular injuries (BCVI) are a rare but potentially devastating injury with stroke rates up to 50%. Over the past decade, the recognition and subsequent management of these injuries has undergone a marked evolution. This review will focus on the rationale for BCVI screening, imaging optio...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e32833ee8b4
更新日期:2010-12-01 00:00:00
abstract:PURPOSE OF REVIEW:The large variability in clinical practice plus the increasing awareness that certain processes of care are associated with improved medical outcomes has led to the development of clinical practice guidelines in serious infection. The evolution of guidelines and their impact on delivery of care in sev...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/01.ccx.0000244131.15484.4e
更新日期:2006-10-01 00:00:00
abstract:PURPOSE OF REVIEW:Severe acute respiratory syndrome (SARS) is a new disease that caused large outbreaks in several countries in the first half of 2003, resulting in infection in more than 8000 people and more than 900 deaths. During that time, a large body of literature rapidly emerged describing the clinical disease, ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200402000-00009
更新日期:2004-02-01 00:00:00
abstract:PURPOSE OF REVIEW:Management of the patient with traumatic brain injury is a rapidly advancing field, characterized in recent years by an improved understanding of intracranial pathophysiology and ways in which outcomes can be improved. Many traditional therapies, such as fluid restriction and hyperventilation, have be...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200312000-00007
更新日期:2003-12-01 00:00:00
abstract:PURPOSE OF REVIEW:Fluid removal and relief of congestion are central to treatment of acute heart failure. Diuretics have been the decongestive mainstay but their known limitations have led to the exploration of alternative strategies. This review compares diuretics with ultrafiltration and examines the recent evidence ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000134
更新日期:2014-10-01 00:00:00
abstract:PURPOSE OF REVIEW:Securing the airway to provide sufficient oxygenation and ventilation is of paramount importance in the management of all types of emergency patients. Particularly in severely injured patients, strategies should be adapted according to useful recent literature findings. RECENT FINDINGS:The role of ou...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000160
更新日期:2014-12-01 00:00:00
abstract:PURPOSE OF REVIEW:Ventilator weaning forms an integral part in critical care medicine and strategies to shorten duration are rapidly evolving alongside our knowledge of the relevant physiological processes. The purpose of the current review is to discuss new physiological and clinical insights in ventilator weaning tha...
journal_title:Current opinion in critical care
pub_type: 杂志文章
doi:10.1097/MCC.0000000000000790
更新日期:2021-02-01 00:00:00
abstract:PURPOSE OF REVIEW:A significant number of patients hospitalized with heart failure are malnourished. Depletion of micronutrients, which is known to occur in heart failure for a variety of reasons, may contribute to myocardial abnormalities noted in heart failure. In this review, we focus on nutritional supplementation ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e32833e10d4
更新日期:2010-10-01 00:00:00
abstract:PURPOSE OF REVIEW:Early prognostication in acute brain damage remains a challenge in the realm of critical care. There remains controversy over the most optimal methods that can be utilized to predict outcome. The utility of recently reported prognostic biomarkers and clinical methods will be reviewed. RECENT FINDINGS...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e32835eba56
更新日期:2013-04-01 00:00:00
abstract:PURPOSE OF REVIEW:Acute kidney injury (AKI) is commonplace in most ICUs. In many cases the cause is believed to be multifactorial with sepsis being a major component. However, occasionally intrinsic renal disease will present to the ICU and as such critical care practitioners should be aware of this possibility and the...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000155
更新日期:2014-12-01 00:00:00
abstract:PURPOSE OF REVIEW:Professional organizations, consensus groups, and stakeholders are calling for better palliative care in acute care settings, particularly in ICUs. Our ability to deliver that care is dependent on the outcomes associated with palliative care in the ICU. This review provides a conceptual framework for ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e328364d50f
更新日期:2013-10-01 00:00:00
abstract::During the past decade, enormous advances have been made in cell biology. Major advances included the publication of the human genome sequence, the development of proteomics, and DNA microarray technologies and techniques to selectively "silence" genes using short strands of double-stranded RNA. Some areas of great pr...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/01.ccx.0000130150.33814.71
更新日期:2004-08-01 00:00:00
abstract:PURPOSE OF REVIEW:Acute kidney injury (AKI) is a frequent and serious event associated with a high rate of complications, with an increased risk of progression to multiple organ dysfunction and excessive 'attributable' mortality. AKI affects all physiologic functions and organ systems with interrelated mechanisms, incl...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000150
更新日期:2014-12-01 00:00:00
abstract:PURPOSE OF REVIEW:This review intends to summarize the recent findings regarding the presence of increased oxidative stress in critically ill patients and its potential pathophysiologic role, as well as the results of recent clinical trials of antioxidant therapies. RECENT FINDINGS:Several lines of evidence confirm th...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/00075198-200308000-00003
更新日期:2003-08-01 00:00:00
abstract:PURPOSE OF REVIEW:The use of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS) and acute lung injury remains controversial, although frequent. This review analyzes the effects of NMBAs on thoracopulmonary mechanics, gas exchange, patient outcome and their potential advers...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
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更新日期:2009-02-01 00:00:00
abstract:PURPOSE OF REVIEW:Research and studies related to the long-term consequences of intensive care are increasing. This review focuses on some of the most recent knowledge in this field. RECENT FINDINGS:Still studies regarding the health-related quality of life (HRQOL) in survivors after intensive care are frequently publ...
journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
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更新日期:2010-10-01 00:00:00
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journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0b013e3282fad4e1
更新日期:2008-06-01 00:00:00
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journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
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更新日期:2014-12-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2012-10-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2012-12-01 00:00:00
abstract:PURPOSE OF REVIEW:Therapeutic hypothermia following out-of-hospital cardiac arrest improves neurological recovery. Coupled with neurological benefit, multiple complications including infection have been associated with therapeutic hypothermia following out-of-hospital cardiac arrest. In this review, we will discuss the...
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pub_type: 杂志文章,评审
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更新日期:2014-10-01 00:00:00
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journal_title:Current opinion in critical care
pub_type: 杂志文章,评审
doi:10.1097/MCC.0000000000000367
更新日期:2016-12-01 00:00:00