Abstract:
INTRODUCTION:Early multimodal treatment of severe sepsis, including the use of drotrecogin alfa (activated) (DrotAA) when indicated, is considered essential for optimum outcome. However, predicting which infected patients will progress to severe sepsis and the need for aggressive intervention continues to be problematic. We therefore wished to explore whether there were any potential early markers that might predict improved survival in response to early use of DrotAA in patients with severe sepsis. In particular, in the dynamic setting of severe sepsis, we postulated that changes in markers reflecting evolving rather than baseline clinical status might guide therapy. METHODS:Data on a cohort of 305 Canadian patients from the open label ENHANCE trial of DrotAA in severe sepsis was retrospectively analyzed to search for potential clinical predictors of outcome in severe sepsis. Patients received a 96-hour infusion of DrotAA and were followed for 28 days. The association between time to treatment and mortality within subgroups defined by dynamic changes in various potential markers was explored. RESULTS:Mortality at 28 days was 22.6% and the variables of age, time to treatment, and early changes in serum creatinine and platelet count were identified by logistic regression as independent predictors of mortality. Across all age ranges, 28-day mortality was lower when DrotAA was administered within 24 hours of first sepsis-induced organ dysfunction compared to administration after 24 hours for both subgroups of patients defined by changes in platelet count and creatinine within the first day. CONCLUSIONS:These findings suggest that when indicated, treatment with DrotAA should be initiated as soon as possible, regardless of age. TRIAL REGISTRATION:Previous trial registration number: NCT00568893.
journal_name
Crit Carejournal_title
Critical care (London, England)authors
Hodder RV,Hall R,Russell JA,Fisher HN,Lee Bdoi
10.1186/cc7893subject
Has Abstractpub_date
2009-01-01 00:00:00pages
R78issue
3eissn
1364-8535issn
1466-609Xpii
cc7893journal_volume
13pub_type
杂志文章,多中心研究相关文献
CRITICAL CARE文献大全abstract:: ...
journal_title:Critical care (London, England)
pub_type: 评论,信件
doi:10.1186/s13054-019-2310-3
更新日期:2019-01-17 00:00:00
abstract:INTRODUCTION:Blood transfusion in the perioperative period has frequently been associated with an excess of nosocomial infections. Whilst transfused whole blood induces specific host immune alteration that may predispose to nosocomial infections, the immunomodulating properties associated with leukodepleted blood remai...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-014-0541-x
更新日期:2014-10-01 00:00:00
abstract:INTRODUCTION:The aim of this study was to determine whether the degree of fluid responsiveness in critically ill septic patients is related to baseline mixed venous oxygen saturation (SvO2) levels. We also sought to define whether fluid responsiveness would be less likely in the presence of a high SvO2 (>70%). METHODS...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc10326
更新日期:2011-07-26 00:00:00
abstract:INTRODUCTION:Despite recent interest in measurement of central venous oxygen saturation (ScvO2), there are no published data describing the pattern of ScvO2 changes after major general surgery or any relationship with outcome. METHODS:ScvO2 and other biochemical, physiological and demographic data were prospectively m...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc3888
更新日期:2005-01-01 00:00:00
abstract::BACKGROUND: This study evaluated the feasibility of blood gas analysis and electrolyte measurements during emergency transport prior to hospital admission. RESULTS: A portable, battery-powered blood analyzer was used on patients in life threatening conditions to determine pH, pCO2, pO2, sodium, potassium and ionized c...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc108
更新日期:1997-01-01 00:00:00
abstract:BACKGROUND:Simvastatin therapy for patients with acute respiratory distress syndrome (ARDS) has been shown to be safe and associated with minimal adverse effects, but it does not improve clinical outcomes. The aim of this research was to report on mortality and cost-effectiveness of simvastatin in patients with ARDS at...
journal_title:Critical care (London, England)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/s13054-017-1695-0
更新日期:2017-05-17 00:00:00
abstract:BACKGROUND:Patients with COVID-19 (COVID) may develop acute respiratory distress syndrome with or without sepsis, coagulopathy and visceral damage. While chest CT scans are routinely performed in the initial assessment of patients with severe pulmonary forms, thymus involvement and reactivation have not been investigat...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-020-03440-1
更新日期:2021-01-04 00:00:00
abstract:INTRODUCTION:Glutamine supplementation has beneficial effects on morbidity and mortality in critically ill patients, possibly in part through an attenuation of the proinflammatory cytokine response and a stimulation of heat shock protein (HSP)70. We infused either alanine-glutamine or saline during endotoxin challenge ...
journal_title:Critical care (London, England)
pub_type: 杂志文章,随机对照试验
doi:10.1186/cc7696
更新日期:2009-01-01 00:00:00
abstract:INTRODUCTION:Little is known about mortality rates following general surgical procedures in the United Kingdom. Deaths are most common in the 'high-risk' surgical population consisting mainly of older patients, with coexisting medical disease, who undergo major surgery. Only limited data are presently available to desc...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc4928
更新日期:2006-01-01 00:00:00
abstract:INTRODUCTION:Subarachnoid haemorrhage (SAH) may damage the hypothalamo-pituitary-adrenal gland (HPA) axis and disturb cortisol metabolism. There are no available data that relates to the response of the HPA axis in the acute phase of SAH. We aimed to characterise the behavior of serum adrenocorticotropic hormone (ACTH)...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc7084
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:For patients who survive a critical illness and have their oral endotracheal tube removed, dysphagia is highly prevalent, and without intervention, it may persist far beyond hospital discharge. This pre- and post-intervention study with historical controls tested the effects of a swallowing and oral care (SO...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-019-2623-2
更新日期:2019-11-09 00:00:00
abstract::Owing to an increasing focus on the rising cost of medical care in the United States, bending the cost curve has become the central tenet of healthcare reform. The exact definition of this phrase, however, remains elusive. In order to affect change in the cost and quality of healthcare, the importance of comparative e...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc9045
更新日期:2010-01-01 00:00:00
abstract:INTRODUCTION:Partial pressure of end-tidal carbon dioxide (PetCO2) during cardiopulmonary resuscitation (CPR) correlates with cardiac output and consequently has a prognostic value in CPR. In our previous study we confirmed that initial PetCO2 value was significantly higher in asphyxial arrest than in ventricular fibri...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc9417
更新日期:2011-01-01 00:00:00
abstract::Perioperative hemodynamic optimization, or goal-directed therapy (GDT), has been show to significantly decrease complications and risk of death in high-risk patients undergoing noncardiac surgery. An important aim of GDT is to prevent an imbalance between oxygen delivery and oxygen consumption in order to avoid the de...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc11861
更新日期:2013-03-19 00:00:00
abstract:INTRODUCTION:Management of daily activities in ICUs is challenging. ICU shift leaders, charge nurses and intensivists have to make several immediate ad hoc decisions to enable the fluent flow of ICU activities. Even though the management of ICU activities is quite well delineated by international consensus guidelines, ...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc10341
更新日期:2011-08-08 00:00:00
abstract:INTRODUCTION:The aim of the study was to evaluate the ability of different static and dynamic measurements of preload to predict fluid responsiveness in patients with spontaneous respiratory movements. METHODS:The subjects were 21 critically ill patients with spontaneous breathing movements receiving mechanical ventil...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc4970
更新日期:2006-01-01 00:00:00
abstract:INTRODUCTION:Fever is frequently observed in critically ill patients. An independent association of fever with increased mortality has been observed in non-neurological critically ill patients with mixed febrile etiology. The association of fever and antipyretics with mortality, however, may be different between infect...
journal_title:Critical care (London, England)
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1186/cc11211
更新日期:2012-02-28 00:00:00
abstract:INTRODUCTION:Intravenous fluid administration is an essential component of sepsis management, but a positive fluid balance has been associated with worse prognosis. We analyzed whether a positive fluid balance and its persistence over time was an independent prognostic factor in septic patients. METHODS:We prospective...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-015-0970-1
更新日期:2015-06-15 00:00:00
abstract:BACKGROUND:In patients intubated for mechanical ventilation, prolonged diaphragm inactivity could lead to weakness and poor outcome. Time to resume a minimal diaphragm activity may be related to sedation practice and patient severity. METHODS:Prospective observational study in critically ill patients. Diaphragm electr...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-020-03435-y
更新日期:2021-01-11 00:00:00
abstract:INTRODUCTION:There is a need for continuous glucose monitoring in critically ill patients. The objective of this trial was to determine the point accuracy and reliability of a device designed for continuous monitoring of interstitial glucose levels in intensive care unit patients. METHODS:We evaluated point accuracy b...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-015-0757-4
更新日期:2015-02-05 00:00:00
abstract::The impressive benefits related to the use of tight glucose control by intensive insulin therapy have not been reproduced until now in multicenter large-scale prospective randomized trials. Although the reasons for these failures are not entirely clear, we suggest the use of a stepwise approach - Safe, Effective Gluco...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc6889
更新日期:2008-01-01 00:00:00
abstract:INTRODUCTION:The performance of N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) to predict clinical outcomes in ICU patients is unimpressive. We aimed to assess the prognostic value of NT-proBNP, CRP or the combination of both in unselected medical ICU patients. METHODS:A total of 576...
journal_title:Critical care (London, England)
pub_type: 临床试验,杂志文章
doi:10.1186/cc10004
更新日期:2011-01-01 00:00:00
abstract:INTRODUCTION:The analysis of flow and pressure waveforms generated by ventilators can be useful in the optimization of patient-ventilator interactions, notably in chronic obstructive pulmonary disease (COPD) patients. To date, however, a real clinical benefit of this approach has not been proven. METHODS:The aim of th...
journal_title:Critical care (London, England)
pub_type: 杂志文章,随机对照试验
doi:10.1186/cc10567
更新日期:2011-01-01 00:00:00
abstract::Despite continuous advances in technologic and pharmacologic management, the mortality rate from septic shock remains high. Care of patients with sepsis includes measures to support the circulatory system and treat the underlying infection. There is a substantial body of knowledge indicating that fluid resuscitation, ...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc2940
更新日期:2005-08-20 00:00:00
abstract:INTRODUCTION:Inter-hospital transport of critically ill patients is increasing. When performed by specialized retrieval teams there are less adverse events compared to transport by ambulance. These transports are performed with technical equipment also used in an Intensive Care Unit (ICU). As a consequence technical pr...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc11191
更新日期:2012-02-12 00:00:00
abstract:BACKGROUND:Acute kidney injury (AKI) affects a large proportion of the critically ill and is associated with worse patient outcomes. Early identification of AKI can lead to earlier initiation of supportive therapy and better management. In this study, we evaluate the impact of computerized AKI decision support tool int...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-020-03343-1
更新日期:2020-11-23 00:00:00
abstract:INTRODUCTION:Some guidelines to prevent ventilator-associated pneumonia (VAP) do not establish a recommendation for the preferential use of either heat and moisture exchangers (HMEs) or heated humidifiers (HHs), while other guidelines clearly advocate the use of HMEs. The aim of this study was to determine the incidenc...
journal_title:Critical care (London, England)
pub_type: 杂志文章,随机对照试验
doi:10.1186/cc5009
更新日期:2006-01-01 00:00:00
abstract:INTRODUCTION:Lung protective ventilation requires low tidal volume and suitable positive end-expiratory pressure (PEEP). To date, few methods have been accepted for clinical use to set the appropriate PEEP. The aim of this study was to test the feasibility of PEEP titration guided by ventilation homogeneity using the g...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc8860
更新日期:2010-01-01 00:00:00
abstract:INTRODUCTION:Prevalence of iron deficiency (ID) at intensive care (ICU) admission is around 25 to 40%. Blood losses are important during ICU stay, leading to iron losses, but prevalence of ID at ICU discharge is unknown. ID has been associated with fatigue and muscular weakness, and may thus impair post-ICU rehabilitat...
journal_title:Critical care (London, England)
pub_type: 杂志文章,多中心研究
doi:10.1186/s13054-014-0542-9
更新日期:2014-09-30 00:00:00
abstract::A new randomised controlled trial suggested that plasma exchange hastened removal from the ventilator in mechanically ventilated children with Guillain-Barré syndrome compared with intravenous immunoglobulin. Two larger trials in adults showed the opposite result. ...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc10312
更新日期:2011-07-28 00:00:00