Abstract：
PURPOSE:To determine the feasibility of conducting a multicenter ICU RCT of AFS compared to either protocol-directed sedation (PDS) or both PDS and daily sedation interruption (DSI) in North America. MATERIALS AND METHODS:This single-center RCT compared AFS [fentanyl (bolus ± infusions) to reach CPOT ≤2; if RASS ≥1, CPOT ≤2 and additional fentanyl failed to reach RASS goal (-2 to 0), low-dose propofol (up to 6 h) was given] with either PDS or both PDS and DSI daily in adults mechanically ventilated (MV) ≥48 h. Relevant feasibility, safety, and clinical outcomes were defined and evaluated. RESULTS:90 of 160 eligible patients were enrolled [AFS = 27; PDS = 28; PDS + DSI = 31]; rate = 3/month. Time from intubation to randomization was 17.5 ± 11.6 h. Study days fully adherent to the study intervention [AFS = 95%; PDS = 99%; PDS + DSI = 96%] and time spent in the first 48 h after randomization without pain (CPOT ≤2)[AFS = 82%; PDS = 78%; PDS + DSI = 77%] and at goal RASS[AFS = 88%; PDS = 83%; PDS + DSI = 95%] were high and similar. Nurse-perceived [median (IQR)] study workload (10-point VAS) was higher with AFS [4(2-6)] than PDS [1(1-3)] or PDS + DSI [2(1-5)]; p = .002). Unplanned extubation was rare (AFS = 1; PDS = 0; PDS + DSI = 1). Days [median (IQR)] free of MV in the 28d after intubation [AFS 24(23,26); PDS 24(20,26); PDS + DSI 24(21,26)] was not different (p = .62). CONCLUSION:A multicenter RCT evaluating AFS is feasible to conduct in North America.
journal_name
J Crit Carejournal_title
Journal of critical careauthors
Tanios M,Nguyen HM,Park H,Mehta S,Epstein SK,Youssef F,Beltran A,Flores G,Sidhom R,Sehgal A,Leo J,Devlin JWdoi
10.1016/j.jcrc.2019.06.008subject
Has Abstractpub_date
2019-10-01 00:00:00pages
107-113eissn
0883-9441issn
1557-8615pii
S0883-9441(19)30431-9journal_volume
53pub_type
杂志文章,多中心研究,随机对照试验abstract：BACKGROUND:Studies investigating the metabolic effects of citrate-based substitution fluids are lacking. This study aims to compare the effect of citrate- vs bicarbonate-based substitution fluid used during continuous venovenous hemofiltration (CVVH) for acute kidney injury on acid-base balance and electrolytes in crit...
journal_title：Journal of critical care
pub_type： 临床试验,杂志文章
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journal_title：Journal of critical care
pub_type： 杂志文章,多中心研究
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doi：10.1016/j.jcrc.2008.06.012
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pub_type： 杂志文章,随机对照试验
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pub_type： 杂志文章
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更新日期：2014-02-01 00:00:00
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journal_title：Journal of critical care
pub_type： 杂志文章,多中心研究,随机对照试验
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