Abstract:
OBJECTIVE:To appraise the literature on the effect of initial renal replacement therapy (RRT) modality on clinical outcomes. DESIGN:Systematic review and meta-analysis. SETTING:Academic medical center. PATIENTS AND PARTICIPANTS:Adult critically ill patients with acute kidney injury. INTERVENTIONS:Continuous vs. intermittent RRT. MEASUREMENTS AND RESULTS:MEDLINE, EMBASE, Cochrane Controlled Clinical Trials Register, and other sources were searched. We identified nine unique randomized trials (n = 1,403). No trial satisfied all quality indicators and several had limitations related to selection bias, randomization, imbalances in patient characteristics, and high treatment crossover. No trial standardized the timing, criteria, for initiation or dose of RRT. There was no statistical evidence that initial modality influenced mortality (odds ratio, 0.99; 95% confidence interval, 0.78-1.26, p = .93; I2 = 11%; nine trials, n = 1,403) or recovery to RRT independence (odds ratio, 0.76; 95% confidence interval, 0.28-2.07, p = .59; I2 = 0%; four trials, n = 306). There was suggestion that continuous RRT had fewer episodes of hemodynamic instability and better control of fluid balance. CONCLUSIONS:We identified numerous issues related to study design, conduct, and quality that dispute the validity and question any inferences that can be drawn from these trials. In the context of these limitations, the initial RRT modality did not seem to affect mortality or recovery to RRT independence. There is urgent need for additional high-quality and suitably powered trials to adequately address this issue.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Bagshaw SM,Berthiaume LR,Delaney A,Bellomo Rdoi
10.1097/01.CCM.0B013E3181611F552subject
Has Abstractpub_date
2008-02-01 00:00:00pages
610-7issue
2eissn
0090-3493issn
1530-0293pii
00003246-200802000-00034journal_volume
36pub_type
杂志文章,meta分析,评审abstract:OBJECTIVE:To evaluate the tolerance and the efficacy of noninvasive continuous positive airway pressure (CPAP) in severe acute respiratory failure occurring in intensive care unit (ICU) neutropenic patients with hematologic malignancies, and to establish predictive variables of efficacy of this method. DESIGN:Prospect...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200009000-00012
更新日期:2000-09-01 00:00:00
abstract:OBJECTIVES:Critically ill patients routinely receive vancomycin as empiric antibiotic therapy. A continuous infusion administration strategy may be superior to intermittent infusion by minimizing peak concentrations and variability thereby optimizing safety. We performed a systematic review and meta-analysis to investi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004326
更新日期:2020-06-01 00:00:00
abstract:OBJECTIVE:Antimicrobial effects of nitric oxide (NO) have been demonstrated in vitro against a variety of infectious pathogens, yet in vivo evidence of a potential therapeutic role for exogenous NO as an antimicrobial agent is limited. Thus, we assessed the effects of inhaled NO on pulmonary infection, leukocyte infilt...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200007000-00035
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVE:To assess the possible benefits of sympatholytics on uncontrolled hemorrhage in unanesthetized rats. DESIGN:A randomized laboratory study using rats to test the effects of sympatholytics on uncontrolled hemorrhage. SETTING:Research laboratory. SUBJECTS:Forty female Sprague-Dawley rats, randomly assigned in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199909000-00025
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND AND METHODS:Calcium-channel blockers may attenuate vasospasm after transient ischemia and improve organ blood flow after resuscitation. Our aim was to assess the effect of diltiazem on systemic oxygen delivery and consumption, hemodynamics, electroencephalogram (EEG), and organ blood flow after restoration o...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199205000-00018
更新日期:1992-05-01 00:00:00
abstract:OBJECTIVE:Critical care medicine trainees and faculty must acquire and maintain the skills necessary to provide state-of-the art clinical care to critically ill patients, to improve patient outcomes, optimize intensive care unit utilization, and continue to advance the theory and practice of critical care medicine. Thi...
journal_title:Critical care medicine
pub_type: 指南,杂志文章,实务指引
doi:10.1097/01.CCM.0000104916.33769.9A
更新日期:2004-01-01 00:00:00
abstract::A closed system device with teflon needle, sideholes, and attached stopcock was designed and evaluated for diagnosis and evacuation of neonatal pneumothoraces. Experience with this device has demonstrated specific advantages over existing needles and techniques. Since the system is airtight, diagnosis of pneumothorax ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197811000-00007
更新日期:1978-11-01 00:00:00
abstract:OBJECTIVE:Increasing evidence, including publication of the Transfusion Requirements in Critical Care trial in 1999, supports a lower hemoglobin threshold for RBC transfusion in ICU patients. However, little is known regarding the influence of this evidence on clinical practice over time in a large population-based coh...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31828e9a49
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:A lack of intensive care units beds in Israel results in critically ill patients being treated outside of the intensive care unit. The survival of such patients is largely unknown. The present study's objective was to screen entire hospitals for newly deteriorated patients and compare their survival in and ou...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000253407.89594.15
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVES:To determine the accuracy of intramucosal pH (pHi) calculated using arterial bicarbonate instead of mucosal capillary bicarbonate in the Henderson-Hasselbalch equation. DESIGN:Simulation of progressive ischemia in mucosal capillary blood. SETTING:University research laboratory. SUBJECTS:Normal human blood...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199911000-00028
更新日期:1999-11-01 00:00:00
abstract:OBJECTIVE:To compare the outcomes and the short- and long-term complications of percutaneous translaryngeal tracheostomy (TLT) and surgical tracheostomy (ST). DESIGN:Prospective, randomized clinical trial with 1-yr double-blind follow-up. SETTING:A general intensive care unit of a university hospital. PATIENTS:A tot...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.ccm.0000163401.77581.86
更新日期:2005-05-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that a pretransport Pediatric Risk of Mortality (PRISM) score underestimates the requirement for both intensive care and interventions during pediatric interhospital transport. DESIGN:Prospective, descriptive study. SETTING:All children were treated in a regional hospital and then tra...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199401000-00020
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVES:To describe the impact of choice of therapy on renal recovery. DESIGN:Literature review. MAIN RESULTS:Randomized controlled trials conducted have not shown a benefit of continuous renal replacement therapy in mortality over intermittent renal replacement therapy. However, renal recovery is another importan...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318168e4a8
更新日期:2008-04-01 00:00:00
abstract::Measuring gas exchange in critically ill patients can provide valuable information on their nutritional status and energy expenditure. Several semiautomated machines are available for measuring oxygen consumption (VO2) and carbon dioxide production (VCO2). This study evaluated, under controlled laboratory conditions, ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198609000-00010
更新日期:1986-09-01 00:00:00
abstract:BACKGROUND:Increased cardiac index, oxygen delivery (DO2), and oxygen consumption (VO2) patterns were shown to characterize the physiologic status of surviving high-risk surgical patients, and indicate increased metabolic needs; relatively normal DO2 and VO2 values were found to characterize the sequential pattern of n...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199105000-00014
更新日期:1991-05-01 00:00:00
abstract:OBJECTIVES:Our primary goal was to evaluate the impact on in-hospital mortality rate of adequate empirical antibiotic therapy, after controlling for confounding variables, in a cohort of patients admitted to the intensive care unit (ICU) with sepsis. The impact of adequate empirical antibiotic therapy on early (<3 days...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000098031.24329.10
更新日期:2003-12-01 00:00:00
abstract::Sepsis and resulting multiple system organ failure are the leading causes of mortality in intensive care units. Although it is generally appreciated that rampant, deregulated inflammatory pathways play a major role in sepsis, a comprehensive understanding based on the integrated response of multiple signal transductio...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200301001-00001
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVE:To assess the mortality rate and complications in a population of surgical patients with severe adult respiratory distress syndrome (ARDS) treated with positive end-expiratory pressure (PEEP) of > 15 cm H2O in an attempt to reduce intrapulmonary shunt to approximately 0.20 and reduce FIO2 to < 0.50. DESIGN:R...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199509000-00008
更新日期:1995-09-01 00:00:00
abstract:OBJECTIVE:To determine whether plasma lipid hydroperoxides may be a useful marker for sepsis. DESIGN:Exploratory, open-label study. SETTING:Critical care unit at a university medical center. PATIENTS:Twelve patients with sepsis syndrome requiring hemodynamic monitoring with pulmonary artery catheters. Seven patients...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199109000-00004
更新日期:1991-09-01 00:00:00
abstract:OBJECTIVES:The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. DESIGN:Analysis of data from the National Hospital Ambulatory Medical Care Survey. SETTING:U.S. emergency...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002538
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVES:Formal guidelines recommend that therapeutic hypothermia be considered after in-hospital cardiac arrest. The rate of therapeutic hypothermia use after in-hospital cardiac arrest and details about its implementation are unknown. We aimed to determine the use of therapeutic hypothermia for adult in-hospital ca...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318287f2c4
更新日期:2013-06-01 00:00:00
abstract::Total parenteral nutrition (TPN) increases CO2 production (VCO2) in patients on intermittent positive-pressure ventilation who cannot match their CO2 excretion to the CO2 load, leading to an increase in PaCO2. We studied gas exchange and blood gas values in six patients with chronic respiratory failure, who were venti...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198507000-00005
更新日期:1985-07-01 00:00:00
abstract:OBJECTIVE:To determine the impact of the rotation of antimicrobial agents on the rates of infection, intestinal colonization, and acquisition with antimicrobial-resistant Gram-negative bacteria. DESIGN:Pre- and postintervention design. SETTING:A 19-bed, medical intensive care unit. PATIENTS:Individuals admitted to t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000147685.79487.28
更新日期:2004-12-01 00:00:00
abstract:OBJECTIVE:To describe the incidence of non-neurologic organ dysfunction and its association with outcome in patients with severe traumatic brain injury admitted to intensive care. DESIGN:Observational cohort study. SETTING:Foothills Medical Centre, which is the only neurosurgical service in southern Alberta (populati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000155911.01844.54
更新日期:2005-03-01 00:00:00
abstract:OBJECTIVES:Myocardial ischemia plays a central role in the development of right ventricular failure after acute pulmonary embolism. This study investigates whether pulmonary mediators act specifically on coronary tone and cardiac contractile function in acute pulmonary microembolization and whether such effects are alt...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199803000-00024
更新日期:1998-03-01 00:00:00
abstract:OBJECTIVES:Studies have shown that endothelium-dependent relaxation (mediated by endothelium-derived nitric oxide) is depressed during the early, hyperdynamic stage of sepsis. Although it is known that ATP-MgCl2 produces beneficial effects following various adverse circulatory conditions, it remains unknown whether thi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199905000-00035
更新日期:1999-05-01 00:00:00
abstract::In a prospective randomized study to determine whether prevention of colonization of Gram-negative bacteria results in prevention of Gram-negative bacterial infections, 96 intensive care patients were randomly allocated into a control group and a study group. The study group received oral nonabsorbable antimicrobial a...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-198811000-00001
更新日期:1988-11-01 00:00:00
abstract:OBJECTIVES:Chronic subdural hematoma is a commonly encountered disease in neurosurgic practice, whereas its increasing prevalence is compatible with the ageing population. Recommendations concerning postoperative thrombosis prophylaxis after burr-hole drainage of chronic subdural hematoma are lacking. The aim of this s...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002804
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVE:This report will describe the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center. DATA SOURCES:Patient medical records. STUDY SELECTION:Not applicable. DATA EXTRACTION:Not applicable. DATA SYNTHESIS:No...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000935
更新日期:2015-06-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to determine the clinical features associated with candidemia caused by non-albicans Candida spp. and with potentially fluconazole-resistant Candida spp. (C. glabrata and C. krusei) among candidemic intensive care unit patients. DESIGN:The authors conducted a nationwide prospe...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181760f42
更新日期:2008-07-01 00:00:00