Abstract:
BACKGROUND:(1,3)-β-D-Glucan has been widely used in clinical practice for the diagnosis of invasive Candida infections. However, such serum biomarker showed potential to guide antimicrobial therapy in order to reduce the duration of empirical antifungal treatment in critically ill septic patients with suspected invasive candidiasis. METHODS:This was a single-centre, randomized, open-label clinical trial in which critically ill patients were enrolled during the admission to the intensive care unit (ICU). All septic patients who presented invasive Candida infection risk factors and for whom an empirical antifungal therapy was commenced were randomly assigned (1:1) in those stopping antifungal therapy if (1,3)-β-D-glucan was negative ((1,3)-β-D-glucan group) or those continuing the antifungal therapy based on clinical rules (control group). Serum 1,3-β-D-glucan was measured at the enrolment and every 48/72 h over 14 days afterwards. The primary endpoint was the duration of antifungal treatment in the first 30 days after enrolment. RESULTS:We randomized 108 patients into the (1,3)-β-D-glucan (n = 53) and control (n = 55) groups. Median [IQR] duration of antifungal treatment was 2 days [1-3] in the (1,3)-β-D-glucan group vs. 10 days [6-13] in the control group (between-group absolute difference in means, 6.29 days [95% CI 3.94-8.65], p < 0.001). Thirty-day mortality was similar (28.3% [(1,3)-β-D-glucan group] vs. 27.3% [control group], p = 0.92) as well as the overall rate of documented candidiasis (11.3% [(1,3)-β-D-glucan group] vs. 12.7% [control group], p = 0.94), the length of mechanical ventilation (p = 0.97) and ICU stay (p = 0.23). CONCLUSIONS:In critically ill septic patients admitted to the ICU at risk of invasive candidiasis, a (1,3)-β-D-glucan-guided strategy could reduce the duration of empirical antifungal therapy. However, the safety of this algorithm needs to be confirmed in future, multicentre clinical trial with a larger population. TRIAL REGISTRATION:ClinicalTrials.gov, NCT03117439 , retrospectively registered on 18 April 2017.
journal_name
Crit Carejournal_title
Critical care (London, England)authors
De Pascale G,Posteraro B,D'Arrigo S,Spinazzola G,Gaspari R,Bello G,Montini LM,Cutuli SL,Grieco DL,Di Gravio V,De Angelis G,Torelli R,De Carolis E,Tumbarello M,Sanguinetti M,Antonelli Mdoi
10.1186/s13054-020-03265-ysubject
Has Abstractpub_date
2020-09-05 00:00:00pages
550issue
1eissn
1364-8535issn
1466-609Xpii
10.1186/s13054-020-03265-yjournal_volume
24pub_type
杂志文章相关文献
CRITICAL CARE文献大全abstract:INTRODUCTION AND METHODS:Dynamic fluorescence quenching is a technique that may overcome some of the limitations associated with measurement of tissue partial oxygen tension (PO2). We compared this technique with a polarographic Eppendorf needle electrode method using a saline tonometer in which the PO2 could be contro...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc1457
更新日期:2002-02-01 00:00:00
abstract::The future of critical care medicine will be shaped not only by the evidence-validated foundations of science, but also by innovations based on unproven and, in many cases, untested concepts and thoughtful visions of scientists and clinicians familiar with the complex problems actually faced in clinical practice. Clin...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc11507
更新日期:2013-01-01 00:00:00
abstract::The encouraging results of recent clinical trials on therapy of severe sepsis and septic shock are paralleled by ongoing studies on the epidemiology of sepsis and infection in intensive care unit patients all over the world. The development of network-based systems for assessing morbidity and mortality in intensive ca...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc2175
更新日期:2003-10-01 00:00:00
abstract:INTRODUCTION:In severely neutropenic septic acute respiratory distress syndrome (ARDS) patients, macrophages and monocytes are the last potentially remaining innate immune cells. We have previously shown, however, a deactivation of the alveolar macrophage in neutropenic septic ARDS patients. In the present study, we tr...
journal_title:Critical care (London, England)
pub_type: 临床试验,杂志文章
doi:10.1186/cc6791
更新日期:2008-01-01 00:00:00
abstract::Tight glycemic control has engendered large numbers of investigations, with conflicting results. The world has largely embraced intensive insulin as a practice, but applies this therapy with great variability in the manner of glucose control and measurement. The present commentary reviews what we actually know with ce...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章,评审
doi:10.1186/cc9236
更新日期:2010-01-01 00:00:00
abstract::Tight glycemic control in the ICU has been shown to reduce mortality in some but not all prospective randomized control trials. Confounding the interpretation of these studies are differences in how the control was achieved and underlying incidence of hypoglycemia, which can be expected to be affected by the introduct...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc13950
更新日期:2014-06-27 00:00:00
abstract::Mechanotransduction holds the underlying mechanisms of ventilator-induced lung injury. Research on this subject, however, could be difficult for clinicians, especially when results are controversial. A recent study by Li and co-workers is used as an example, to explain how to critically read literatures related to bas...
journal_title:Critical care (London, England)
pub_type: 评论,社论
doi:10.1186/cc6131
更新日期:2007-01-01 00:00:00
abstract::Acute pancreatitis results from a sequence of events that involve the systemic inflammatory response. Activated C has multiple anti-inflammatory activities and may attenuate the degree of pancreatic injury and systemic organ dysfunction when infused early in pancreatitis. ...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc3515
更新日期:2005-06-01 00:00:00
abstract:INTRODUCTION:Hypoxemia and high fractions of inspired oxygen (FiO2) are concerns in critically ill patients. An automated FiO2 controller based on continuous oxygen saturation (SpO2) measurement was tested. Two different SpO2-FiO2 feedback open loops, designed to react differently based on the level of hypoxemia, were ...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc13734
更新日期:2014-02-19 00:00:00
abstract:INTRODUCTION:Bacterial meningitis (BM) is a severe complication in patients with aneurysmal subarachnoid haemorrhage (SAH). Clinical signs of meningitis are often masked by SAH-related symptoms, and routine cerebrospinal fluid (CSF) analysis fails to indicate BM. Microdialysis (MD) is a technique for monitoring cerebra...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc7689
更新日期:2009-01-01 00:00:00
abstract::The early detection and treatment of sepsis are the most important factors in improving the outcome of patients with this condition. However, many patients admitted to hospital experience a long delay in the diagnosis of sepsis. Furthermore, it is not uncommon for febrile patients to be sent home from the Emergency De...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/s13054-014-0529-6
更新日期:2014-09-27 00:00:00
abstract:INTRODUCTION:Recent data have suggested that patient admission during intensive care unit (ICU) morning bedside rounds is associated with less favorable outcome. We undertook the present study to explore the association between morning round-time ICU admissions and hospital mortality in a large Canadian health region. ...
journal_title:Critical care (London, England)
pub_type: 杂志文章,多中心研究
doi:10.1186/cc11329
更新日期:2012-05-03 00:00:00
abstract::Stridor is one of the most frequent causes of early extubation failure. The cuff-leak test may help to identify patients at risk to develop post-extubation laryngeal edema. However the discrimination power of the cuff-leak test is highly variable and can be use, at best, to detect patients at risk to develop edema but...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc3031
更新日期:2005-02-01 00:00:00
abstract:INTRODUCTION:In critically ill patients, delirium is a serious and frequent disorder that is associated with a prolonged intensive care and hospital stay and an increased morbidity and mortality. Without the use of a delirium screening instrument, delirium is often missed by ICU nurses and physicians. The effects of im...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc7991
更新日期:2009-01-01 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::Severe sepsis is more and more frequent, especially because of an increased rate of immunocompromised patients. Despite the improvement in the overall prognosis of HIV/AIDS patients and the improvement of global ICU care, the prognosis of HIV/ADS patients hospitalized in ICU with severe sepsis remained poor. This situ...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc3923
更新日期:2005-01-01 00:00:00
abstract:INTRODUCTION:Succinylcholine and rocuronium are widely used to facilitate rapid sequence induction (RSI) intubation in intensive care. Concerns relate to the side effects of succinylcholine and to slower onset and inferior intubation conditions associated with rocuronium. So far, succinylcholine and rocuronium have not...
journal_title:Critical care (London, England)
pub_type: 杂志文章,随机对照试验
doi:10.1186/cc10367
更新日期:2011-08-16 00:00:00
abstract:BACKGROUND:Optimal glycaemic targets in traumatic brain injury (TBI) remain unclear. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing intensive with conventional glycaemic control in TBI requiring admission to an intensive care unit (ICU). METHODS:We systematically se...
journal_title:Critical care (London, England)
pub_type: 杂志文章,meta分析,评审
doi:10.1186/s13054-017-1883-y
更新日期:2018-01-19 00:00:00
abstract:INTRODUCTION:Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. The aim of this study was to assess the association of early sedation strategies with o...
journal_title:Critical care (London, England)
pub_type: 杂志文章,多中心研究
doi:10.1186/cc13995
更新日期:2014-07-21 00:00:00
abstract:INTRODUCTION:This prospective, randomized, controlled, experimental animal study looks at the effects of recombinant human activated protein C (rhAPC) on global hemodynamics and microcirculation in ovine acute lung injury (ALI) and septic shock, resulting from smoke inhalation injury. METHODS:Twenty-one sheep (37 ± 2 ...
journal_title:Critical care (London, England)
pub_type: 杂志文章,随机对照试验
doi:10.1186/cc9342
更新日期:2010-01-01 00:00:00
abstract:INTRODUCTION:Mechanical ventilation (MV) with high tidal volumes may induce or aggravate lung injury in critical ill patients. We compared the effects of a protective versus a conventional ventilatory strategy, on systemic and lung production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-8 (IL-8) in patien...
journal_title:Critical care (London, England)
pub_type: 杂志文章,随机对照试验
doi:10.1186/cc8919
更新日期:2010-01-01 00:00:00
abstract:INTRODUCTION:Delivery of bronchodilators with a metered-dose inhaler (MDI) and a spacer device in mechanically ventilated patients has become a widespread practice. However, except for the short-acting beta2-agonist salbutamol, the duration of action of other bronchodilators, including long-acting beta2-agonists, deliv...
journal_title:Critical care (London, England)
pub_type: 临床试验,杂志文章
doi:10.1186/cc7117
更新日期:2008-01-01 00:00:00
abstract:INTRODUCTION:Leukocyte infiltration is central to the development of acute lung injury, but it is not known how mechanical ventilation strategy alters the distribution or activation of inflammatory cells. We explored how protective (vs. injurious) ventilation alters the magnitude and distribution of lung leukocyte acti...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc12854
更新日期:2013-08-15 00:00:00
abstract::Women are generally under-represented in many academic medical settings. Through a brief commentary on this issue, the present article discusses possible explanations for this under-representation as well as potential solutions. Issues examined include women in leadership positions, attrition out of academic medicine,...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc11915
更新日期:2013-01-29 00:00:00
abstract:BACKGROUND:The first FDA-approved test to assess risk for acute kidney injury (AKI), [TIMP-2]•[IGFBP7], is clinically available in many parts of the world, including the USA and Europe. We sought to understand how the test is currently being used clinically. METHODS:We invited a group of experts knowledgeable on the u...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-019-2504-8
更新日期:2019-06-20 00:00:00
abstract::Five to 10% of the coronavirus SARS-CoV-2-infected patients, i.e., with new coronavirus disease 2019 (COVID-19), are presenting with an acute respiratory distress syndrome (ARDS) requiring urgent respiratory and hemodynamic support in the intensive care unit (ICU). However, nutrition is an important element of care. T...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/s13054-020-03159-z
更新日期:2020-07-19 00:00:00
abstract::High mobility group box protein 1 (HMGB1) has been shown to participate in acute inflammatory reactions, including acute lung injury and sepsis. There is also evidence that circulating levels of HMGB1 are increased after severe trauma and are associated with clinically important outcome parameters, including mortality...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc8141
更新日期:2009-01-01 00:00:00
abstract:INTRODUCTION:Sepsis, severe sepsis and septic shock are common conditions with high mortality. Their early diagnosis in the Emergency Department (ED) is one of the keys to improving survival. Procalcitonin (PCT) has been used as a biomarker in septic patients but has limited specificity and can be elevated in other sce...
journal_title:Critical care (London, England)
pub_type: 杂志文章,多中心研究
doi:10.1186/cc12847
更新日期:2013-07-30 00:00:00
abstract::Severe burn injury remains a major burden on patients and healthcare systems. Following severe burns, the injured tissues mount a local inflammatory response aiming to restore homeostasis. With excessive burn load, the immune response becomes disproportionate and patients may develop an overshooting systemic inflammat...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc7794
更新日期:2009-01-01 00:00:00
abstract::Bacterial sepsis and septic shock are complex inflammatory disorders associated with a systemic inflammatory response syndrome. In the most severe cases of infection, an overzealous release of pro-inflammatory cytokines and inflammatory mediators by activated leukocytes, epithelial cells and endothelial cells, known a...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc12700
更新日期:2013-08-27 00:00:00