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12 papers 0 to 25 followers Research Papers used in aid of the in-house ICU registrar teaching programme at Royal Perth Hospital in the first half of 2016.
Paul R Mouncey, Tiffany M Osborn, G Sarah Power, David A Harrison, M Zia Sadique, Richard D Grieve, Rahi Jahan, Jermaine C K Tan, Sheila E Harvey, Derek Bell, Julian F Bion, Timothy J Coats, Mervyn Singer, J Duncan Young, Kathryn M Rowan
BACKGROUND: Early goal-directed therapy (EGDT) is recommended in international guidance for the resuscitation of patients presenting with early septic shock. However, adoption has been limited and uncertainty remains over its clinical effectiveness and cost-effectiveness. OBJECTIVES: The primary objective was to estimate the effect of EGDT compared with usual resuscitation on mortality at 90 days following randomisation and on incremental cost-effectiveness at 1 year...
November 2015: Health Technology Assessment: HTA
Sandra L Peake, Anthony Delaney, Michael Bailey, Rinaldo Bellomo, Peter A Cameron, D James Cooper, Alisa M Higgins, Anna Holdgate, Belinda D Howe, Steven A R Webb, Patricia Williams
BACKGROUND: Early goal-directed therapy (EGDT) has been endorsed in the guidelines of the Surviving Sepsis Campaign as a key strategy to decrease mortality among patients presenting to the emergency department with septic shock. However, its effectiveness is uncertain. METHODS: In this trial conducted at 51 centers (mostly in Australia or New Zealand), we randomly assigned patients presenting to the emergency department with early septic shock to receive either EGDT or usual care...
October 16, 2014: New England Journal of Medicine
Donald M Yealy, John A Kellum, David T Huang, Amber E Barnato, Lisa A Weissfeld, Francis Pike, Thomas Terndrup, Henry E Wang, Peter C Hou, Frank LoVecchio, Michael R Filbin, Nathan I Shapiro, Derek C Angus
BACKGROUND: In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock, mortality was markedly lower among those who were treated according to a 6-hour protocol of early goal-directed therapy (EGDT), in which intravenous fluids, vasopressors, inotropes, and blood transfusions were adjusted to reach central hemodynamic targets, than among those receiving usual care. We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary...
May 1, 2014: New England Journal of Medicine
Bruno Hoen, Xavier Duval
No abstract text is available yet for this article.
April 11, 2013: New England Journal of Medicine
R Phillip Dellinger, Mitchell M Levy, Andrew Rhodes, Djillali Annane, Herwig Gerlach, Steven M Opal, Jonathan E Sevransky, Charles L Sprung, Ivor S Douglas, Roman Jaeschke, Tiffany M Osborn, Mark E Nunnally, Sean R Townsend, Konrad Reinhart, Ruth M Kleinpell, Derek C Angus, Clifford S Deutschman, Flavia R Machado, Gordon D Rubenfeld, Steven A Webb, Richard J Beale, Jean-Louis Vincent, Rui Moreno
OBJECTIVE: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. DESIGN: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout...
February 2013: Critical Care Medicine
Harold W Horowitz
No abstract text is available yet for this article.
January 17, 2013: New England Journal of Medicine
Gennaro De Pascale, Giuseppe Bello, Mario Tumbarello, Massimo Antonelli
PURPOSE OF REVIEW: Severe pneumonia is a common disease that intensive care physicians have to face. The review highlights recent findings about microbiology, diagnosis and treatment, including the management of critically ill patients with severe respiratory failure. RECENT FINDINGS: Epidemiological and clinical risk factors strongly influence microbiological cause in patients with severe pneumonia. In addition to typical respiratory pathogens, less common microrganisms and multidrug-resistant (MDR) germs may cause severe lung infections...
May 2012: Current Opinion in Pulmonary Medicine
Paul E Marik
An intact hypothalamic-pituitary-adrenal (HPA) axis with effective intracellular glucocorticoid anti-inflammatory activity is essential for host survival following exposure to an infectious agent. Glucocorticoids play a major role in regulating the activity of nuclear factor-kappa- B, which has a crucial and generalized role in inducing cytokine gene transcription after exposure to an invading pathogen. Severe sepsis is, however, associated with complex alterations of the HPA axis, which may result in decreased production of cortisol as well as glucocorticoid tissue resistance...
2011: Critical Care: the Official Journal of the Critical Care Forum
Charles L Sprung, Djillali Annane, Didier Keh, Rui Moreno, Mervyn Singer, Klaus Freivogel, Yoram G Weiss, Julie Benbenishty, Armin Kalenka, Helmuth Forst, Pierre-Francois Laterre, Konrad Reinhart, Brian H Cuthbertson, Didier Payen, Josef Briegel
BACKGROUND: Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. METHODS: In this multicenter, randomized, double-blind, placebo-controlled trial, we assigned 251 patients to receive 50 mg of intravenous hydrocortisone and 248 patients to receive placebo every 6 hours for 5 days; the dose was then tapered during a 6-day period...
January 10, 2008: New England Journal of Medicine
Diederik van de Beek, Jan de Gans, Allan R Tunkel, Eelco F M Wijdicks
No abstract text is available yet for this article.
January 5, 2006: New England Journal of Medicine
Djillali Annane, Véronique Sébille, Claire Charpentier, Pierre-Edouard Bollaert, Bruno François, Jean-Michel Korach, Gilles Capellier, Yves Cohen, Elie Azoulay, Gilles Troché, Philippe Chaumet-Riffaud, Philippe Chaumet-Riffaut, Eric Bellissant
CONTEXT: Septic shock may be associated with relative adrenal insufficiency. Thus, a replacement therapy of low doses of corticosteroids has been proposed to treat septic shock. OBJECTIVE: To assess whether low doses of corticosteroids improve 28-day survival in patients with septic shock and relative adrenal insufficiency. DESIGN AND SETTING: Placebo-controlled, randomized, double-blind, parallel-group trial performed in 19 intensive care units in France from October 9, 1995, to February 23, 1999...
August 21, 2002: JAMA: the Journal of the American Medical Association
E Rivers, B Nguyen, S Havstad, J Ressler, A Muzzin, B Knoblich, E Peterson, M Tomlanovich
BACKGROUND: Goal-directed therapy has been used for severe sepsis and septic shock in the intensive care unit. This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with oxygen demand. The purpose of this study was to evaluate the efficacy of early goal-directed therapy before admission to the intensive care unit. METHODS: We randomly assigned patients who arrived at an urban emergency department with severe sepsis or septic shock to receive either six hours of early goal-directed therapy or standard therapy (as a control) before admission to the intensive care unit...
November 8, 2001: New England Journal of Medicine
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