Journal ArticleDOI
Pooled analysis of higher versus lower blood pressure targets for vasopressor therapy septic and vasodilatory shock
Francois Lamontagne,Andrew G. Day,Maureen O. Meade,Maureen O. Meade,Deborah J. Cook,Deborah J. Cook,Gordon H. Guyatt,Mathieu Hylands,Peter Radermacher,J. M. Chretien,Nicolas Beaudoin,Paul C. Hébert,Frédérick D’Aragon,Ferhat Meziani,Pierre Asfar +14 more
TLDR
Targeting higher blood pressure targets may increase mortality in patients who have been treated with vasopressors for more than 6 h in patients with underlying chronic hypertension and atherosclerosis, including chronically hypertensive patients.Abstract:
Guidelines for shock recommend mean arterial pressure (MAP) targets for vasopressor therapy of at least 65 mmHg and, until recently, suggested that patients with underlying chronic hypertension and atherosclerosis may benefit from higher targets. We conducted an individual patient-data meta-analysis of recent trials to determine if patient variables modify the effect of different MAP targets. We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for randomized controlled trials of higher versus lower blood pressure targets for vasopressor therapy in adult patients in shock (until November 2017). After obtaining individual patient data from both eligible trials, we used a modified version of the Cochrane Collaboration’s instrument to assess the risk of bias of included trials. The primary outcome was 28-day mortality. Included trials enrolled 894 patients. Controlling for trial and site, the OR for 28-day mortality for the higher versus lower MAP targets was 1.15 (95% CI 0.87–1.52). Treatment effect varied by duration of vasopressors before randomization (interaction p = 0.017), but not by chronic hypertension, congestive heart failure or age. Risk of death increased in higher MAP groups among patients on vasopressors > 6 h before randomization (OR 3.00, 95% CI 1.33–6.74). Targeting higher blood pressure targets may increase mortality in patients who have been treated with vasopressors for more than 6 h. Lower blood pressure targets were not associated with patient-important adverse events in any subgroup, including chronically hypertensive patients.read more
Citations
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Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)
Waleed Alhazzani,Morten Hylander Møller,Yaseen M. Arabi,Mark Loeb,Michelle Ng Gong,Eddy Fan,Simon Oczkowski,Mitchell M. Levy,Mitchell M. Levy,Lennie P. G. Derde,Lennie P. G. Derde,Amy L. Dzierba,Bin Du,Michael S. Aboodi,Hannah Wunsch,Hannah Wunsch,Maurizio Cecconi,Younsuck Koh,Daniel S. Chertow,Kathryn Maitland,Fayez Alshamsi,Emilie P. Belley-Côté,Emilie P. Belley-Côté,Massimiliano Greco,Matthew Laundy,Jill S. Morgan,Jozef Kesecioglu,Allison McGeer,Leonard A. Mermel,Manoj J. Mammen,Paul E. Alexander,Amy S. Arrington,John Centofanti,Giuseppe Citerio,Bandar Baw,Bandar Baw,Ziad A. Memish,Naomi E Hammond,Naomi E Hammond,Frederick G Hayden,Laura Evans,Andrew Rhodes +41 more
TL;DR: The Surviving Sepsis Campaign CO VID-19 panel issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19, and will provide new recommendations in further releases of these guidelines.
Journal ArticleDOI
Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19).
Waleed Alhazzani,Morten Hylander Møller,Yaseen M. Arabi,Mark Loeb,Michelle Ng Gong,Eddy Fan,Simon Oczkowski,Mitchell M. Levy,Lennie P. G. Derde,Amy L. Dzierba,Bin Du,Michael S. Aboodi,Hannah Wunsch,Maurizio Cecconi,Younsuck Koh,Daniel S. Chertow,Kathryn Maitland,Fayez Alshamsi,Emilie P. Belley-Côté,Massimiliano Greco,Matthew Laundy,Jill S. Morgan,Jozef Kesecioglu,Allison McGeer,Leonard A. Mermel,Manoj J. Mammen,Paul E. Alexander,Amy S. Arrington,John Centofanti,Giuseppe Citerio,Bandar Baw,Bandar Baw,Ziad A. Memish,Naomi E Hammond,Frederick G Hayden,Laura Evans,Andrew Rhodes +36 more
TL;DR: A panel of 36 experts from 12 countries issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19, and assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach.
Journal ArticleDOI
Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children
Scott L. Weiss,Mark J. Peters,Waleed Alhazzani,Michael S. D. Agus,Heidi R. Flori,David Inwald,Simon Nadel,Luregn J. Schlapbach,Robert C. Tasker,Andrew C. Argent,Joe Brierley,Joseph Carcillo,Enitan D. Carrol,Christopher L. Carroll,Ira M. Cheifetz,Karen Choong,Jeffry J. Cies,Andrea T. Cruz,Daniele De Luca,Daniele De Luca,Akash Deep,Saul N. Faust,Claudio Flauzino De Oliveira,Mark W. Hall,Paul Ishimine,Etienne Javouhey,Koen F. M. Joosten,Poonam Joshi,Oliver Karam,Martin C. J. Kneyber,Joris Lemson,Graeme MacLaren,Nilesh M. Mehta,Morten Hylander Møller,Christopher J. L. Newth,Trung C. Nguyen,Akira Nishisaki,Mark E. Nunnally,Margaret M. Parker,Raina Paul,Adrienne G. Randolph,Suchitra Ranjit,Lewis H. Romer,Halden F. Scott,Lyvonne N Tume,Judy T. Verger,Judy T. Verger,Eric A. Williams,Joshua Wolf,Hector R. Wong,Jerry J. Zimmerman,Niranjan Kissoon,Pierre Tissieres,Pierre Tissieres +53 more
TL;DR: A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations.
Journal ArticleDOI
Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children
Scott L. Weiss,Mark J. Peters,Waleed Alhazzani,Michael S. D. Agus,Heidi R. Flori,David Inwald,Simon Nadel,Luregn J. Schlapbach,Robert C. Tasker,Andrew C. Argent,Joe Brierley,Joseph Carcillo,Enitan D. Carrol,Christopher L. Carroll,Ira M. Cheifetz,Karen Choong,Jeffry J. Cies,Andrea T. Cruz,Daniele De Luca,Daniele De Luca,Akash Deep,Saul N. Faust,Claudio Flauzino De Oliveira,Mark W. Hall,Paul Ishimine,Etienne Javouhey,Koen F. M. Joosten,Poonam Joshi,Oliver Karam,Martin C. J. Kneyber,Joris Lemson,Graeme MacLaren,Graeme MacLaren,Nilesh M. Mehta,Morten Hylander Møller,Christopher J. L. Newth,Trung C. Nguyen,Akira Nishisaki,Mark E. Nunnally,Margaret M. Parker,Raina Paul,Adrienne G. Randolph,Suchitra Ranjit,Lewis H. Romer,Halden F. Scott,Lyvonne N Tume,Judy T. Verger,Judy T. Verger,Eric A. Williams,Joshua Wolf,Hector R. Wong,Jerry J. Zimmerman,Niranjan Kissoon,Pierre Tissieres,Pierre Tissieres +54 more
TL;DR: A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations.
Journal ArticleDOI
Early prediction of circulatory failure in the intensive care unit using machine learning.
Stephanie L. Hyland,Martin Faltys,Matthias Hüser,Matthias Hüser,Xinrui Lyu,Xinrui Lyu,Thomas Gumbsch,Cristóbal Esteban,Cristóbal Esteban,Christian Bock,Max Horn,Michael Moor,Bastian Rieck,Marc Zimmermann,Dean A. Bodenham,Karsten M. Borgwardt,Gunnar Rätsch,Tobias M. Merz,Tobias M. Merz +18 more
TL;DR: An early-warning system that integrates measurements from multiple organ systems using a high-resolution database with 240 patient-years of data that predicts 90% of circulatory-failure events and provides early identification of patients at risk for circulatory failure with a much lower false-alarm rate than conventional threshold-based systems.
References
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Journal ArticleDOI
Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.
R. P. 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,Konrad Reinhart,Ruth M. Kleinpell,Derek C. Angus,Clifford S. Deutschman,Flávia Ribeiro Machado,Gordon D. Rubenfeld,Steven A R Webb,Richard Beale,Jean Louis Vincent,Rui Moreno +21 more
TL;DR: An update to the “Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock,” last published in 2008 is provided.
BookDOI
Regression modeling strategies : with applications to linear models, logistic regression, and survival analysis
TL;DR: In this article, the authors present a case study in least squares fitting and interpretation of a linear model, where they use nonparametric transformations of X and Y to fit a linear regression model.
Journal ArticleDOI
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012
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,Flávia Ribeiro Machado,Gordon D. Rubenfeld,Steven A R Webb,Richard Beale,Jean Louis Vincent,Rui Moreno +22 more
TL;DR: A consensus committee of 68 international experts representing 30 international organizations was convened in 2008 to provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock".
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Multiple imputation of discrete and continuous data by fully conditional specification
TL;DR: FCS is a semi-parametric and flexible alternative that specifies the multivariate model by a series of conditional models, one for each incomplete variable, but its statistical properties are difficult to establish.
Journal ArticleDOI
Higher vs Lower Positive End-Expiratory Pressure in Patients With Acute Lung Injury and Acute Respiratory Distress Syndrome: Systematic Review and Meta-analysis
Matthias Briel,Maureen O. Meade,Alain Mercat,Roy G. Brower,Daniel Talmor,Stephen D. Walter,Arthur S. Slutsky,Eleanor Pullenayegum,Qi Zhou,Deborah J. Cook,Laurent Brochard,Jean-Christophe Richard,Francois Lamontagne,Francois Lamontagne,Neera Bhatnagar,Thomas E. Stewart,Gordon H. Guyatt +16 more
TL;DR: Evaluating the association of higher vs lower PEEP with patient-important outcomes in adults with acute lung injury or ARDS who are receiving ventilation with low tidal volumes found that higher levels were associated with improved survival among the subgroup of patients with ARDS, but lower levels were not associated withImproved hospital survival.
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