ACP journal club最新文献_第9页

Thiazolidinediones increased risk for heart failure, myocardial infarction, and death in older patients with type 2 diabetes. 噻唑烷二酮类药物增加老年2型糖尿病患者心力衰竭、心肌梗死和死亡的风险。

ACP journal club Pub Date : 2008-06-17

Raj Padwal

引用次数: 0

Low-dose hydrocortisone did not improve survival in patients with septic shock but reversed shock earlier. 低剂量氢化可的松不能改善脓毒性休克患者的生存，但能早期逆转休克。

ACP journal club Pub Date : 2008-06-17

Francois Lamontagne, Maureen O Meade

引用次数: 0

CT pulmonary angiography was not inferior to ventilation-perfusion lung scanning for ruling out pulmonary embolism. CT肺血管造影在排除肺栓塞方面不逊于肺通气灌注扫描。

ACP journal club Pub Date : 2008-06-17

Andrew Dunn

引用次数: 0

Review: nonpsychiatric physicians have low accuracy for recognizing depression. 回顾:非精神科医生在识别抑郁症方面准确率较低。

ACP journal club Pub Date : 2008-06-17

A Niro Siriwardena

引用次数: 0

Intensive insulin therapy and starch (HES 200/0.5) had some risk and no clear benefit in severe sepsis. 强化胰岛素和淀粉治疗(HES 200/0.5)对严重脓毒症有一定的风险，没有明显的益处。

ACP journal club Pub Date : 2008-06-17 DOI: 10.7326/0003-4819-148-12-200806170-02004

Deborah Cook, Lauralyn McIntyre

{"title":"Intensive insulin therapy and starch (HES 200/0.5) had some risk and no clear benefit in severe sepsis.","authors":"Deborah Cook, Lauralyn McIntyre","doi":"10.7326/0003-4819-148-12-200806170-02004","DOIUrl":"https://doi.org/10.7326/0003-4819-148-12-200806170-02004","url":null,"abstract":"Questions In critically ill patients with severe sepsis or septic shock, how does intensive insulin therapy (IIT) compare with conventional therapy for mortality? How does fluid resuscitation with hydroxyethyl starch (HES) compare with Ringer's lactate (RL)? Methods Design Randomized, 2 2 factorial design, controlled trial (Efficacy of Volume Substitution and Insulin Therapy in Severe Sepsis [VISEP] study). Allocation {Concealed}.* Blinding {Unblinded}.* Follow-up period 28 days. Setting 18 intensive care units (ICUs) in Germany. Patients 537 patients (mean age 65 y, 60% men) with severe sepsis or septic shock developing < 24 hours before ICU admission or < 12 hours after admission if condition developed in the ICU. Exclusion criteria included receipt of HES >1000 mL in the 24 hours before randomization. Intervention IIT (n =247) or conventional therapy (n =290) and fluid resuscitation with HES (n =262) or RL (n =275). IIT consisted of insulin infusion when plasma glucose levels were >110 mg/dL, then adjusted to maintain euglycemia (80 to 110 mg/dL). Conventional therapy consisted of continuous insulin infusion when glucose levels were >200 mg/dL, then adjusted to maintain levels at 180 to 200 mg/dL. Outcomes All-cause mortality and Sequential Organ Failure Assessment (SOFA) score. Secondary outcomes included length of ICU stay, acute renal failure, renal replacement therapy (RRT), hypoglycemia (40 mg/dL), and development of 1 adverse event and 1 serious adverse event. Patient follow-up 89% (intention-to-treat analysis). Main results The trial was stopped early by the safety committee. More patients in the IIT group had hypoglycemia, 1 adverse event, and 1 serious adverse event than the conventional therapy group (Table), but groups did not differ for all-cause mortality (Table), SOFA scores, length of ICU stay, acute renal failure, or RRT. Cumulative median dose of HES was 70.4 mL/kg; 38% of patients in the HES group exceeded the maximum dose of 20 mL/kg/d. HES led to more acute renal failure and RRT than RL (Table); groups did not differ for mortality (Table), SOFA scores, length of ICU stay, hypoglycemia, or adverse events. Conclusions Intensive insulin therapy increased hypoglycemia and adverse events compared with conventional therapy. Fluid resuscitation with hydroxyethyl starch increased acute renal failure and renal replacement therapy compared with Ringer's lactate. Intensive insulin therapy (IIT) vs conventional insulin therapy (CIT) and fluid resuscitation with hydroxyethyl starch (HES) vs Ringer's lactate (RL) in severe sepsis or septic shock Outcomes at 28 d IIT CIT RRR (95% CI) NNT All-cause mortality 25% 26% 4.8% (27 to 29) Not significant RRI (CI) NNH (CI) Hypoglycemia (40 mg/dL) 17% 4.1% 311% (124 to 658) 8 (6 to 13) 1 adverse event 22% 8.6% 158% (67 to 301) 8 (6 to 14) 1 serious adverse event 11% 5.2% 111% (16 to 285) 18 (10 to 83) HES RL All-cause mortality 27% 24% 11% (17 to 48) Not significant Acute renal failure 35% 23% 53% ","PeriodicalId":79388,"journal":{"name":"ACP journal club","volume":"148 4","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2008-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40431500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Evidence-based medicine targets the individual patient. Part 1: how clinicians can use study results to determine optimal individual care. 循证医学针对的是个体患者。第一部分:临床医生如何使用研究结果来确定最佳的个人护理。

ACP journal club Pub Date : 2008-06-17

Dirk Bassler, Jason W Busse, Paul J Karanicolas, Gordon H Guyatt

引用次数: 0

Spontaneous awakening trials added to spontaneous breathing trials improved weaning from mechanical ventilation. 自发觉醒试验与自发呼吸试验相结合，改善了机械通气的脱机效果。

ACP journal club Pub Date : 2008-06-17

Randolph J Lipchik

引用次数: 0

Review: epoetin and darbepoetin reduce need for blood transfusions but increase risk for thrombosis in patients with cancer. 综述:依泊丁和达贝泊丁减少了癌症患者的输血需求，但增加了血栓形成的风险。

ACP journal club Pub Date : 2008-06-17

David P Steensma