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1.
Yongguo Tang Junfang Kang Yu Zhang Xuejun Zhang 《The American journal of emergency medicine》2017,35(11):1750-1754
Aims
Greater occipital nerve (GON) block may be a promising approach to treat migraine. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the efficacy of GON block in migraine patients.Methods
PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the efficacy of GON block versus placebo in migraine patients were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. Meta-analysis was performed using the random-effect model.Results
Six RCTs were included in the meta-analysis. Overall, compared with control intervention in migraine patients, GON block intervention was found to significantly reduce pain score (Std. mean difference = ? 0.51; 95% CI = ? 0.81 to ? 0.21; P = 0.0008), number of headache days (Std. mean difference = ? 0.68; 95% CI = ? 1.02 to ? 0.35; P < 0.0001), and medication consumption (Std. mean difference = ? 0.35; 95% CI = ? 0.67 to ? 0.02; P = 0.04), but demonstrated no influence on duration of headache per four weeks (Std. mean difference = ? 0.07; 95% CI = ? 0.41 to 0.27; P = 0.70).Conclusions
Compared to control intervention, GON block intervention can significantly alleviate pain, reduce the number of headache days and medication consumption, but have no significant influence on the duration of headache per four weeks for migraine patients. 相似文献2.
Background
Simvastatin might be beneficial to the patients with aneurysmal subarachnoid hemorrhage. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the efficacy of simvastatin for aneurysmal subarachnoid hemorrhage.Methods
PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of simvastatin versus placebo on aneurysmal subarachnoid hemorrhage were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were delayed ischaemic deficit and delayed cerebral infarction. Meta-analysis was performed using the random-effect model.Results
Six RCTs involving 1053 patients were included in the meta-analysis. Overall, compared with control intervention, simvastatin intervention had no influence on delayed ischaemic deficit (RR = 0.99; 95% CI = 0.78 to 1.27; P = 0.96), delayed cerebral infarction (RR = 1.17; 95% CI = 0.60 to 2.29; P = 0.65), mRS ≤ 2 (RR = 0.97; 95% CI = 0.87 to 1.09; P = 0.61), vasospasm (RR = 0.79; 95% CI = 0.49 to 1.29; P = 0.35), ICU stay (Std. mean difference = 0.04; 95% CI = ? 0.54 to 0.63; P = 0.88), hospital stay (Std. mean difference = 0.01; 95% CI = ? 0.13 to 0.14; P = 0.90) and mortality (RR = 0.71; 95% CI = 0.25 to 2.05; P = 0.53) after aneurysmal subarachnoid hemorrhage.Conclusions
Compared to control intervention, simvastatin intervention was found to have no influence on delayed ischaemic deficit, delayed cerebral infarction, mRS ≤ 2, vasospasm, ICU stay, hospital stay, and mortality in patients with acute aneurysmal subarachnoid hemorrhage. 相似文献3.
Maurício Oliveira Magalhães Josielli Comachio Paulo Henrique Ferreira Evangelos Pappas Amélia Pasqual Marques 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2018,22(1):82-91
Background
Low back pain (LBP) is a major health and economic problem worldwide. Graded activity and physiotherapy are commonly used interventions for nonspecific low back pain. However, there is currently little evidence to support the use of one intervention over the other in the medium-term.Objective
To compare the effectiveness of graded activity exercises to physiotherapy-based exercises at mid-term (three and six months’ post intervention) in patients with chronic nonspecific LBP.Methods
Sixty-six patients were randomly allocated to two groups: graded activity group (n = 33) and physiotherapy group (n = 33). These patients received individual sessions twice a week for six weeks. Follow-up measurements were taken at three and six months. The main outcome measurements were intensity pain (Pain Numerical Rating Scale) and disability (Rolland Morris Disability Questionnaire).Results
No significant differences between groups after three and six month-follow ups were observed. Both groups showed similar outcomes for pain intensity at three months [between group differences: ?0.1 (95% confidence interval [CI] = ?1.5 to 1.2)] and six months [0.1 (95% CI = ?1.1 to 1.5)], disability at three months was [-0.6 (95% CI = ?3.4 to 2.2)] and six months [0.0 (95% CI = ?2.9 to 3.0)].Conclusion
The results of this study suggest that graded activity and physiotherapy have similar effects in the medium-term for patients with chronic nonspecific low back pain. 相似文献4.
Yan-ling Li Jun-rong Mo Nga-man Cheng Stewart S.W. Chan Pei-yi Lin Xiao-hui Chen Colin A. Graham Timothy H. Rainer 《The American journal of emergency medicine》2018,36(6):988-992
Objective
The diagnosis of shock in patients presenting to the emergency department (ED) is often challenging. We aimed to compare the accuracy of experienced emergency physician gestalt against Li's pragmatic shock (LiPS) tool for predicting the likelihood of shock in the emergency department, using 30-day mortality as an objective standard.Method
In a prospective observational study conducted in an urban, academic ED in Hong Kong, adult patients aged 18 years or older admitted to the resuscitation room or high dependency unit were recruited. Eligible patients had a standard ED workup for shock. The emergency physician treating the patient was asked whether he or she considered shock to be probable, and this was compared with LiPS. The proxy ‘gold’ or reference standard was 30-day mortality. The area under the receiver operating curve (AUROC) was used to predict prognosis. The primary outcome measure was 30-day mortality.Results
A total of 220 patients fulfilled the inclusion criteria and were included in the analysis. The AUROC for LiPS (0.722; sensitivity = 0.733, specificity = 0.711, P < 0.0001) was greater than emergency physician gestalt (0.620, sensitivity = 0.467, specificity = 0.774, P = 0.0137) for diagnosing shock using 30-day mortality as a proxy (difference P = 0.0229). LiPS shock patients were 6.750 times (95%CI = 2.834–16.076, P < 0.0001) more likely to die within 30-days compared with non-shock patients. Patients diagnosed by emergency physicians were 2.991 times (95%CI = 1.353–6.615, P = 0.007) more likely to die compared with the same reference.Conclusions
LiPS has a higher diagnostic accuracy than emergency physician gestalt for shock when compared against an outcome of 30-day mortality. 相似文献5.
6.
Ning Zhang Jianhua Liu Zeliang Qiu Yiping Ye Jian Zhang Tianzheng Lou 《The American journal of emergency medicine》2017,35(1):1-6
Purpose
To assess the efficacy of Shenfu injection (SFI) for enhancing cellular immunity and improving the clinical outcomes of patients with septic shock.Methods
Patients with sepsis were randomly assigned to receive either SFI at a dose of 100 mL every 24 hours for 7 consecutive days or a placebo in addition to conventional therapy. The immunologic parameters were collected on days 1, 3, and 7 after the above treatments, and the clinical outcomes were updated for 28 days.Results
Of these160 patients, 3 were excluded from the analysis due to protocol violation and withdrawal of consent; thus, 157 completed the study (78 in the SFI group and 79 in the placebo group). We found that SFI increased both CD4+ and CD8+ T cells in peripheral blood and up-regulated HLA-DR expression in monocytes (P < .05). Furthermore, SFI was also found to restore ex vivo monocytic tumor necrosis factor α and interleukin 6 proinflammatory cytokine release in response to the endotoxin (P < .05). Importantly, the SFI group showed better clinical outcomes than did the placebo group in terms of the duration of vasopressor use (P = .008), Acute Physiology and Chronic Health Evaluation II score (P = .034), Marshall score (P = .01), and length of intensive care unit stay (10.5 ± 3.2 vs 12.2 ± 2.8 days; P = .012). However, the 28-day mortality rate was not significantly different between the SFI (20.5%; 16/78) and placebo groups (27.8%; ?22/79; P = .28).Conclusion
These findings suggest that SFI can enhance the cellular immunity of patients with septic shock and could be a promising adjunctive treatment for patients with septic shock. 相似文献7.
Qiang Zhang Bo Liu Lianxing Zhao Zhijiang Qi Huan Shao Le An Chunsheng Li 《The American journal of emergency medicine》2017,35(10):1555-1560
Objective
The aim of this study was to conduct a meta-analysis to evaluate the efficacy of vasopressin-epinephrine compared to epinephrine alone in patients who suffered out-of-hospital cardiac arrest (OHCA).Methods
Relevant studies up to February 2017 were identified by searching in PubMed, EMBASE, the Cochrane Library, Wanfang for randomized controlled trials(RCTs) assigning adults with cardiac arrest to treatment with vasopressin-epinephrine (VEgroup) vs adrenaline (epinephrine) alone (E group). The outcome point was return of spontaneous circulation (ROSC) for patients suffering from OHCA. Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were explored.Results
Individual patient data were obtained from 5047 participants who experienced OHCA in nine studies. Odds ratios (ORs) were calculated using a random-effects model and results suggested that vasopressin-epinephrine was associated with higher rate of ROSC (OR = 1.67, 95% CI = 1.13–2.49, P < 0.00001, and total I2 = 83%). Subgroup showed that vasopressin-epinephrine has a significant association with improvements in ROSC for patients from Asia (OR = 3.30, 95% CI = 1.30–7.88); but for patients from other regions, there was no difference between vasopressin-epinephrine and epinephrine alone (OR = 1.07, 95% CI = 0.72–1.61).Conclusion
According to the pooled results of the subgroup, combination of vasopressin and adrenaline can improve ROSC of OHCA from Asia, but patients from other regions who suffered from OHCA cannot benefit from combination of vasopressin and epinephrine. 相似文献8.
Ebru Biyikli Afsin Emre Kayipmaz Cemil Kavalci 《The American journal of emergency medicine》2018,36(4):647-650
Background
Sepsis is a potentially fatal condition with high treatment costs, and is especially common among the elderly population. The emergency management of septic patients has gained importance.Objective
Herein, we investigated the effect of admission lactate levels and the platelet-lymphocyte ratio (PLR) on the 30-day mortality among patients older than 65 years who were diagnosed with sepsis and septic shock according to the qSOFA criteria at our hospital's emergency department.Methods
This observational study was conducted retrospectively. We obtained information regarding patients' demographic characteristics, comorbid conditions, hemodynamic parameters at admission, initial treatment needs at the emergency department.Results
131 patients received a diagnosis of sepsis and septic shock at our emergency department in two years. Among these, 45% (n = 59) of the patients died within 30 days of admission. Forty (30.5%) patients required mechanical ventilation. There was a significant difference between the survival and non-survival groups with regard to systolic and diastolic blood pressures (p = 0.013 and 0.045, respectively). There were significant differences between the two groups with respect to the Glasgow Coma Scale score (p < 0.001) and BUN levels (p < 0.001). The mortality status according to qSOFA scores was revealed a significant difference between the two groups (p < 0.001).Conclusion
Our results showed that the patients who died within 30 days of admission and those who did not had comparable PLR and lactate levels (p = 0.821 and 0.120, respectively). We opine that serial lactate measurements would be more useful than a single admission lactate measurement for the prediction of mortality. 相似文献9.
Paul Barbara Christopher Graziano William Caputo Ilya Litvak Dominick Battinelli Barry Hahn 《The American journal of emergency medicine》2018,36(6):1022-1026
Background
Recently a multispecialty, multinational task force convened to redefine the criteria for organ dysfunction, sepsis, severe sepsis, and septic shock. The study recommended the quick sequential organ failure assessment (qSOFA) score to identify sepsis patients. The qSOFA is felt to be the initial screen to prompt a more in-depth sepsis workup. This may be particularly true in resource-limited environments such as the prehospital arena.Objectives
The goal of this study was to identify whether emergency medical services (EMS) patients who met all three qSOFA criteria correlated with an emergency department (ED) identification of sepsis.Methods
This was a retrospective chart review of adult patients ≥ 18 years of age, meeting qSOFA criteria and presenting to the emergency department between 1/01/2014 and 6/30/2016. Subjects were identified through an electronic query of the EMS record repository.Results
72 subjects were included in the final analysis. Subjects in the septic group tended to be older with a mean age of 72 years vs 64 years. There was no observed discrepancy relating to gender. 48 of the subjects (67%) were identified as septic and 24 (33%) were identified as non-septic after review of the ED chart. This yielded a positive predictive value of the prehospital qSOFA as 66.67% (95% CI 55.8–77.6).Conclusions
EMS patients with positive qSOFA screens were more likely to be septic upon disposition to the ED. 相似文献10.
Jung-Man Lee Jiwon Lee Jin-Young Hwang Jee-Eun Chang Heyrim Kim Sohee Oh Eun-Ah Oh Seong-Won Min 《The American journal of emergency medicine》2017,35(5):743-748
Objective
Guidewire-induced arrhythmias that occur during central venous catheterization can progress to malignant arrhythmias in rare cases. This study compared the incidence of arrhythmia during central venous catheterization using three different depths of guidewire insertion into the right internal jugular vein.Methods
Sixty-nine patients undergoing elective surgery requiring central venous catheterization through the right internal jugular vein were enrolled in this double-blind, prospective, randomized, and controlled study. Patients were randomly allocated to receive guidewire insertions to 15 cm, 17.5 cm, or 20 cm before tissue dilation. Arrhythmic episodes were then monitored during dilation of the soft tissue.Results
A total of 29 patients (42%) experienced arrhythmic episodes during tissue dilation. The guidewire-induced arrhythmia rates of the 15 cm group, 17.5 cm group, and 20 cm group were 0.26 (95% confidence interval [CI] = 0.10, 0.48), 0.35 (95% CI = 0.16, 0.57), and 0.65 (95% CI = 0.43, 0.84), respectively. The incidence of arrhythmic episodes was higher in the 20 cm group than in the 15 cm (odds ratio [OR] = 5.31; 95% CI = 1.50, 18.84) and 17.5 cm (OR = 3.52; 95% CI = 1.05, 11.83) groups. There was no significant difference in arrhythmia rates between the 15 cm group and 17.5 cm group (p = 0.542).Conclusions
During central venous catheterization through the right internal jugular vein, inserting guidewires to depths of 15 or 17.5 cm before tissue dilation reduced the incidence of arrhythmic episodes compared to a depth of 20 cm. 相似文献11.
Tatiane Calve Douglas Vicente Russo Júnior Ana Maria Forti Barela 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2018,22(1):64-69
Background
Exercises that could prevent gait impairment of older adults should be implemented in such a way that practitioners can keep motivation and adherence independent of older adults fitness levels.Objective
This study describes how younger and older adults use a non-pedal tricycle to transport their bodies along a pathway.Methods
Nine younger (24 ± 4.9 y) and nine older (66 ± 4.0 y) adults participated in this study. They moved along a straight pathway at a self-selected comfortable speed with reflective markers on their main lower limb landmarks. A computerized gait analysis system with infrared cameras was used to obtain kinematic data to calculate spatial-temporal parameters and lower limb angles.Results
Overall, participants from both groups were able to perform the task moving at a similar mean speed, with similar stride length and ankle joint excursion. Older adults had higher cadence (mean difference of 17 steps/min; 95% CI = 0.99–1.15) and hip excursion (mean difference of 12°; 95% CI = 28–33), longer stance duration (mean difference of 3.4%; 95% CI = 56.2–59.5), and lower knee excursion (mean difference of 6°; 95% CI = 47.9–53.8) than younger adults.Conclusion
Older adults were able to transport their body with a non-pedal tricycle with more hip and less knee excursion than younger adults. Professionals that work with the older population should look at and take into consideration the use of non-pedal tricycles in exercise protocols and investigate the long-term impacts. 相似文献12.
Qing-quan Lv Xiao-hua Gu Qi-hong Chen Jiang-quan Yu Rui-qiang Zheng 《The American journal of emergency medicine》2017,35(12):1810-1814
Background
Physiologic dose hydrocortisone is part of the suggested adjuvant therapies for patients with septic shock. However, the association between the corticosteroid therapy and mortality in patients with septic shock is still not clear. Some authors considered that the mortality is related to the time frame between development of septic shock and start of low dose hydrocortisone. Thus we designed a placebo-controlled, randomized clinical trial to assess the importance of early initiation of low dose hydrocortisone for the final outcome.Methods
A total of 118 patients with septic shock were recruited in the study. All eligible patients were randomized to receive hydrocortisone (n = 58) or normal saline (n = 60). The study medication (hydrocortisone and normal saline) was initiated simultaneously with vasopressors. The primary end-point was 28-day mortality. The secondary end-points were the reversal of shock, in-hospital mortality and the duration of ICU and hospital stay.Results
The proportion of patients with reversal of shock was similar in the two groups (P = 0.602); There were no significant differences in 28-day or hospital all-cause mortality; length of stay in the ICU or hospital between patients treated with hydrocortisone or normal saline.Conclusion
The early initiation of low-dose of hydrocortisone did not decrease the risk of mortality, and the length of stay in the ICU or hospital in adults with septic shock.Trial registration: www.clinicaltrials.govNCT02580240. 相似文献13.
Indiara Soares Oliveira Leonardo Oliveira Pena Costa Alessandra Narciso Garcia Gisela Cristiane Miyamoto Cristina Maria Nunes Cabral Lucíola da Cunha Menezes Costa 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2018,22(4):328-335
Objective
To identify potential prognostic factors that may predict clinical improvement of patients treated with different physical therapy interventions in the short-term.Methods
This is a prospective cohort study. A total of 616 patients with chronic non-specific low back pain treated with interventions commonly used by physical therapists were included. These patients were selected from five randomized controlled trials. Multivariate linear regression models were used to verify if sociodemographic characteristics (age, gender, and marital status), anthropometric variables (height, body mass, and body mass index), or duration of low back pain, pain intensity at baseline, and disability at baseline could be associated with clinical outcomes of pain intensity and disability four weeks after baseline.Results
The predictive variables for pain intensity were age (β = 0.01 points, 95% CI = 0.00 to 0.03, p = 0.03) and pain intensity at baseline (β = 0.23 points, 95% CI = 0.13 to 0.33, p = 0.00), with an explained variability of 4.6%. Similarly, the predictive variables for disability after four weeks were age (β = 0.03 points, 95% CI = 0.00 to 0.06, p = 0.01) and disability at baseline (β = 0.71 points, 95% CI = 0.65 to 0.78, p = 0.00), with an explained variability of 42.1%.Conclusion
Only age, pain at baseline and disability at baseline influenced the pain intensity and disability after four weeks of treatment. The beta coefficient for age was statistically significant, but the magnitude of this association was very small and not clinically important. 相似文献14.
15.
The utility of presepsin in diagnosis and risk stratification for the emergency patients with sepsis
Bin Lu Yan Zhang Chen Li Chenyan Liu Ying Yao Minghuan Su Songtao Shou 《The American journal of emergency medicine》2018,36(8):1341-1345
Objectives
To evaluate the value of presepsin in diagnosis and risk stratification of septic patients in emergency department, and investigate the utility in differentiation of gram-positive and gram-negative bacterial infection.Methods
We enrolled 72 patients with sepsis and 23 nonbacterial patients with systemic inflammatory response syndrome (SIRS) who were admitted to the emergency department of Tianjin Medical University General Hospital. Meanwhile, 20 healthy volunteers were included. Plasma presepsin, serum PCT, C-reactive protein (CRP), lactate and white blood cells (WBC) were measured, and APACHE II score were calculated upon admission. The receiver-operating-characteristic curve (ROC) was computed and the area under the ROC curve was for evaluating the value to diagnose sepsis. Then the patients were grouped according to the result of culture and severity of sepsis.Results
The levels of presepsin, PCT, CRP and WBC were apparently higher in sepsis patients than in nonbacterial SIRS group (P < 0.05). The levels of presepsin and the APACHEII score were demonstrated the significant difference among sepsis, severe sepsis and septic shock patients (P < 0.05). The area under the ROC curve of presepsin, PCT, CRP and WBC were 0.954, 0.874, 0.859 and 0.723 respectively. The cutoff of presepsin for discrimination of sepsis and nonbacterial infectious SIRS was determined to be 407 pg/ml, of which the clinical sensitivity and specificity were 98.6% and 82.6%, respectively. Moreover, presepsin was significantly different between gram-positive and gram-negative bacterial infection (P < 0.05).Conclusion
Presepsin was a promising biomarker for initially diagnosis and risk stratification of sepsis, and a potential marker to distinguish gram-positive and gram-negative bacterial infection. 相似文献16.
Fangyan Wang Zengyou Jin Kaiyi Shen Tingting Weng Zhisong Chen Jiahui Feng Zhengzheng Zhang Jiaming Liu Xiaolong Zhang Maoping Chu 《The American journal of emergency medicine》2017,35(3):402-409
Objectives
The depressed heart function is the main complication to cause death of septic patients in clinic. It is urgent to find effective interventions for this intractable disease. In this study, we investigated whether butyrate could be protective for heart against sepsis and the underlying mechanism.Methods
Mice were randomly divided into three groups. Model group challenged with LPS (30 mg/kg, i.p.) only. Butyrate group received butyrate (200 mg/kg·d) for 3 days prior to LPS administration (30 mg/kg). Normal group received saline only. 6 h and 12 h after LPS administration were chosen for detection the parameters to estimate the effects or mechanism of butyrate pretreatment on heart of sepsis.Results
The data showed that septic heart depression was attenuated by butyrate pretreatment through improvement of heart function depression (P < 0.01) and reduction of morphological changes of myocardium. The overexpression of proinflammatory factors, TNF-α, IL-6 and LTB4, in heart tissues induced by sepsis was significantly alleviated by butyrate pretreatment (P < 0.01). As oxidative stress indicators, SOD and CAT activity, and MDA content in heart were deteriorated by LPS challenge, which was noticeably ameliorated by butyrate pretreatment (P < 0.01 or P < 0.05).Conclusions
In conclusion, pretreatment with butyrate attenuated septic heart depression via anti-inflammation and anti-oxidation. 相似文献17.
Diego G.D. Christofaro Breno Q. Farah Luiz Carlos M. Vanderlei Leandro D. Delfino William R. Tebar Mauro Virgílio G. de Barros Raphael M. Ritti-Dias 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2018,22(1):49-54
Background
High blood pressure is strongly associated with obesity in different populations. However, it is unclear whether different anthropometric indicators of obesity can satisfactorily predict high blood pressure in the school setting.Objectives
This study evaluated the sensitivity and specificity of body mass index, waist circumference, and waist to height ratio in the detection of high blood pressure in adolescents.Methods
The sample consisted of 8295 adolescents aged 10–17 years. Weight was measured using a digital scale, height with a stadiometer, and waist circumference using a tape measure. Blood pressure was measured by an automatic blood pressure measuring device. ROC curves were used for the analysis of sensitivity and specificity of the three anthropometric indices in identifying high blood pressure. Binary Logistic Regression was used to assess the association of body mass index, waist circumference, and waist to height ratio with high blood pressure.Results
Low values of sensitivity were observed for body mass index (0.35), waist circumference (0.37), and waist to height ratio (0.31) and high values of specificity for body mass index (0.86), waist circumference (0.82), and waist to height ratio (0.83) in the detection of high blood pressure. An association was observed between adolescents classified with high body mass index (OR = 3.57 [95% CI = 3.10–4.10]), waist cirumference (OR = 3.24 [95% CI = 2.83–3.72]), and waist to height ratio (OR = 2.94 [95% CI = 2.54–3.40]) with high blood pressure.Conclusions
Body mass index, waist circumference, and waist to height ratio presented low sensitivity to identify adolescents with high blood pressure. However, adolescents classified with high body mass index, waist circumference, and waist to height ratio demonstrated a high association of presenting high blood pressure. 相似文献18.
Alexandru Ulici Jon Jancik Timothy S. Lam Shannon Reidt Domenico Calcaterra Jon B. Cole 《The American journal of emergency medicine》2017,35(10):1514-1518
Aim
Intravenous vasodilators are often added to beta-blocking agents to reach blood pressure (BP) goals in aortic dissection. Control of BP using clevidipine has been described in hypertensive emergencies and cardiac surgery but not in aortic dissection. The aim of this study was to compare clevidipine versus sodium nitroprusside (SNP) as adjunct agents to esmolol for BP management in aortic dissection.Methods
A single-center retrospective chart review evaluated patients diagnosed with aortic dissection. The primary outcome measure was time to reach patient specific systolic blood pressure (SBPPT) goals after initiation of esmolol infusion. Efficacy of clevidipine and SNP was assessed using area under the curve analysis of positive and negative excursions outside of SBPPT goals (AUCSBPe). Cost data was calculated using average wholesale price in U.S. dollars.Results
Fourteen patients were included in final analyses. Median systolic BP immediately prior to initiation of esmolol was 162 mm Hg vs 161 mm Hg for clevidipine and SNP groups, respectively (p = 0.99). Median time to reach SBPPT goal was similar between clevidipine and SNP (1.68 versus 1.03 h [p = 0.99]). Median AUCSBPe was similar for clevidipine and SNP (206.9 versus 538.9 mm Hg 1 min 1 hr? 1 [p = 0.11]). Cost was significantly reduced using clevidipine versus SNP ($1223.28/day versus $7674.24/day [p < 0.001]).Conclusions
Clevidipine administration during initial medical management of aortic dissection showed similar efficacy compared to SNP when used as adjunct therapy to esmolol. These data suggest clevidipine is a less costly, reasonable alternative to SNP in acute aortic dissection as adjunct therapy to esmolol. Further studies are needed to validate these results. 相似文献19.
An-Yi Wang Hon-Ping Ma Wei-Fong Kao Shin-Han Tsai Cheng-Kuei Chang 《The American journal of emergency medicine》2018,36(6):949-953
Introduction
RDW is a prognostic biomarker and associated with mortality in cardiovascular disease, stroke and metabolic syndrome. For elderly patients, malnutrition and multiple comorbidities exist, which could affect the discrimination ability of RDW in sepsis. The main purpose of our study was to evaluate the prognostic value of RDW in sepsis among elderly patients.Methods
This was a retrospective cohort study conducted in emergency department intensive care units (ED-ICU) between April 2015 and November 2015. Elderly patients (≥ 65 years old) who were admitted to the ED-ICU with a diagnosis of severe sepsis and/or septic shock were included. The demographic data, biochemistry data, qSOFA, and APACHE II score were compared between survivors and nonsurvivors.Results
A total of 117 patients was included with mean age 81.5 ± 8.3 years old. The mean APACHE II score was 21.9 ± 7.1. In the multivariate Cox proportional hazards model, RDW level was an independent variable for mortality (hazard ratio: 1.18 [1.03–1.35] for each 1% increase in RDW, p = 0.019), after adjusting for CCI, any diagnosed malignancy, and eGFR. The AUC of RDW in predicting mortality was 0.63 (95% confidence interval [CI]: 0.52–0.74, p = 0.025). In subgroup analysis, for qSOFA < 2, nonsurvivors had higher RDW levels than survivors (17.0 ± 3.3 vs. 15.3 ± 1.4%, p = 0.044).Conclusions
In our study, RDW was an independent predictor of in-hospital mortality in elderly patients with sepsis. For qSOFA scores < 2, higher RDW levels were associated with poor prognosis. RDW could be a potential parameter used alongside the clinical prediction rules. 相似文献20.
Jeong-Oh Yoon Min-Hyeok Kang Jun-Seok Kim Jae-Seop Oh 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2018,22(2):161-167