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1.
Sine Wichmann Martin Schønemann-Lund Anders Perner Theis S. Itenov Theis Lange Christian Gluud Rasmus E. Berthelsen Anne C. Brøchner Jørgen Wiis Morten H. Bestle 《Acta anaesthesiologica Scandinavica》2023,67(4):470-478
Background
Salt and water accumulation leading to fluid overload is associated with increased mortality in intensive care unit (ICU) patients, but diuretics' effects on patient outcomes are uncertain. In this first version of the GODIF trial, we aimed to assess the effects of goal-directed fluid removal with furosemide versus placebo in adult ICU patients with fluid overload.Methods
We conducted a multicentre, randomised, stratified, parallel-group, blinded, placebo-controlled trial in clinically stable, adult ICU patients with at least 5% fluid overload. Participants were randomised to furosemide versus placebo infusion aiming at achieving neutral cumulative fluid balance as soon as possible. The primary outcome was the number of days alive and out of the hospital at 90 days.Results
The trial was terminated after the enrolment of 41 of 1000 participants because clinicians had difficulties using cumulative fluid balance as the only estimate of fluid status (32% of participants had their initially registered cumulative fluid balance adjusted and 29% experienced one or more protocol violations). The baseline cumulative fluid balance was 6956 ml in the furosemide group and 6036 ml in the placebo group; on day three, the cumulative fluid balances were 1927 ml and 5139 ml. The median number of days alive and out of hospital at day 90 was 50 days in the furosemide group versus 45 days in the placebo group (mean difference 1 day, 95% CI -19 to 21, p-value .94).Conclusions
The use of cumulative fluid balance as the only estimate of fluid status appeared too difficult to use in clinical practice. We were unable to provide precise estimates for any outcomes as only 4.1% of the planned sample size was randomised. 相似文献2.
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Robert J. Motzer MD Bernard Escudier MD Saby George MD Hans J. Hammers MD PhD Sandhya Srinivas MD Scott S. Tykodi MD PhD Jeffrey A. Sosman MD Elizabeth R. Plimack MD Giuseppe Procopio MD David F. McDermott MD Daniel Castellano MD Toni K. Choueiri MD Frede Donskov MD PhD Howard Gurney MD Stéphane Oudard MD Martin Richardet MD PhD Katriina Peltola MD PhD Ajjai S. Alva MD Michael Carducci MD John Wagstaff MD Christine Chevreau MD Satoshi Fukasawa MD Yoshihiko Tomita MD PhD Thomas C. Gauler MD Christian K. Kollmannsberger MD Fabio A. Schutz PhD James Larkin MD PhD David Cella PhD M. Brent McHenry PhD Shruti Shally Saggi BEng Nizar M. Tannir MD 《Cancer》2020,126(18):4156-4167
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Toni Kulju Joonas Haapasalo Ryan Verner Maxine Dibu‐Adjei Kai Lehtimki Sirpa Rainesalo Jukka Peltola 《Neuromodulation》2020,23(6):852-858
BackgroundIn vagal nerve stimulation (VNS) therapy, the release of VNS model 106 (AspireSR) allowed for responsive VNS (rVNS). rVNS utilizes a cardiac-based seizure detection algorithm to detect seizure-induced tachycardia to trigger additional stimulation. There are some studies suggesting clinical benefits of rVNS over traditional VNS, but the performance and significance of autostimulation mode in clinical practice are poorly understood.ObjectivesTo assess the effect of initiation of rVNS therapy and altered stimulation settings on the number of daily stimulations and energy consumption in VNS therapy and to compare autostimulation performance in different epilepsy types.Materials and MethodsRetrospective follow-up of 30 patients with drug-resistant epilepsy treated with rVNS including 17 new implantations and 13 battery replaces at a single center in Finland. Our data consist of 208 different stimulation periods, that is, episodes with defined stimulation settings and both autostimulation and total stimulation performance-related data along with clinical follow-up.ResultsThe variation in autostimulation frequency was highly dependent on the duration of the OFF-time and autostimulation threshold (p < 0.05). There was a large additional effect of autostimulation mode on therapy time and energy consumption with longer OFF-times, but a minor effect with shorter OFF-times. Significantly more autostimulations were triggered in the temporal lobe and multifocal epilepsies than in extratemporal lobe epilepsies.ConclusionsThe initiation of autostimulation mode in VNS therapy increased the total number of stimulations. Shortening the OFF-time leads to a decreased number and share of automatic activations. Epilepsy type may affect autostimulation activity. 相似文献
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Berenika Olszewska MD Anton Żawrocki MD PhD Joanna Lakomy MD PhD Joanna Karczewska PhD Jolanta Gleń PhD Monika Zabłotna PhD Marta Malek MD PhD Jerzy Jankau MD PhD Magdalena Lange MD PhD Wojciech Biernat MD PhD Roman J. Nowicki MD PhD Małgorzata Sokołowska-Wojdyło MD PhD 《International journal of dermatology》2020,59(9):1106-1112
10.
Marie Warrer Petersen Tine Sylvest Meyhoff Marie Helleberg Maj-Brit Nørregaard Kjær Anders Granholm Carl Johan Steensen Hjortsø Thomas Steen Jensen Morten Hylander Møller Peter Buhl Hjortrup Mik Wetterslev Gitte Kingo Vesterlund Lene Russell Vibeke Lind Jørgensen Klaus Tjelle Thomas Benfield Charlotte Suppli Ulrik Anne Sofie Andreasen Thomas Mohr Morten H. Bestle Lone Musaeus Poulsen Mette Friberg Hitz Thomas Hildebrandt Lene Surland Knudsen Anders Møller Christoffer Grant Sølling Anne Craveiro Brøchner Bodil Steen Rasmussen Henrik Nielsen Steffen Christensen Thomas Strøm Maria Cronhjort Rebecka Rubenson Wahlin Stephan Jakob Luca Cioccari Balasubramanian Venkatesh Naomi Hammond Vivekanand Jha Sheila Nainan Myatra Christian Gluud Theis Lange Anders Perner 《Acta anaesthesiologica Scandinavica》2020,64(9):1365-1375