Early goal-directed nutrition in icU patients (EAT-ICU):protocol for a randomised trial

INTRODUCTION: Extensive weight loss has been documented in intensive care unit (ICU) survivors, primarily as the result of muscle loss, leading to impaired physical function and reduced quality of life. The aim of the EAT-ICU trial is to test the effect of early goal-directed protein-energy nutrition based on measured requirements on short-term clinical outcomes and long-term physical quality of life in ICU patients. METHODS: The EAT-ICU trial is a single-centre, randomised, parallel-group trial with concealed allocation and blinded outcome assessment. A total of 200 consecutive, acutely admitted, mechanically ventilated intensive care patients will be randomised 1: 1 to early goal-directed nutrition versus standard of care to show a potential 15% relative risk reduction in the primary outcome measure (physical function) at six months (two-sided significance level alpha = 0.05; power beta = 80%). Secondary outcomes include energy-and protein balances, metabolic control, new organ failure, use of life support, nosocomial infections, ICU- and hospital length of stay, mortality and cost analyses. CONCLUSION : The optimal nutrition strategy for ICU patients remains unsettled. The EAT-ICU trial will provide important data on the effects of early goal-directed proteinenergy nutrition based on measured requirements in these patients.Copenhagen University Hospital; Rigshospitalet; Fresenius Kabi A/S; European Society for Clinical Nutrition and Metabolism (ESPEN)SCI(E)[email protected]

Hearing in cetaceans : from natural history to experimental biology

Author Posting. © The Author(s), 2012. This is the author's version of the work. It is posted here by permission of Elsevier for personal use, not for redistribution. The definitive version was published in Advances in Marine Biology 63, edited by Michael Lesser, :197-246. Academic Press (Elsevier), 2013. ISBN: 9780123942821. doi:10.1016/B978-0-12-394282-1.00004-1Sound is the primary sensory cue for most marine mammals, and this is especially true for cetaceans. To passively and actively acquire information about their environment, cetaceans have perhaps the most derived ears of all mammals, capable of sophisticated, sensitive hearing and auditory processing. These capabilities have developed for survival in an underwater world where sound travels five times faster than in air, and where light is quickly attenuated and often limited at depth, at night, and in murky waters. Cetacean auditory evolution has capitalized on the ubiquity of sound cues and the efficiency of underwater acoustic communication. The sense of hearing is central to cetacean sensory ecology, enabling vital behaviors such as locating prey, detecting predators, identifying conspecifics, and navigating. Increasing levels of anthropogenic ocean noise appears to influence many of these activities. Here we describe the historical progress of investigations on cetacean hearing, with a particular focus on odontocetes and recent advancements. While this broad topic has been studied for several centuries, new technologies in the last two decades have been leveraged to improve our understanding of a wide range of taxa, including some of the most elusive species. This paper addresses topics including how sounds are received, what sounds are detected, hearing mechanisms for complex acoustic scenes, recent anatomy and physiology studies, the potential impacts of noise, and mysticete hearing. We conclude by identifying emerging research topics and areas which require greater focus.In compiling this review, TAM was supported by the John E. and Anne W. Sawyer Endowed Fund and the Penzance Endowed Fund

Is the performance of acceleromyography improved with preload and normalization?: A comparison witth mechanomyography

Background: Many studies have indicated that acceleromyography and mechanomyography cannot be used interchangeably. To improve the agreement between the two methods, it has been suggested to use a preload and to refer all train-of-four (TOF) ratios to the control TOF (normalization) when using acceleromyography. The first purpose of this study was to test whether a preload applied to acceleromyography would increase the precision and the agreement with mechanomyography. The second purpose was to evaluate whether normalization would improve the agreement with mechanomyography. Methods: Sixty patients were randomized to acceleromyography with or without a preload (Hand Adapter; Organon, Oss, the Netherlands). On the contralateral arm, mechanomyography was used. Anesthesia was induced with propofol and an opioid, and neuromuscular block with 0.6 mg/kg rocuronium. The precision and the bias and limits of agreement (with or without normalization) between the methods were evaluated using TOF stimulation. Results: Preload improved the precision of acceleromyography by 21%, but it also increased the mean control TOF ratio from 1.07 to 1.13. Normalization of the acceleromyographic TOF ratios diminished the bias to mechanomyography during recovery (e.g., from 0.15 to 0.05 at TOF 0.90); when the mechanomyographic TOF values were normalized as well, the bias was eliminated. However, normalization did not exclude wide individual differences between acceleromyography and mechanomyography (+/- 0.10-0.20 at TOF 0.90). Conclusion: Preload increases the precision of acceleromyography, and normalization of the TOF ratios decreases bias in relation to mechanomyography. When both acceleromyography and mechanomyography are normalized, there is no significant bias between the two methods. (C) 2009 American Society of Anesthesiologists, Inc

Nebulised dornase alfa versus placebo or hypertonic saline in adult critically ill patients:a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis

BACKGROUND: Nebulised dornase alfa is used off-label in critically ill patients. We aimed to assess the benefits and harms of nebulised dornase alfa versus placebo, no prophylaxis, or hypertonic saline on patient-important outcome measures in adult critically ill patients. METHODS: We performed a systematic review with meta-analysis and trial sequential analysis (TSA) using the Cochrane Collaboration methodology. Eligible trials were randomised clinical trials comparing nebulised dornase alfa with placebo, no prophylaxis, or hypertonic saline. The predefined outcome measures were all-cause mortality, duration of mechanical ventilation, length of stay, and adverse events. Two reviewers independently assessed trials for inclusion, data extraction, and risk of bias. Risk ratios (RRs) with 95 % confidence intervals (CIs) were estimated by conventional cumulative meta-analysis, and the robustness of the primary estimate was assessed by TSA. RESULTS: Two trials (n = 63) were included; both were judged to have high risk of bias. There was no statistically significant difference in mortality (random effects model RR (95 % CI) 0.73 (0.09–5.77); P = 0.24; I(2) = 30 %). TSA could not be conducted because less than 1 % of the required information size had been accrued. None of the two trials reported adequate and detailed data on any of the secondary outcome measures. CONCLUSIONS: We found very low quantity and quality of evidence for use of nebulised dornase alfa in adult critically ill patients in this systematic review with meta-analysis. SYSTEMATIC REVIEW REGISTRATION: The International Prospective Register of Systematic Reviews (PROSPERO), no. CRD442015016047. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13643-015-0142-z) contains supplementary material, which is available to authorized users

Additional file 1: of Nebulised dornase alfa versus placebo or hypertonic saline in adult critically ill patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis

PRISMA flowchart. (JPG 29 kb