13 research outputs found
A multi-center, randomized, double-blind, parallel, placebo-controlled trial to evaluate the efficacy, safety, and pharmacokinetics of intravenous ibuprofen for the treatment of fever in critically ill and non-critically ill adults
Aerosolized Surfactant in Adults with Sepsis-Induced Acute Respiratory Distress Syndrome
BACKGROUND: Patients with acute respiratory distress syndrome (ARDS) have a deficiency of surfactant. Surfactant replacement improves physiologic function in such patients, and preliminary data suggest that it may improve survival.
METHODS: We conducted a prospective, multicenter, double-blind, randomized, placebo-controlled trial involving 725 patients with sepsis-induced ARDS. Patients were stratified according to the risk of death at base line (indicated by their score on the Acute Physiological and Chronic Health Evaluation [APACHE III] index) and randomly assigned to receive either continuously administered synthetic surfactant (13.5 mg of dipalmitoylphosphatidylcholine per milliliter, 364 patients) or placebo (o.45 percent saline; 361 patients) in aerosolized form for up to five days.
RESULTS: The demographic and physiologic characteristics of the two treatment groups were similar at base line. The mean (+/- SD) age was 50 +/- 17 years in the surfactant group and 53 +/- 18 years in the placebo group, and the mean APACHE III scores at randomization were 70.4 +/- 25 and 70.5 +/- 25, respectively. Hemodynamic measures, measures of oxygenation, duration of mechanical ventilation, and length of stay in intensive care unit did not differ significantly in the two groups. Survival at 30 days was 60 percent for both groups. Survival was similar in the groups when analyzed according to APACHE III score, cause of death, time of onset and severity of ARDS, presence or absence of documented sepsis, underlying disease, whether or not there was a do-not-resuscitate order, and medical center. Increased secretions were significantly more frequent in the surfactant group; the rates of other complications were similar in the two groups.
CONCLUSIONS: The continuous administration of aerosolized synthetic surfactant to patients with sepsis-induced ARDS had no significant effect on 30-day survival, length of stay in the intensive care unit, duration of mechanical ventilation, or physiologic function
Comparison of anxiety, depression, and post-traumatic stress symptoms in relatives of ICU patients in an American and an Indian public hospital
Context: An intensive care unit (ICU) admission of a patient causes
considerable stress among relatives. Whether this impact differs among
populations with differing sociocultural factors is unknown. Aims: The
aim was to compare the psychological impact of an ICU admission on
relatives of patients in an American and Indian public hospital.
Settings and Design: A cross-sectional study was carried out in ICUs of
two tertiary care hospitals, one each in major metropolitan cities in
the USA and India. Materials and Methods: A total of 90 relatives
visiting patients were verbally administered a questionnaire between 48
hours and 72 hours of ICU admission that included the Hospital Anxiety
and Depression Scale (HADS), Beck Depression Inventory-II (BDI-II) and
Impact of Events Scale-Revised (IES-R) for post-traumatic stress
response. Statistical Analysis: Statistical analysis was done using the
Mann-Whitney and chi-square tests. Results: Relatives in the Indian ICU
had more anxiety symptoms (median HADS-A score 11 [inter-quartile range
9-13] vs. 4 [1.5-6] in the American cohort; P<0.0001), more
depression symptoms (BDI-II score 14 [8.5-19] vs. 6 [1.5-10.5],
P<0.0001) but a comparable post-traumatic stress response (IES-R
score>30). 55% of all relatives had an incongruous perception
regarding "change in the patient\u2032s condition" compared to the
objective change in severity of illness. "Change in worry" was
incongruous compared to the "perception of improvement of the
patient\u2032s condition" in 78% of relatives. Conclusions: Relatives
of patients in the Indian ICU had greater anxiety and depression
symptoms compared to those in the American cohort, and had significant
differences in factors that may be associated with this psychological
impact. Both groups showed substantial discordance between the
perceived and objective change in severity of illness
Comparison of anxiety, depression, and post-traumatic stress symptoms in relatives of ICU patients in an American and an Indian public hospital
Context: An intensive care unit (ICU) admission of a patient causes
considerable stress among relatives. Whether this impact differs among
populations with differing sociocultural factors is unknown. Aims: The
aim was to compare the psychological impact of an ICU admission on
relatives of patients in an American and Indian public hospital.
Settings and Design: A cross-sectional study was carried out in ICUs of
two tertiary care hospitals, one each in major metropolitan cities in
the USA and India. Materials and Methods: A total of 90 relatives
visiting patients were verbally administered a questionnaire between 48
hours and 72 hours of ICU admission that included the Hospital Anxiety
and Depression Scale (HADS), Beck Depression Inventory-II (BDI-II) and
Impact of Events Scale-Revised (IES-R) for post-traumatic stress
response. Statistical Analysis: Statistical analysis was done using the
Mann-Whitney and chi-square tests. Results: Relatives in the Indian ICU
had more anxiety symptoms (median HADS-A score 11 [inter-quartile range
9-13] vs. 4 [1.5-6] in the American cohort; P<0.0001), more
depression symptoms (BDI-II score 14 [8.5-19] vs. 6 [1.5-10.5],
P<0.0001) but a comparable post-traumatic stress response (IES-R
score>30). 55% of all relatives had an incongruous perception
regarding "change in the patient\u2032s condition" compared to the
objective change in severity of illness. "Change in worry" was
incongruous compared to the "perception of improvement of the
patient\u2032s condition" in 78% of relatives. Conclusions: Relatives
of patients in the Indian ICU had greater anxiety and depression
symptoms compared to those in the American cohort, and had significant
differences in factors that may be associated with this psychological
impact. Both groups showed substantial discordance between the
perceived and objective change in severity of illness