Indirect calorimetry versus usual care: a retrospective cohort study.

NTRODUCTION: : This is a study evaluating the effect of Indirect calorimetry on the length of stay. The study comprises of the comparison between the use of indirect calorimetry versus usual care in critically ill mechanically ventilated patients with respect to the length of stay in the intensive care unit, and duration of time on ventilator. Patients were divided on basis of their nutrition risk to study the effect of Indirect calorimetry on the length of stay. MATERIAL AND METHODS: This was a retrospective cohort study of 166 mechanical ventilated patients in S .L Raheja Hospital. Data was collected from 83 patients who were mechanically ventilated between January 2019 and November 2019 on whom indirect calorimetry was used to measure energy requirements. This cohort was compared to 83 patients between January 2018 and November 2918 where the energy requirements were calculated with the use of predictive equations. Both groups were matched for age, sex, comorbidities, APACHE score and use of vasopressors. RESULTS: Significant difference in the sicker group of patients was seen in the Length of stay in the intensive care unit. (9.23 ± 8.14 vs. 11.52 ± 5.65, p = 0.0034) Patients at risk for malnutrition demonstrated reduced length of time on ventilation as compared to those not at risk. (10.2 ± 11.01 vs. 13 ± 5.87; p = 0.0042). CONCLUSIONS: The use of indirect calorimetry may be associated with a lower length of ICU stay among ventilated patients in a reasonably sick group of mixed surgical patients

L'Institut de France et les anciennes Académies, par Léon Aucoc.

Bonnassieux Pierre. L'Institut de France et les anciennes Académies, par Léon Aucoc.. In: Bibliothèque de l'école des chartes. 1889, tome 50. pp. 464-465

Effect of 12 mg vs 6 mg of Dexamethasone on the Number of Days Alive Without Life Support in Adults With COVID-19 and Severe Hypoxemia: The COVID STEROID 2 Randomized Trial.

Importance A daily dose with 6 mg of dexamethasone is recommended for up to 10 days in patients with severe and critical COVID-19, but a higher dose may benefit those with more severe disease. Objective To assess the effects of 12 mg/d vs 6 mg/d of dexamethasone in patients with COVID-19 and severe hypoxemia. Design, Setting, and Participants A multicenter, randomized clinical trial was conducted between August 2020 and May 2021 at 26 hospitals in Europe and India and included 1000 adults with confirmed COVID-19 requiring at least 10 L/min of oxygen or mechanical ventilation. End of 90-day follow-up was on August 19, 2021. Interventions Patients were randomized 1:1 to 12 mg/d of intravenous dexamethasone (n = 503) or 6 mg/d of intravenous dexamethasone (n = 497) for up to 10 days. Main Outcomes and Measures The primary outcome was the number of days alive without life support (invasive mechanical ventilation, circulatory support, or kidney replacement therapy) at 28 days and was adjusted for stratification variables. Of the 8 prespecified secondary outcomes, 5 are included in this analysis (the number of days alive without life support at 90 days, the number of days alive out of the hospital at 90 days, mortality at 28 days and at 90 days, and ≥1 serious adverse reactions at 28 days). Results Of the 1000 randomized patients, 982 were included (median age, 65 [IQR, 55-73] years; 305 [31%] women) and primary outcome data were available for 971 (491 in the 12 mg of dexamethasone group and 480 in the 6 mg of dexamethasone group). The median number of days alive without life support was 22.0 days (IQR, 6.0-28.0 days) in the 12 mg of dexamethasone group and 20.5 days (IQR, 4.0-28.0 days) in the 6 mg of dexamethasone group (adjusted mean difference, 1.3 days [95% CI, 0-2.6 days]; P = .07). Mortality at 28 days was 27.1% in the 12 mg of dexamethasone group vs 32.3% in the 6 mg of dexamethasone group (adjusted relative risk, 0.86 [99% CI, 0.68-1.08]). Mortality at 90 days was 32.0% in the 12 mg of dexamethasone group vs 37.7% in the 6 mg of dexamethasone group (adjusted relative risk, 0.87 [99% CI, 0.70-1.07]). Serious adverse reactions, including septic shock and invasive fungal infections, occurred in 11.3% in the 12 mg of dexamethasone group vs 13.4% in the 6 mg of dexamethasone group (adjusted relative risk, 0.83 [99% CI, 0.54-1.29]). Conclusions and Relevance Among patients with COVID-19 and severe hypoxemia, 12 mg/d of dexamethasone compared with 6 mg/d of dexamethasone did not result in statistically significantly more days alive without life support at 28 days. However, the trial may have been underpowered to identify a significant difference. Trial Registration ClinicalTrials.gov Identifier: NCT04509973 and ctri.nic.in Identifier: CTRI/2020/10/028731