Core PICU publications

FEAST-trial

Exploring mechanisms of excess mortality with early fluid resuscitation: insights from the FEAST trial

Mailtand et al. BMC Medicine 2013, 11:68

 

Conclusion:

Excess mortality from boluses occurred in all subgroups of children. Contrary to expectation, cardiovascular collapse rather than fluid overload appeared to contribute most to excess deaths with rapid fluid resuscitation. These results should prompt a re-evaluation of evidence on fluid resuscitation for shock and a re-appraisal of the rate, composition and volume of resuscitation fluids.

 

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SAFE-study

A comparison of Albumin and Saline for fluid resuscitation in the intensive care unit

N Engl J M 2004;350:2247-56 

 

Conclusion:
In patients in the ICU, use of either 4 percent albumin or normal saline for fluid resuscitation results in similar outcomes at 28 days.
 
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PRIMACORP-study

Prophylactic intravenous use of Milrinone after cardiac operation in pediatrics (primacorp) study

Hoffman et al, Am Heart J 2002;143:15-21

 

Conclusion:

The PRIMACORP study will address several questions regarding the safety and efficacy of prophylactic milrinone use in pediatric patients at high risk for development of LCOS after cardiac surgery.
 

 

Centralised PICU

Should paediatric intensive care be centralised? Trent versus Victoria

 

Pearson et al, Lancet 1997;349:1213-1217

 

Conclusion:

The findings suggest that substantial reductions in mortality could be achieved if every UK child who needed endotracheal intubation for more than 12-24 h were admitted to one of 12 large specialist paediatric ICUs.
 

Surviving Sepsis Campaign

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock

Dellinger et al. Intensive Care Medicine,  39:165–228

 

Conclusion:

Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients.
 

CRASH-2 trial

A Randomised Controlled Trial & economic evaluation of the effects of tranexamic acid in trauma patients

Roberts et al, Health Technol Assess. 2013 Mar;17(10):1-79

 

Conclusion:

Tranexamic acid safely reduces the risk of bleeding trauma patients in this study. TXA appears most effective when given early after trauma and should be given only within approximately 3 hours. Treatment beyond 3 hours of injury is unlikely to be effective.
 

 

Parental Nutrition

Early versus Late Parental Nutrition in Critically Ill Children

 

Fivez et al, N Engl J Med. 2016 Mar 24;374(12):1111-22

 

Conclusion:

In critically ill children, withholding parental nutrition for 1 week in the ICU was clinically superior to providing early parental nutrition.