tailieunhanh - Báo cáo y học: " Persistent organ dysfunction plus death: a novel, composite outcome measure for critical care trials"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Persistent organ dysfunction plus death: a novel, composite outcome measure for critical care trials. | Heyland et al. Critical Care 2011 15 R98 http content 15 2 R98 KS CRITICAL CARE RESEARCH Open Access Persistent organ dysfunction plus death a novel composite outcome measure for critical care trials 13 13 2 3 3 Daren K Heyland 1 John Muscedere 1 John Drover Xuran Jiang Andrew G Day the Canadian Critical Care Trials Group Abstract Introduction Due to resource limitations few critical care interventions have been rigorously evaluated with adequately powered randomized clinical trials RCTs . There is a need to improve the efficiency of RCTs in critical care so that more definitive high quality RCTs can be completed with the available resources. The objective of this study was to validate and demonstrate the utility of a novel composite outcome measure persistent organ dysfunction POD plus death for clinical trials of critically ill patients. Methods We performed a secondary analysis of a dataset from a prospective randomized trial involving 38 intensive care units ICUs in Canada Europe and the United States. We define POD as the persistence of organ dysfunction requiring supportive technologies during the convalescent phase of critical illness and it is present when a patient has an ongoing requirement for vasopressors dialysis or mechanical ventilation at the outcome assessments time points. In 600 patients enrolled in a randomized trial of nutrition therapy and followed prospectively for six months we evaluated the prevalence of POD and its association with outcome. Results At 28 days of patients had circulatory failure had renal failure had respiratory failure and had died for an overall prevalence of POD death . Of survivors at Day 28 those with POD compared to those without POD had a higher mortality rate in the six-month follow-up period had longer ICU and hospital stays and a reduced quality of life at three months. Given these rates of POD death and using a two-sided Chi-squared test at alpha we would require 616 .