Multicenter, randomized, double-blind low-dose vasopressinNorepinephrine 396 patients 382 patients...

July 3, 2008

December 18, 2008

(relative risk of survival, 0.87; 95% confidence interval, 0.65 to 1.15; P =

0.36)

June 5, 2008

October 1, 2009

July 10,, 2008

January 1,, 2009

Chest 2010;137;544-551

seven RCT studies that included 11,425 patients.

JAMA, March 3, 2010—Vol 303, No. 9

JAMA. 2010;303(8):739-746

JAMA. 2009;302(18):1977-1984

The COIITSS Study InvestigatorsJAMA. 2010;303(4):341-348

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Avoid

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Total cohort number 66,184

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155/255 survival 61%

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Overall, 22% (n 71,486) of patients developed acute kidney injury

(Stage I: 17.5%; Stage II: 2.4%; Stage III: 2%)

Odds of death associated with AKI in ICU

Crit Care Med 2010 Vol. 38, No. 2

The need for early serial IAP monitoring when IAH/ACS risk factors are present

Improving abdominal wall compliance through sedation, analgesia, and pharmacologic paralysis

Evacuating intraluminal contents through nasogastric or rectal decompression

Evacuating abdominal fluid collections via percutaneous drainage

Correcting positive fluid balance through the use of hypertonic fluids, colloids, and careful diuresis

Supporting organ function vasopressors and judicious goal-directed fluid resuscitation to maintain an abdominal perfusion pressure (calculated as mean arterial pressure IAP) 60 mm Hg

Early surgical intervention when IAP exceeds 25 mm Hg

Crit Care Med 2009 Vol. 37, No. 2

Score Variables Points

Predisposition COPD or Immunosuppression

1

Age > 70 ys 1

Insult Bacteremia 1

Multilobar opacities on radiograph

1

Response Shock 1

Severe hypoxemia 1

Organ dysfunction Acute renal failure 1

Respiratory distress syndrome

1

Critical Care Medicine: February 2009 - Volume 37 - Issue 2 - pp 456-462

Range 0-8 points

Critical Care Medicine: February 2009 - Volume 37 - Issue 2 - pp 456-462

HOMEHOSPITAL

ICU?CARE

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24%

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Total parenteral nutrition X1 Surgery X1 Multifocal Candida colonization X1 Severe sepsis X 2.