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Purpose: Owing to the recommendations of the Surviving Sepsis Campaign guidelines, protocol-based resuscitation or goal-directedtherapy (GDT) is broadly advocated for the treatment of septic shock. However, the most recently published trials showed no survival benefit from protocol-based resuscitation in septic shock patients. Hence, we aimed to assess the effect of GDT on clinical outcomes in such patients. Materials and Methods: We performed a systematic review that included a meta-analysis. We used electronic search engines includingPubMed, Embase, and the Cochrane database to find studies comparing protocol-based GDT to common or standard care in patients with septic shock and severe sepsis. Results: A total of 13269 septic shock patients in 24 studies were included [12 randomized controlled trials (RCTs) and 12 observationalstudies]. The overall mortality odds ratio (OR) [95% confidence interval (CI)] for GDT versus conventional care was 0.746 (0.631–0.883). In RCTs only, the mortality OR (95% CI) for GDT versus conventional care in the meta-analysis was 0.93 (0.75–1.16). The beneficial effect of GDT decreased as more recent studies were added in an alternative, cumulative meta-analysis. No significant publication bias was found. Conclusion: The result of this meta-analysis suggests that GDT reduces mortality in patients with severe sepsis or septic shock. However, our cumulative meta-analysis revealed that the reduction of mortality risk was diminished as more recent studies were added.
We report a 66-yr-old male patient who developed tricuspid regurgitation secondary to internal cardiac massage. After uneventful off-pump coronary artery bypass surgery, the subject experienced cardiac arrest in the intensive care unit. External cardiac massage was initiated and internal cardiac massage was performed eventually. A transesophageal echocardiography revealed avulsion of the anterior papillary muscle and chordae to the anterior leaflet after successful cardiopulmonary resuscitation. Emergency repair of the papillary muscle was performed under cardiopulmonary bypass.
컴퓨터의 급속한 보급과 인터넷을 기반으로 웹 서비스가 날로 향상되고 있으며, 웹을 활용한 사이버학습은 웹의 등장과 함께 인터넷의 가장 중요한 교수도구로 자리잡고 일다. 본 연구에서는 수리영역의 특성 학습과 웹에서 구축된 서버와 클라이언트 환경을 통하여 학습 부진아의 학업 성취도를 높이기 위하여 사이버 학습 시스템을 설계 및 구현하였으며, 학습자가 웹 데이터베이스 시스템 환경과 멀티미디어를 활용하여 추상적인 개념보다 직접 참여하는 학습이 되도록 하였다. It is rising to Web service from the rapid supply of the computer, from the basis of Internet, and virtual learning which is the best use of Web is very important teaching instrument. This study was design and embody of the cyber teaming system that teaching of the specific character in mathematical fed and improving to learn-depression-student through driven out sever & client in Web, and the student direct take part in teaming through the Web data base system environment and using multimedia than abstract conception.
Background: Nutrition delivery is frequently interrupted or delayed by physicians’ ordering patterns. We conducted this study to investigate the effect of physician compliance with tube feeding (TF) protocol on the nutritional and clinical outcomes in acute lung injury (ALI) patients. Methods: After implementing a TF protocol, 71 ALI patients with mechanical ventilation (MV) for ≥ 7 days were observed. A dietician assessed the nutritional status of the patients and established individualized nutrition plans according to the protocol. If the physicians followed the dietician’s recommendation within 48 hours, the patients were classified under the compliant group (Group 1). Results: Forty patients (56.3%) were classified into Group 1. Prealbumin was comparable in both groups at ICU admission but higher in Group 1 at the time of discharge from the ICU (228 ± 81 vs 157 ± 77 mg/dl, p =0.025). Nitrogen balance was only improved in Group 1. The time to reach calorie goal was shorter and non-feeding days were reduced in Group 1. The proportion of parenteral nutrition to nutritional support days was lower and delivered calories on the 4th and 7th day of TF were higher in Group 1 (p < 0.001). ICU mortality/stay and hospital mortality failed to show differences but hospital stay was prolonged in the noncompliant group (Group 2) (p =0.023). Arterial oxygen tension and PaO2/FiO2 were maintained during the 1st week of ICU stay in Group 1 but were decreased in Group 2. Conclusions: Physicians’ compliance with the TF protocol contributed to the likelihood of nutritional improvement and a shorter hospital stay in ALI patients with prolonged MV.