Publications by authors named "F Zampieri"
Hemodynamic effects of slower versus faster intravenous fluid bolus rates in critically ill patients: An observational study.
J Crit Care
December 2024
Purpose: We compared the immediate and sustained effects of 500 mL of crystalloid administered at slow (333 mL/h) versus fast rates (999 mL/h) on mean arterial pressure (MAP) in critically ill patients.
Materials And Methods: Hemodynamic variables were collected immediately before and every 30 min up to 60 min after the end of the infusion. The primary outcome was the adjusted difference in MAP.
Article Synopsis
- Intravenous vasopressors are commonly used for unstable patients in critical care, but the potential of oral vasopressors like midodrine is still being explored.
- A study was conducted at the University of Alberta Hospital to assess the feasibility of using midodrine in ICU patients who were reliant on IV vasopressors, involving random assignment to midodrine or placebo.
- Results showed that midodrine had a slightly shorter ICU stay and lower hospital mortality compared to the placebo, indicating a need for further research on oral vasopressors in critically ill patients.
Effect of a driving pressure-limiting strategy for patients with acute respiratory distress syndrome secondary to community-acquired pneumonia: the STAMINA randomised clinical trial.
Br J Anaesth
November 2024
Background: This study aimed to assess whether a driving pressure-limiting strategy based on positive end-expiratory pressure (PEEP) titration according to best respiratory system compliance and tidal volume adjustment increases the number of ventilator-free days within 28 days in patients with moderate to severe acute respiratory distress syndrome (ARDS).
Methods: This is a multi-centre, randomised trial, enrolling adults with moderate to severe ARDS secondary to community-acquired pneumonia. Patients were randomised to a driving pressure-limiting strategy or low PEEP strategy based on a PEEP:FiO table.
Article Synopsis
- Oliguria, a condition characterized by decreased urine output, may be misinterpreted as acute kidney injury (AKI) in patients post-surgery, despite being a potential adaptive response during surgery.
- A study analyzing 1,476 patients revealed that 34.4% exhibited oliguria within the first 24 hours after surgery, with certain factors like vasopressor use and non-elective procedures linked to increased risk.
- Although oliguria was associated with a higher rate of AKI development compared to non-oliguric patients, 87.6% of oliguric patients did not show kidney dysfunction based on serum creatinine levels, questioning the accuracy of oliguria as an indicator for AKI.
Clinical trials in acute care settings, particularly those involving small populations or high mortality contexts, present unique challenges in design and analysis. In this review we explore novel statistical approaches and methodological considerations for such trials, with a focus on cardiovascular therapies. We discuss the concept of "small" sample sizes and their limitations and cover various analytical frameworks, including frequentist and Bayesian approaches, and emphasize their implications for result interpretation and reproducibility.
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