Heart & lung : the journal of critical care
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Review Meta Analysis
De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: A meta-analysis.
To evaluate the impact of de-escalation therapy on clinical outcomes in patients with severe sepsis and/or septic shock. ⋯ Antibiotic de-escalation therapy has no detrimental impact on mortality in patients with severe sepsis and/or septic shock, as compared to the continuation of broad-spectrum antibiotics. Since de-escalation affords an opportunity to limit overuse of broad-spectrum antibiotics, it should be considered as an option in clinical practice.
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Review Meta Analysis
The effect of reintubation on ventilator-associated pneumonia and mortality among mechanically ventilated patients with intubation: A systematic review and meta-analysis.
This meta-analysis summarized the risks that reintubation impose on ventilator-associated pneumonia (VAP) and mortality. ⋯ Reintubation can represent a threat to survival and increase the risk of VAP. The risk of mortality after reintubation differs between planned and unplanned extubation. Extubation failure is associated with a higher risk of VAP in the cardiac surgery population than in the general population.
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Review Meta Analysis Comparative Study
Efficacy of noninvasive ventilation after planned extubation: A systematic review and meta-analysis of randomized controlled trials.
The objective our meta-analysis is to update the evidence on the efficacy of noninvasive ventilation (NIV) compared with conventional oxygen therapy after planned extubation. We did a systematic literature review of database, including Pubmed, EMBASE, and Cochrane. We included randomized controlled trials comparing NIV with conventional oxygen therapy after planned extubation in medical intensive care unit (ICU) in our analysis. ⋯ However, in a mixed medical ICU population, there was no statistical difference of reintubation rate between the two groups (RR, 0.66; 95% CI, 0.25-1.73; I2 = 68%). Our study suggests that use of NIV after planned extubation significantly decreases the reintubation rate in COPD patients and patients at high risk for extubation failure, confirming the findings of previous reviews. There is no difference in the reintubation rate between the two groups in the mixed medical ICU population.
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Review Meta Analysis
The prognostic significance of troponin elevation in patients with sepsis: a meta-analysis.
To confirm the association between troponin elevation in patients with sepsis and mortality. ⋯ Troponin elevation in patients with sepsis confers poorer prognosis and is a predictor of mortality. Further studies are needed to see if more aggressive treatment of this subset of patients, or utilizing new therapeutic approaches will improve mortality.
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Meta Analysis
The efficacy of noninvasive ventilation in managing postextubation respiratory failure: a meta-analysis.
To determine the effectiveness of noninvasive ventilation (NIV) in the management of postextubation respiratory failure. ⋯ Current evidence suggests that the use of NIV in patients with established postextubation respiratory failure should be monitored cautiously. Early use of NIV can benefit patients with planned extubation by decreasing the reintubation rate and the ICU and hospital mortality rates.