Journal of critical care
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Journal of critical care · Aug 2016
Review Meta AnalysisEffect of traditional Chinese medicine on intra-abdominal hypertension and abdominal compartment syndrome: A systematic review and Meta-analysis.
Traditional Chinese medicine (TCM) recently become a widely used treatment option for treating intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). However, we still lack large-scale, high-quality, randomized controlled trials (RCTs). The purpose of this systematic review was to evaluate the existing clinical trials and to provide additional specific evidence. ⋯ TCMs seem to be effective for patients with IAH and ACS; however, most of the reviewed trials are of poor quality. Large-scale, high-quality clinical trials are warranted.
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Journal of critical care · Aug 2016
Review Meta AnalysisDiastolic dysfunction as a predictor of weaning failure: A systematic review and meta-analysis.
Weaning failure and prolonged mechanical ventilation are associated with increased morbidity, cost of care, and high mortality rates. In the last few years, cardiac performance has been recognized as a common etiology of weaning failure, and growing evidence suggests that left ventricular diastolic dysfunction is a key factor that determines weaning outcomes. Therefore, we performed a systematic review and a meta-analysis to evaluate whether diastolic dysfunction in the critically ill patient subjected to mechanical ventilation is an independent predictor of weaning failure. ⋯ A higher E/e' ratio is significantly associated with weaning failure, although a high heterogeneity of diastolic dysfunction criteria and different clinical scenarios limit additional conclusions linking diastolic dysfunction with weaning failure.
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Journal of critical care · Aug 2016
Randomized Controlled TrialIs inhaled prophylactic heparin useful for prevention and Management of Pneumonia in ventilated ICU patients?: The IPHIVAP investigators of the Australian and New Zealand Intensive Care Society Clinical Trials Group.
To determine whether prophylactic inhaled heparin is effective for the prevention and treatment of pneumonia patients receiving mechanical ventilation (MV) in the intensive care unit. ⋯ A phase 2, double blind randomized controlled trial stratified for study center and patient type (non-operative, post-operative) was conducted in three university-affiliated intensive care units. Patients aged ≥18years and requiring invasive MV for more than 48hours were randomized to usual care, nebulization of unfractionated sodium heparin (5000 units in 2mL) or placebo nebulization with 0.9% sodium chloride (2mL) four times daily with the main outcome measures of the development of ventilator associated pneumonia (VAP), ventilator associated complication (VAC) and sequential organ failure assessment scores in patients with pneumonia on admission or who developed VAP.
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Journal of critical care · Aug 2016
Observational StudyCharacteristics and outcomes of patients treated with airway pressure release ventilation for acute respiratory distress syndrome: A retrospective observational study.
The optimal mode of ventilation in acute respiratory distress syndrome (ARDS) remains uncertain. Airway pressure release ventilation (APRV) is a recognized treatment for mechanically-ventilated patients with severe hypoxaemia. However, contemporary data on its role as a rescue modality in ARDS is lacking. The goal of this study was to describe the clinical and physiological effects of APRV in patients with established ARDS. ⋯ In patients with ARDS-related refractory hypoxaemia treated with APRV, an early and sustained improvement in oxygenation, low incidence of clinically significant barotrauma and progression to ECMO was observed. The safety and efficacy of APRV requires further consideration.
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Journal of critical care · Aug 2016
ReviewTime to loss of brain function and activity during circulatory arrest.
Brain function during the dying process and around the time of cardiac arrest is poorly understood. To better inform the clinical physiology of the dying process and organ donation practices, we performed a scoping review of the literature to assess time to loss of brain function and activity after circulatory arrest. ⋯ The time required to lose brain function varied according to clinical context and method by which this function is measured. Most studies show that clinical loss of consciousness and loss of EEG activity occur within 30seconds after abrupt circulatory arrest and may occur before circulatory arrest after progressive hypoxia-ischemia. Prospective clinical studies are required to confirm these observations.