Journal of critical care
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Journal of critical care · Apr 2020
Review Meta AnalysisPharmacological interventions to reduce edema following cardiopulmonary bypass: A systematic review and meta-analysis.
To compare the effectiveness of different types of pharmacological agents to reduce organ specific edema following cardiopulmonary bypass (CPB). ⋯ Overall, neutrophil inhibitors and direct modulators of endothelial barrier (PAR1, Tie2 signaling) most effectively reduced edema following CPB, in particular pulmonary edema. Future research should focus on a combination of these strategies to reduce edema and assess the effect on organ function and outcome following CPB.
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Journal of critical care · Apr 2020
Review Meta AnalysisPharmacological interventions to reduce edema following cardiopulmonary bypass: A systematic review and meta-analysis.
To compare the effectiveness of different types of pharmacological agents to reduce organ specific edema following cardiopulmonary bypass (CPB). ⋯ Overall, neutrophil inhibitors and direct modulators of endothelial barrier (PAR1, Tie2 signaling) most effectively reduced edema following CPB, in particular pulmonary edema. Future research should focus on a combination of these strategies to reduce edema and assess the effect on organ function and outcome following CPB.
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Journal of critical care · Apr 2020
Meta AnalysisKetamine sedation in mechanically ventilated patients: A systematic review and meta-analysis.
Ketamine use as a sedative agent in mechanically ventilated patients is increasing. This systematic review and meta-analysis collates existing literature and quantifies the impact of ketamine in mechanically ventilated patients. ⋯ The data regarding ketamine use in mechanically ventilated patients is limited in terms of quantity, methodological quality, and demonstrated clinical benefit. Ketamine may play a role as a sedative-sparing agent, but may be associated with harm. High-quality studies are needed before widespread adoption of ketamine earlier in the sedation pathway.
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Journal of critical care · Apr 2020
Review Case ReportsFrom a pressure-guided to a perfusion-centered resuscitation strategy in septic shock: Critical literature review and illustrative case.
To support a paradigm shift in the management of septic shock from pressure-guided to perfusion-centered, expected to improve outcome while reducing adverse effects from vasopressor therapy and aggressive fluid resuscitation. ⋯ We propose focusing the hemodynamic management of septic shock on reversing organ hypoperfusion instead of attaining a predefined MAP target as the key strategy for improving outcome.
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Journal of critical care · Apr 2020
ReviewManagement of civilians with penetrating brain injury: A systematic review.
There has been a dramatic increase in penetrating gunshot-inflicted civilian penetrating brain injuries (cvPBI). We undertook a systematic review with exclusive focus on the management of cvPBI. ⋯ Limited amount of published work is clinically meaningful; this systematic review identified key knowledge gaps.