Journal of critical care
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Journal of critical care · Oct 2023
Multicenter StudyDisparities between randomized clinical trial participants and sepsis patients in real-world.
The external validity or "generalizability" of randomized controlled trials (RCTs) often needs be considered when making treatment decisions. We evaluate whether participants in large multicenter RCTs investigating sepsis were similar in age, disease severity, comorbidities, and mortality to the general population of sepsis patients. ⋯ On average, trial participants were younger than the general sepsis patient population. Commercial support influenced patient selection. Efforts to understand and address the above-described patient disparities are necessary to improve the generalizability of RCT results.
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Journal of critical care · Oct 2023
Multicenter Study Observational StudyEvaluation of whole blood thiamine pyrophosphate concentrations in critically ill patients receiving chronic diuretic therapy prior to admission to Turkish intensive care units: A pragmatic, multicenter, prospective study.
Thiamine plays a pivotal role in energy metabolism. The aim of the study was to determine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations. ⋯ Our results show that 18% of these critically ill patients exhibited low whole blood TPP concentrations on ICU admission and 26% had low levels during the initial 10 ICU days, respectively. The modest correlation between TPP and phosphorus concentrations suggests a possible association due to a refeeding effect in ICU patients requiring chronic diuretic therapy.
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Journal of critical care · Oct 2023
Review Meta AnalysisOptimal dosing of heparin for prophylactic anticoagulation in critically ill COVID-19 patients a systematic review and meta-analysis of randomized controlled trials.
The optimal amount of anticoagulation for critically ill COVID-19 patients is controversial. Therefore, we aimed to evaluate the efficacy and safety of escalated doses of anticoagulation in critically ill patients with severe COVID-19. ⋯ This systematic review and meta-analysis fail to support escalated anticoagulation doses to reduce mortality in critically ill COVID-19 patients. However, higher doses of anticoagulants appear to reduce thrombotic events while increasing the risk of bleeding effectively.
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Journal of critical care · Oct 2023
Review Meta AnalysisEffects of tracheostomy timing in adult patients receiving mechanical ventilation: A systematic review and network meta-analysis.
We performed a network meta-analysis (NMA) of multiple tracheostomy timings using data from randomized control trials (RCTs) to investigate the impact on patient prognosis. ⋯ Tracheostomy ≤4 days may result in lower short-term mortality than tracheostomy ≥13 days.
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Journal of critical care · Oct 2023
Review Meta AnalysisNebulized colistin as the adjunctive treatment for ventilator-associated pneumonia: A systematic review and meta-analysis.
Nebulized colistin (NC) is a potential therapy for ventilator-associated pneumonia (VAP); however, the clinical efficacy and safety of NC remain unclear. This study investigated whether NC is an effective therapy for patients with VAP. ⋯ NC was associated with better microbiological outcomes but did not result in any remarkable changes in the prognosis of patients with VAP.