Journal of critical care
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Journal of critical care · Dec 2015
Review Meta AnalysisIncreased return of spontaneous circulation at the expense of neurologic outcomes: Is prehospital epinephrine for out-of-hospital cardiac arrest really worth it?
Current guidelines for the management of out-of-hospital cardiac arrest (OHCA) recommend the use of prehospital epinephrine by initial responders. This recommendation was initially based on data from animal models of cardiac arrest and minimal human data, but since its inception, more human data regarding prehospital epinephrine in this setting are now available. Although out-of-hospital return of spontaneous circulation (ROSC) may be higher with the use of epinephrine, worse neurologic outcomes may be associated with its use. ⋯ Use of epinephrine before arrival to the hospital for OHCA does not increase survival to discharge but does make it more likely for those who are discharged to have poor neurologic outcome. There is a need for additional randomized controlled trials.
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Journal of critical care · Dec 2015
Review Meta AnalysisProtocolized sedation effect on post-ICU posttraumatic stress disorder prevalence: A systematic review and network meta-analysis.
Strategies aiming light sedation are associated with decreased length on mechanical ventilation. However, awake or easily arousable patients may be prone to greater prevalence of posttraumatic stress disorder (PTSD). These systematic review and meta-analysis aimed to evaluate the safety of light sedation strategies regarding the prevalence of PTSD. ⋯ Light sedation strategies seem to be safe in terms of PTSD prevalence. However, the small number of included trials and patients may not be sufficient to drive strong statements.
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Journal of critical care · Oct 2015
Review Meta AnalysisE7ffect of critical care pharmacist's intervention on medication errors: A systematic review and meta-analysis of observational studies.
Pharmacists are integral members of the multidisciplinary team for critically ill patients. Multiple nonrandomized controlled studies have evaluated the outcomes of pharmacist interventions in the intensive care unit (ICU). This systematic review focuses on controlled clinical trials evaluating the effect of pharmacist intervention on medication errors (MEs) in ICU settings. ⋯ Four studies were included in the meta-analysis. Results suggest that pharmacist intervention has no significant contribution to reducing general MEs, although pharmacist intervention may significantly reduce preventable adverse drug events and prescribing errors. This meta-analysis highlights the need for high-quality studies to examine the effect of the critical care pharmacist.
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Journal of critical care · Aug 2015
Review Meta AnalysisAssociations of fluid overload with mortality and kidney recovery in patients with acute kidney injury: A systematic review and meta-analysis.
Fluid resuscitation is commonly administered to maintain adequate renal perfusion in critically ill patients to prevent or even treat acute kidney injury (AKI). However, recent studies show that fluid overload is common and might be associated with poor outcomes in patients with AKI. Hence, the objective of this study was to assess the associations of fluid overload with mortality and kidney recovery in patients with AKI. ⋯ Fluid overload is associated with an increased risk of mortality in patients with AKI. The evidence of the relationship between fluid overload and kidney recovery is insufficient.
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Journal of critical care · Jun 2015
Review Meta AnalysisDoppler-based renal resistive index for prediction of renal dysfunction reversibility: A systematic review and meta-analysis.
Doppler-based renal resistive index (RI) might help in distinguishing transient from persistent acute kidney injury (AKI). The main objective of these systematic review and meta-analysis was to investigate the diagnostic performance of RI in predicting short-term reversibility of AKI. ⋯ These results suggest that an elevated RI may be a predictor of persistent AKI in critically ill patients. Further studies are warranted, however, to clarify the exact test performance given the marked heterogeneity among the included studies.