Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Abstract
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Review Meta Analysis
A systematic review of interventions to facilitate extubation in patients difficult-to-wean due to delirium, agitation, or anxiety and a meta-analysis of the effect of dexmedetomidine.
Delirium, agitation, and anxiety may hinder weaning from mechanical ventilation and lead to increased morbidity and healthcare costs. The most appropriate clinical approach to weaning in these contexts remains unclear and challenging to clinicians. The objective of this systematic review was to identify effective and safe interventions to wean patients that are difficult-to-wean from mechanical ventilation due to delirium, agitation, or anxiety. ⋯ This systematic review and meta-analysis provides low quality evidence to suggest the use of dexmedetomidine in patients deemed difficult-to-wean due to agitation, delirium, or anxiety. Insufficient evidence was found regarding other interventions to provide any recommendation.
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Statistical approaches have been developed to detect bias in individual trials, but guidance on how to detect systematic differences at a meta-analytical level is lacking. In this paper, we elucidate whether author bias can be detected in a cohort of randomized trials included in a meta-analysis. ⋯ When combining trial-level data to produce a pooled effect estimate, investigators must consider sources of potential bias. Our results suggest that systematic errors can be detected using meta-regression, although further research is needed to examine the sensitivity of this model. Systematic reviewers will benefit from the availability of methods to guard against the dissemination of results with the potential to mislead decision-making.
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Observational Study
Effect of cultural background and healthcare environment on postoperative opioid requirement.
The objective of this prospective observational study was to investigate the interactions between cultural background, healthcare environment, and postoperative pain experience. ⋯ These results suggest that postoperative pain behaviours and opioid requirement may be influenced by cultural background and healthcare environment in two populations of Chinese descent.
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Abstract