Critical care medicine
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Critical care medicine · Dec 2010
Comment Letter Review Meta AnalysisHigh-dose renal replacement therapy for acute kidney injury: Systematic review and meta-analysis--addendum.
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Critical care medicine · Nov 2010
Review Meta AnalysisStress ulcer prophylaxis in the new millennium: a systematic review and meta-analysis.
Recent observational studies suggest that bleeding from stress ulceration is extremely uncommon in intensive care unit patients. Furthermore, the risk of bleeding may not be altered by the use of acid suppressive therapy. Early enteral tube feeding (initiated within 48 hrs of intensive care unit admission) may account for this observation. Stress ulcer prophylaxis may, however, increase the risk of hospital-acquired pneumonia and Clostridia difficile infection. ⋯ The results of this meta-analysis suggest that, in those patients receiving enteral nutrition, stress ulcer prophylaxis may not be required and, indeed, such therapy may increase the risk of pneumonia and death. However, because no clinical study has prospectively tested the influence of enteral nutrition on the risk of stress ulcer prophylaxis, our findings should be considered exploratory and interpreted with some caution.
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Critical care medicine · Nov 2010
Review Meta AnalysisProcalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: a systematic review and meta-analysis of randomized controlled trials.
There is increasing interest for strategies that could curtail antibiotic resistance in the critical care setting. We sought to determine the effectiveness and safety of procalcitonin-guided algorithms in the management of septic patients in the intensive care unit. ⋯ The implementation of a procalcitonin-based algorithm may reduce antibiotic exposure in critically ill, septic patients without compromising clinical outcomes, but further research is necessary before the wide adoption of this strategy.
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Critical care medicine · Aug 2010
Review Meta Analysis Comparative StudyA survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent only on the risk of death: a meta-analytic/meta-regression study.
To assess whether a potential benefit with combination antibiotic therapy is restricted to the most critically ill subset of patients, particularly those with septic shock. ⋯ Combination antibiotic therapy improves survival and clinical response of high-risk, life-threatening infections, particularly those associated with septic shock but may be detrimental to low-risk patients.
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Critical care medicine · May 2010
Review Meta AnalysisHigh-dose renal replacement therapy for acute kidney injury: Systematic review and meta-analysis.
To determine the effect of renal replacement therapy dose on mortality and dialysis dependence in patients with acute kidney injury. ⋯ High-dose renal replacement therapy in acute kidney injury does not improve patient survival or recovery of renal function overall or in important patient subgroups, including those with sepsis.