Critical care medicine
-
Critical care medicine · Oct 2008
Review Meta AnalysisIntensive care unit mortality trends in children after hematopoietic stem cell transplantation: a meta-regression analysis.
There is ongoing discussion whether intensive care unit mortality has decreased over time for children after hematopoietic stem cell transplantation. ⋯ There is a widely held impression that intensive care unit mortality clearly decreased in children after hematopoietic stem cell transplantation. However, characteristics of intensive care unit admitted patients significantly changed over time. After correcting for this, an improvement in intensive care unit survival was less evident. More studies are needed before a true improvement in intensive care unit survival can be confirmed.
-
Critical care medicine · Oct 2008
Review Meta AnalysisThe effect of a quantitative resuscitation strategy on mortality in patients with sepsis: a meta-analysis.
Quantitative resuscitation consists of structured cardiovascular intervention targeting predefined hemodynamic end points. We sought to measure the treatment effect of quantitative resuscitation on mortality from sepsis. ⋯ This meta-analysis found that applying an early quantitative resuscitation strategy to patients with sepsis imparts a significant reduction in mortality.
-
Critical care medicine · Sep 2008
Review Meta AnalysisEfficacy of red blood cell transfusion in the critically ill: a systematic review of the literature.
Red blood cell (RBC) transfusions are common in intensive care unit, trauma, and surgical patients. However, the hematocrit that should be maintained in any particular patient because the risks of further transfusion of RBC outweigh the benefits remains unclear. ⋯ Despite the inherent limitations in the analysis of cohort studies, our analysis suggests that in adult, intensive care unit, trauma, and surgical patients, RBC transfusions are associated with increased morbidity and mortality and therefore, current transfusion practices may require reevaluation. The risks and benefits of RBC transfusion should be assessed in every patient before transfusion.
-
Critical care medicine · May 2008
Meta AnalysisImpact of impedance threshold devices on cardiopulmonary resuscitation: a systematic review and meta-analysis of randomized controlled studies.
Vital organ hypoperfusion significantly contributes to the dismal survival rates observed with manual cardiopulmonary resuscitation after cardiac arrest. The impedance threshold device is a valve which reduces air entry into lungs during chest recoil between chest compressions, producing a potentially beneficial decrease in intrathoracic pressure and thus increasing venous return to the heart. This review provides an update on the impedance threshold device and underlines its effect on short-term survival. ⋯ This meta-analysis of randomized controlled studies suggests that the impedance threshold device improves early outcome in patients with out-of-hospital cardiac arrest undergoing cardiopulmonary resuscitation.
-
Critical care medicine · Apr 2008
Review Meta AnalysisEffect of dopexamine infusion on mortality following major surgery: individual patient data meta-regression analysis of published clinical trials.
To establish whether perioperative low-dose dopexamine infusion (< or = 1 microg/kg/min) is associated with a reduction in mortality and duration of hospital stay following major surgery. ⋯ For pooled data describing perioperative dopexamine infusion at all doses, there was an improvement in duration of hospital stay but no survival benefit. However, at low doses, dopexamine was associated with improved survival and reduced duration of stay. Further clinical trials are warranted to confirm this observation.