Critical care medicine
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Critical care medicine · Feb 2006
Review Meta AnalysisOxime therapy and outcomes in human organophosphate poisoning: an evaluation using meta-analytic techniques.
The status of oximes in human organophosphate poisoning is controversial. This analysis compares the outcomes of therapy with or without oximes. ⋯ Based on the current available data on human organophosphate poisoning, oxime was associated with either a null effect or possible harm. The lack of current prospective randomized controlled trials, with appropriate patient stratification, mandates ongoing assessment of the role of oximes in organophosphate poisoning.
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Critical care medicine · Sep 2005
Meta AnalysisFluconazole prophylaxis in critically ill surgical patients: a meta-analysis.
To evaluate the impact of fluconazole prophylaxis on the incidence of fungal infections and on mortality among critically ill surgical patients. ⋯ Prophylactic fluconazole administration for prevention of mycoses in SICU patients appears to successfully decrease the rate of these infections, but this strategy does not improve survival. The absence of a survival advantage may reflect the few studies in this area and the possibility that this issue has not been adequately studied. Because of the potential for both resistance and emergence of non-albicans isolates, clinicians must consider these issues when evaluating fluconazole prophylaxis in the SICU. Future trials should focus on more precisely identifying patients at high risk for fungal infections and on determining if broader use of fluconazole alters the distribution of candidal species seen in the SICU and impacts measures of resource utilization such as length of stay and duration of mechanical ventilation.
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Critical care medicine · Feb 2005
Review Meta AnalysisHypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis.
Only a few patients survive cardiac arrest with favorable neurologic recovery. Our objective was to assess whether induced hypothermia improves neurologic recovery in survivors of primary cardiac arrest. ⋯ Mild therapeutic hypothermia improves short-term neurologic recovery and survival in patients resuscitated from cardiac arrest of presumed cardiac origin. Its long-term effectiveness and feasibility at an organizational level need further research.
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Critical care medicine · Jan 2005
Meta Analysis Comparative StudyA metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients.
Nutritional support as enteral or parenteral nutrition (PN) is used in hospitalized patients to reduce catabolism. This study compares outcomes of early enteral nutrition (EN) with early PN in hospitalized patients. ⋯ There was no mortality effect with the type of nutritional supplementation. Although early EN significantly reduced complication rates, this needs to be interpreted in the light of missing data and heterogeneity. The enthusiasm that early EN, as compared with early PN, would reduce mortality appears misplaced.
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Critical care medicine · Jan 2005
Meta Analysis Comparative StudyInvasive approaches to the diagnosis of ventilator-associated pneumonia: a meta-analysis.
Ventilator-associated pneumonia remains a major challenge in the intensive care unit. The role for invasive diagnostic methods (e.g., bronchoscopy) remains unclear. We hypothesized that invasive testing would alter antibiotic management in patients with ventilator-associated pneumonia but would not necessarily alter mortality. ⋯ Few trials have systematically examined the impact of diagnostic techniques on outcomes for patients suspected of suffering from ventilator-associated pneumonia. Invasive strategies do not alter mortality. Invasive approaches to ventilator-associated pneumonia affect antibiotic use and prescribing.