Critical care medicine
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Critical care medicine · Nov 1999
Meta Analysis Comparative StudyProtected specimen brush or bronchoalveolar lavage to diagnose bacterial nosocomial pneumonia in ventilated adults: a meta-analysis.
We conducted a meta-analysis by using summary receiver operating characteristic curves to compare the diagnostic value for bacterial nosocomial pneumonia of the following: a) quantitative culture (colony-forming units per milliliter or CFU/mL) of respiratory secretions collected with a bronchoscopic protected specimen brush (PSB); b) quantitative culture of a bronchoscopic bronchoalveolar lavage (BAL); and c) the percentage of infected cells (IC) in BAL. ⋯ Both PSB and BAL are reliable to diagnose bacterial nosocomial pneumonia. Because CFU-BAL and IC-BAL seemed more resistant to the effects of antibiotics, we recommend BAL rather than PSB if the patient is already receiving antibiotics.
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Critical care medicine · Aug 1999
Meta Analysis Comparative StudyPercutaneous or surgical tracheostomy: a meta-analysis.
To compare percutaneous with surgical tracheostomy using a meta-analysis of studies published from 1960 to 1996. ⋯ Percutaneous tracheostomy is associated with a higher prevalence of perioperative complications and, especially, perioperative deaths and cardiorespiratory arrests. Postoperative complication rates are higher with surgical tracheostomy.
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Critical care medicine · Jan 1999
Meta Analysis Comparative StudyCrystalloids vs. colloids in fluid resuscitation: a systematic review.
To systematically review the effects of isotonic crystalloids compared with colloids in fluid resuscitation. ⋯ Overall, there is no apparent difference in pulmonary edema, mortality, or length of stay between isotonic crystalloid and colloid resuscitation. Crystalloid resuscitation is associated with a lower mortality in trauma patients. Methodologic limitations preclude any evidence-based clinical recommendations. Larger well-designed randomized trials are needed to achieve sufficient power to detect potentially small differences in treatment effects if they truly exist.
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Critical care medicine · Aug 1998
Meta Analysis Comparative StudyTunneling short-term central venous catheters to prevent catheter-related infection: a meta-analysis of randomized, controlled trials.
To evaluate the efficacy of tunneling short-term central venous catheters to prevent catheter-related infections. ⋯ Tunneling decreases central venous catheter-related infections. However, current evidence does not support routine tunneling until its efficacy is evaluated at different placement sites and relative to other interventions.
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Critical care medicine · Oct 1997
Meta AnalysisEffect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis.
To critically appraise and summarize the trials examining the addition of noninvasive positive pressure ventilation to standard therapy on hospital mortality and need for endotracheal intubation in patients admitted with acute respiratory failure. ⋯ The addition of noninvasive positive pressure ventilation to standard therapy in patients with acute respiratory failure improves survival and decreases the need for endotracheal intubation. However, this effect is restricted to patients whose cause of acute respiratory failure is an exacerbation of COPD. Further research is warranted to determine whether noninvasive positive pressure ventilation confers benefit in patients without COPD who have acute respiratory failure.