Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jul 2019
Review Meta AnalysisGlucocorticosteroids for sepsis in children. A protocol for a systematic review.
Sepsis is the primary diagnosis in more than 8% of all critically ill children and sepsis is among the ten leading causes of death in children <10 years. Glucocorticosteroids are currently recommended in septic children with fluid or catecholamine resistant refractory shock. Glucocorticosteroids are widely used for severe sepsis in paediatric intensive care units worldwide. However, the evidence on the clinical effects of glucocorticosteroids for sepsis in children is unclear. ⋯ This review will seek to assess whether glucocorticosteroids indeed have their therapeutic place in the standard treatment for sepsis in children.
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Acta Anaesthesiol Scand · Jul 2019
Review Meta AnalysisMortality in critical illness: The impact of asymmetric dimethylarginine on survival-A systematic review and meta-analysis.
Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of the nitric oxide system, may be associated with an adverse outcome in critically ill patients. The aim of the present review was to clarify if plasma ADMA and the arginine-to-ADMA ratio (arginine/ADMA) are associated with mortality in critically ill patients. ⋯ A high plasma ADMA level upon admission is strongly associated with mortality in critically ill patients. However, there is no association between the arginine/ADMA ratio and mortality in this group of patients. The pathophysiological role of ADMA in circulatory collapse and its potential as a target for intervention remains to be explored.
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Acta Anaesthesiol Scand · Jul 2019
Review Meta AnalysisUse of hydroxyethyl starch in sepsis research: Protocol for a systematic review.
Hydroxyethyl starch (HES) 130/0.38-0.45 is a synthetic colloid, which has been on the market since 1999. In recent years, concern about the use of HES has been raised because of serious adverse events, including acute kidney injury, bleeding and even increased mortality with its use. In the outlined systematic review, we aim to assess if the adverse effects of HES 130/0.38-0.45 in patients with sepsis could have been discovered earlier. ⋯ With the outlined systematic review, we aim to assess whether the adverse effects of HES 130/0.38-0.45 could have been discovered earlier by comparing summary effect estimates of harm from observational studies in patients and randomised trials in animals and patients. The results may have implications for future drug development and approval processes.
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Acta Anaesthesiol Scand · Apr 2019
Review Meta AnalysisLactate versus acetate buffered crystalloid solutions: Protocol for a scoping review.
Intravenous (IV) fluid therapy has become a ubiquitous intervention in everyday clinical practice. Several types of fluid are available including isotonic crystalloid fluids. Among crystalloid fluids, buffered solutions (derivatives of the original Hartmann's and Ringer's solutions) are increasingly recommended as first-line resuscitation fluids. However, the choice between different buffered solutions appears to be difficult with limited data to support the use of lactate vs. acetate buffered solutions. Accordingly, we aim at systematically describing the body of evidence on the use of the different types of buffered crystalloid solutions in hospitalised patients. ⋯ This outlined scoping review will provide a summary of the current body of evidence on the use, effects and side-effects of buffered crystalloid solutions. This will provide an important update of the current evidence on the use, of "buffered" crystalloid solutions including evidence of potential benefits and harms.
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Acta Anaesthesiol Scand · Apr 2019
Review Meta AnalysisDexmedetomidine for the management of delirium in critically ill patients-A protocol for a systematic review.
Delirium is a common complication in critically ill patients and carries an increased risk of mortality and morbidity. Dexmedetomidine can potentially treat delirium by diminishing predisposing factors. The evidence regarding the use of dexmedetomidine in the management of delirium is conflicting. This protocol aims to identify the beneficial and harmful effects of dexmedetomidine in the management of delirium. ⋯ This systematic review can potentially aid clinicians in decision making and benefit the many critically ill patients developing delirium.