Medicina intensiva
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The series of updates on methodology for research in critically ill patients has addressed the difficulties caused by the characteristics of patients of this kind, bioethics, the interpretation of results, and methodological error. New statistical methods for causality research, meta-analysis and big data analysis have also been described. ⋯ We close the series with the hope of having provided a global vision of the statistical methods oriented toward the future, with the aim of promoting statistical culture. In parallel, we have analyzed the evolution in complexity of the methodological analysis in the journal.
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Lower respiratory tract infections in the intubated patient constitute a serious health problem due to their associated morbidity and mortality. Microaspiration of the buccopharyngeal secretions is the main physiopathological mechanism underlying the development of pneumonia and tracheobronchitis in intubated patients. All care bundles designed to prevent these infections include the use of antiseptics to reduce buccopharyngeal colonization. ⋯ However, 2meta-analyses have warned of a possible increase in mortality when chlorhexidine is used as an oral antiseptic. We therefore recommend its use but with extreme caution during application in order to avoid aspiration of the antiseptic. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
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Randomized Controlled Trial
Efficacy of respiratory muscle training in weaning of mechanical ventilation in patients with mechanical ventilation for 48hours or more: A Randomized Controlled Clinical Trial.
To evaluate the efficacy of respiratory muscular training in the weaning of mechanical ventilation and respiratory muscle strength in patients on mechanical ventilation of 48hours or more. ⋯ respiratory muscle training did not demonstrate efficacy in the reduction of the weaning period of mechanical ventilation nor in the increase of respiratory muscle strength in the study population. Registered study at ClinicalTrials.gov (NCT02469064).