British journal of anaesthesia
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Review Meta Analysis
Tracheostomy outcomes in critically ill patients with COVID-19: a systematic review, meta-analysis, and meta-regression.
We performed a systematic review of mechanically ventilated patients with COVID-19, which analysed the effect of tracheostomy timing and technique (surgical vs percutaneous) on mortality. Secondary outcomes included intensive care unit (ICU) and hospital length of stay (LOS), decannulation from tracheostomy, duration of mechanical ventilation, and complications. ⋯ PROSPERO CRD42021272220.
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Editorial Comment
Trials with 'non-significant' results are not insignificant trials: a common significance threshold distorts reporting and interpretation of trial results.
We discuss a newly published study examining how phrases are used in clinical trials to describe results when the estimated P-value is close to (slightly above or slightly below) 0.05, which has been arbitrarily designated by convention as the boundary for 'statistical significance'. Terms such as 'marginally significant', 'trending towards significant', and 'nominally significant' are well represented in biomedical literature, but are not actually scientifically meaningful. ⋯ Instead, investigators could simply report their findings: effect sizes, P-values, and confidence intervals (or their Bayesian equivalents), and leave it to the discerning reader to infer the clinical applicability and importance. Our goal should be to move away from describing studies (or trials) as positive or negative based on an arbitrary P-value threshold, and rather to judge whether the scientific evidence provided is informative or uninformative.
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Opioid analgesia is the cornerstone of anaesthetic management during cardiac surgery. However, a subset of patients use opioids persistently after three months of surgery. We discuss a recent meta-analysis and systematic review by Liu and colleagues describing both patient and peri-procedural risk factors that contribute to this phenomenon in the context of chronic pain after cardiac surgery. Anaesthetists for cardiac surgery should consider opioid alternatives and individual patient risk factors to optimise recovery and pain control.
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Hypersensitivity to general anaesthetics predicts adverse postoperative outcomes in patients. Hypoxia exerts extensive pathophysiological effects on the brain; however, whether hypoxia influences sevoflurane sensitivity and its underlying mechanisms remain poorly understood. ⋯ Intermittent hypoxia exposure decreased mouse sensitivity to sevoflurane anaesthesia through enhanced O-GlcNAc-dependent modulation of the glutamate-glutamine cycle in the brain.
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Acid-base status in full-term pregnant women is characterised by hypocapnic alkalosis. Whether this respiratory alkalosis is primary or consequent to changes in CSF electrolytes is not clear. ⋯ NCT03496311.