Critical care : the official journal of the Critical Care Forum
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Review Meta Analysis
Invasive ventilation modes in children: a systematic review and meta-analysis.
The purpose of the present study was to critically review the existing body of evidence on ventilation modes for infants and children up to the age of 18 years. ⋯ The literature provides scarce data for the best ventilation mode in critically ill children beyond the newborn period. There is no evidence, however, that high-frequency ventilation reduced mortality and LOV. Longer-term outcome measures such as pulmonary function, neurocognitive development, and cost-effectiveness should be considered in future studies.
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Review Meta Analysis
Haemodynamic goal-directed therapy and postoperative infections: earlier is better. A systematic review and meta-analysis.
Infectious complications are the main causes of postoperative morbidity. The early timing of their promoting factors is the rationale for perioperative strategies attempting to reduce them. Our aim was to determine the effects of perioperative haemodynamic goal-directed therapy on postoperative infection rates. ⋯ Flow-directed haemodynamic therapy designed to optimise oxygen delivery protects surgical patients against postoperative hospital-acquired infections and must be strongly encouraged, particularly in the high-risk surgical population.
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Partial ventilatory support modalities are ill defined and different perceptions about these modes might depend on geographic region. Exemplary on two recent publications investigating airway pressure release ventilation (APRV) in an adult ICU population, the question is investigated whether research in ventilation modes can be performed with the current definitions. The lack of precise definitions precludes drawing meaningful conclusions from these studies, as it remains unclear how these patients were actually ventilated and whether or how much spontaneous breathing was factitiously preserved. An argument is made to develop a new taxonomy of ventilation modes.
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Randomized Controlled Trial Comparative Study
Comparison of intravenous immunoglobulin and plasma exchange in treatment of mechanically ventilated children with Guillain Barré syndrome: a randomized study.
Respiratory failure is a life threatening complication of Guillain Barré syndrome (GBS). There is no consensus on the specific treatment for this subset of children with GBS. ⋯ In children with GBS requiring MV, PE is superior to IVIG regarding the duration of MV but not PICU stay or the short term neurological outcome.The negative correlation between CSF protein values and duration of MV in PE group requires further evaluation of its clinical usefulness.
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Review Meta Analysis
Cardiovascular and renal effects of carperitide and nesiritide in cardiovascular surgery patients: a systematic review and meta-analysis.
Acute kidney injury (AKI) following cardiovascular surgery is a common disease process and is associated with both morbidity and mortality. The aim of our study was to evaluate the cardiovascular and renal effects of an atrial natriuretic peptide (ANP, carperitide) and a B-type (or brain) natriuretic peptide (BNP, nesiritide) for preventing and treating AKI in cardiovascular surgery patients. ⋯ The infusion of ANP or BNP may preserve postoperative renal function in cardiovascular surgery patients. A large, multicenter, prospective, randomized controlled trial will have to be performed to assess the therapeutic potential of ANP or BNP in preventing and treating AKI in the cardiovascular surgical setting.