Critical care : the official journal of the Critical Care Forum
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Review Meta Analysis
Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials.
Randomized trials investigating neuromuscular blocking agents in adult acute respiratory distress syndrome (ARDS) have been inconclusive about effects on mortality, which is very high in this population. Uncertainty also exists about the associated risk of ICU-acquired weakness. ⋯ Short-term infusion of cisatracurium besylate reduces hospital mortality and barotrauma and does not appear to increase ICU-acquired weakness for critically ill adults with ARDS.
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Intravenous fluid therapy has evolved significantly over time. From the initial report of the first intravenous administration of sodium-chloride-based solution to the development of goal-directed fluid therapy using novel dynamic indices, efforts have focused on improving patient outcomes. ⋯ Concepts for goal-directed fluid therapy and new modalities for the assessment of fluid status as well as for the prediction of responsiveness to different interventions will continue to emerge. Advances in technology will have to be critically evaluated for their ability to improve outcomes in different clinical scenarios.
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Editorial Comment
The assessment and risk stratification of psychological morbidity in critical care survivors.
Along with the ageing population, there is an expanding number of critical care survivors in the community. This group is at risk for both physical and psychological morbidity following their stay. ⋯ A tool to identify and stratify survivors at discharge may improve outcomes by allowing early and targeted intervention. Looking forward, the identification of aspects of practice associated with long-term adverse consequences should allow us to evolve our current protocols in a way that provides long-term benefit for patients.