Critical care : the official journal of the Critical Care Forum
-
In ventilated critical care patients, both T-piece and pressure support ventilation are comparable as spontaneous breathing trial techniques in their ability to predict successful extubation.
pearl -
Survival after out-of-hospital cardiac arrest has improved globally over the last four decades.
pearl -
Meta Analysis
Validation of neuromuscular blocking agent use in acute respiratory distress syndrome: a meta-analysis of randomized trials.
We aimed to synthesize up-to-date trials to validate the effects of neuromuscular blocking agent (NMBA) use in patients with moderate-to-severe acute respiratory distress syndrome (ARDS). ⋯ The use of NMBAs could significantly decrease mortality in moderate-to-severe ARDS patients and decrease the incidence of barotrauma during mechanical ventilation. However, more large-scale randomized trials are needed to further validate the effect of NMBA use in ARDS.
-
Renal replacement therapy (RRT) is associated with high mortality and costs; however, no clinical guidelines currently provide specific recommendations for clinicians on when and how to stop RRT in recovering patients. Our objective was to systematically review the current evidence for clinical and biochemical parameters that can be used to predict successful discontinuation of RRT. ⋯ Numerous variables have been described to predict successful discontinuation of RRT; however, available studies are limited by study design, variable heterogeneity, and lack of prospective validation. Urine output prior to discontinuation of RRT was the most commonly described and robust predictor. Further research should focus on the determination and validation of urine output thresholds, and the evaluation of additional clinical and biochemical parameters in multivariate models to enhance predictive accuracy.