Critical care : the official journal of the Critical Care Forum
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Review Meta Analysis
Prevention of ventilator-associated pneumonia by metal-coated endotracheal tubes: a meta-analysis.
This study aimed to evaluate whether endotracheal tubes (ETTs) with a metal coating reduce the incidence of ventilator-associated pneumonia (VAP) compared to uncoated ETTs. ⋯ https://www.crd.york.ac.uk/prospero/ , identifier CRD42024560618.
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Meta Analysis
Divergent effects of tumor necrosis factor (TNF) in sepsis: a meta-analysis of experimental studies.
Experimental studies in animals have yielded conflicting results on the role of Tumor Necrosis Factor (TNF) in sepsis and endotoxemia, with some reporting adaptive and others inappropriate effects. A meta-analysis of the available literature was performed to determine the factors explaining this discrepancy. ⋯ The role of TNF during infection varies depending on the experimental model used. Models that mimic clinical conditions, based on virulent bacteria that cause high mortality even at low inocula, demonstrated an adaptive role of TNF. Conversely, models based on LPS or low-pathogenic live bacteria, administered at doses well above physiological thresholds and combined with early antibiotic therapy, were associated with an inappropriate role.
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Maneuvers assessing fluid responsiveness before an intravascular volume expansion may limit useless fluid administration, which in turn may improve outcomes. ⋯ Fluid responsiveness can be reliably assessed in adult patients under mechanical ventilation. Among the five maneuvers compared in predicting fluid responsiveness, PPV, SVV, and PVI were superior to CVP and ∆IVC. However, there is no data supporting any of the above mentioned as being the best maneuver. Additionally, other well-established tests, such as the passive leg raising test, end-expiratory occlusion test, and tidal volume challenge, are also reliable.
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Meta Analysis
Role of age as eligibility criterion for ECMO in patients with ARDS: meta-regression analysis.
Age as an eligibility criterion for V-V ECMO is widely debated and varies among healthcare institutions. We examined how age relates to mortality in patients undergoing V-V ECMO for ARDS. ⋯ The relationship between age and ICU mortality is linear and shows no inflection point. Consequently, no age cut-off can be recommended for determining patient eligibility for V-V ECMO.
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Boumans et al. conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of lung ultrasound (LUS) in acute respiratory distress syndrome (ARDS). The study found that LUS has high specificity (0.942, 95% CI 0.856-0.978) but variable sensitivity (0.631, 95% CI 0.450-0.782) for identifying ARDS-related diffuse lung pathologies. ⋯ However, variability in operator experience and interpretation criteria, as well as challenges in detecting mild or early-stage ARDS, remain. The study highlights the need for further research to refine LUS protocols and training, enhancing its application in clinical practice and improving patient outcomes.