Crit Care Resusc
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Review Meta Analysis Comparative Study
Loop diuretics in the management of acute renal failure: a systematic review and meta-analysis.
Loop diuretics are commonly used in critically ill patients with acute renal failure (ARF), but their effect on clinical outcome remains uncertain. We systematically reviewed the literature comparing loop diuretics with control in the management of ARF. ⋯ Loop diuretics were not associated with improved mortality or rate of independence from RRT, but were associated with shorter duration of RRT and increased urine output. However, these findings have limited relevance to critically ill patients. The relative paucity of high-quality data assessing the value of loop diuretics in ARF for the critically ill suggests a need for a suitably powered randomised trial.
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Extracorporeal membrane oxygenation (ECMO) is a controversial means of life support, particularly in adults. Ongoing refinements in circuit technology and widening global experience have led to ECMO being applied to a broader group of conditions than acute respiratory failure and cardiogenic shock. Septicaemia is no longer viewed as a contraindication to ECMO. ⋯ The last indication is generally more applicable in children than adults, because of differences in the cardiovascular response to severe sepsis seen across age groups. ECMO has a role as rescue therapy in patients with severe sepsis who would otherwise die of either hypoxaemia or inadequate cardiac output. This review describes the basic technique and application of ECMO in neonates, older children, and adults with sepsis.