Crit Care Resusc
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Review Meta Analysis
Thrombolysis is not warranted in submassive pulmonary embolism: a systematic review and meta-analysis.
Acute pulmonary embolism (PE) is a major cause of morbidity and mortality in hospitalised patients. While the vast majority of patients with PE survive, a subset die, mostly within a few hours of presentation. Anatomically massive pulmonary emboli account for only half these deaths, while submassive or recurrent embolism accounts for the other half. ⋯ There is also evidence to support the use of thrombolysis in patients with massive PE. However, the optimal management of patients with submassive PE is controversial. This article looks at the definition and diagnosis of submassive PE, and systematically reviews the role of thrombolytic therapy in this subgroup of patients.
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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.