Articles: patients
-
Among patients with sepsis or septic shock, a variety of extracorporeal blood purification techniques are availableIndividual existing trials evaluating these options are underpowered to provide clear evidence WHAT THIS ARTICLE TELLS US THAT IS NEW: Meta-analysis of very low-quality randomized controlled trial evidence demonstrates a potential benefit of hemoperfusion, hemofiltration, or plasmapheresisAdditional high-quality trials demonstrating benefit in modern clinical practice are needed before recommending these therapies BACKGROUND:: Sepsis and septic shock are severe inflammatory conditions related to high morbidity and mortality. We performed a systematic review with meta-analysis of randomized trials to assess whether extracorporeal blood purification reduces mortality in this setting. ⋯ Very low-quality randomized evidence demonstrates that the use of hemoperfusion, hemofiltration, or plasmapheresis may reduce mortality in sepsis or septic shock. Existing evidence of moderate quality and certainty does not provide any support for a difference in mortality using polymyxin B hemoperfusion. Further high-quality randomized trials are needed before systematic implementation of these therapies in clinical practice.
-
Among patients with sepsis or septic shock, a variety of extracorporeal blood purification techniques are availableIndividual existing trials evaluating these options are underpowered to provide clear evidence WHAT THIS ARTICLE TELLS US THAT IS NEW: Meta-analysis of very low-quality randomized controlled trial evidence demonstrates a potential benefit of hemoperfusion, hemofiltration, or plasmapheresisAdditional high-quality trials demonstrating benefit in modern clinical practice are needed before recommending these therapies BACKGROUND:: Sepsis and septic shock are severe inflammatory conditions related to high morbidity and mortality. We performed a systematic review with meta-analysis of randomized trials to assess whether extracorporeal blood purification reduces mortality in this setting. ⋯ Very low-quality randomized evidence demonstrates that the use of hemoperfusion, hemofiltration, or plasmapheresis may reduce mortality in sepsis or septic shock. Existing evidence of moderate quality and certainty does not provide any support for a difference in mortality using polymyxin B hemoperfusion. Further high-quality randomized trials are needed before systematic implementation of these therapies in clinical practice.
-
Propofol may help to protect against ischaemic acute kidney injury (AKI); however, research on this topic is sparse. ⋯ In this retrospective study, no significant difference was found in the incidence of postoperative AKI after lung resection surgery between patients who received propofol-based TIVA and those who received sevoflurane-based inhalational anaesthesia. Considering the methodological limitation of this retrospective study, further studies are required to confirm these results.
-
Regular or frequent use of analgesics and acute antimigraine drugs can increase the frequency of headache, and induce the transition from episodic to chronic headache or medication overuse headache. The 1-year prevalence of this condition in the general population is between 1% and 2%. Medication overuse headache is more common in women and in people with comorbid depression, anxiety, and other chronic pain conditions. ⋯ Second, some patients benefit from drug withdrawal (discontinuation of the overused medication). Finally, preventive drug therapy and non-medical prevention might be necessary in patients at onset of treatment or in patients who do not respond to the first two steps. The optimal therapeutic approach requires validation in controlled trials.
-
Propofol TIVA anesthesia does not reduce hepatic reperfusion injury after liver transplant when compared to desflurane anesthesia.
pearl