Articles: patients.
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Review Meta Analysis
[Current concepts of augmented spontaneous breathing : New modes of effort-adapted weaning.]
The use of augmented spontaneous breathing is an important component in a bundle concept of weaning from mechanical ventilation as it was demonstrated that controlled ventilation with diaphragmatic underuse induces rapid muscle atrophy and impairs successful weaning. On the other hand spontaneous breathing is often associated with disturbed patient-ventilator interaction resulting in asynchrony (e.g. ineffective triggering, early termination of inspiration and overflow or underflow). ⋯ It was shown in some smaller clinical investigations that these newer modes are able to improve patient-ventilator interaction, to reduce the burden on respiratory muscles and to increase ventilation comfort. Although large randomized controlled studies are lacking, effort-adapted modes of augmented breathing will become a routine part in the management of weaning from mechanical ventilation.
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Review Meta Analysis
No Benefit to Prehospital Initiation of Therapeutic Hypothermia in Out-of-hospital Cardiac Arrest: A Systematic Review and Meta-analysis.
Initiating therapeutic hypothermia for out-of-hospital cardiac arrest pre-hospital does not improve survival or neurological outcome.
pearl -
Int. J. Clin. Pract. · Apr 2014
Meta AnalysisAnti-TNF-α therapy for patients with sepsis: a systematic meta-analysis.
In humans, the role of anti-tumour necrosis factor (TNF)-α therapy in severe sepsis and septic shock is debatable. The aim of this meta-analysis was to determine the efficacy of anti-TNF-α therapies against placebo in patients with severe sepsis or septic shock. ⋯ This meta-analysis suggests that in patients with severe sepsis (before shock), immunotherapy with anti-TNF-α monoclonal antibodies reduces overall mortality. In patients with shock or high levels of IL-6 (> 1000 pg/ml), anti-TNF-α therapy may improve survival.
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Critical care medicine · Mar 2014
Review Meta AnalysisClinical Outcomes, Predictors, and Prevalence of Anterior Pituitary Disorders Following Traumatic Brain Injury: A Systematic Review.
To assess the clinical outcomes, predictors, and prevalence of anterior pituitary disorders following traumatic brain injury. ⋯ Approximately one third of traumatic brain injury patients have persistent anterior pituitary disorder. Older age, traumatic brain injury severity, and skull fractures predict anterior pituitary disorders, which in turn may be associated with higher ICU mortality. Further high-quality studies are warranted to better define the burden of anterior pituitary disorders and to identify high-risk patients.
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Critical care medicine · Mar 2014
Review Meta AnalysisAssessment of Limb Muscle Strength in Critically Ill Patients: A Systematic Review.
To determine the reliability of volitional and nonvolitional limb muscle strength assessment in critically ill patients and to provide guidelines for the implementation of limb muscle strength assessment this population. ⋯ Voluntary muscle strength measurement has proven reliable in critically ill patients provided that strict guidelines on adequacy and standardized test procedures and positions are followed.