Articles: intensive-care-units.
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Critical care medicine · Nov 2010
Review Meta AnalysisProcalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: a systematic review and meta-analysis of randomized controlled trials.
There is increasing interest for strategies that could curtail antibiotic resistance in the critical care setting. We sought to determine the effectiveness and safety of procalcitonin-guided algorithms in the management of septic patients in the intensive care unit. ⋯ The implementation of a procalcitonin-based algorithm may reduce antibiotic exposure in critically ill, septic patients without compromising clinical outcomes, but further research is necessary before the wide adoption of this strategy.
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Review Meta Analysis
Association between time of admission to the ICU and mortality: a systematic review and metaanalysis.
The organizational and staffing structure of an ICU influences the outcome of critically ill and injured patients. A change in the ICU staffing structure frequently occurs at nighttime and on weekends (off-hours). We postulated that patients who are admitted to an ICU during off hours may be at an increased risk of death. ⋯ Whereas patients admitted to an ICU over the weekend appear to be at an increased risk of death, nighttime admissions were not associated with an increased mortality. The lower level of staffing and intensity of care provided by many hospitals over the weekend may account for this finding. The heterogeneity noted between studies evaluating nighttime admissions likely reflects the diverse organizational structure of the hospitals and ICUs where these studies were carried out.
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To systematically examine whether abandoning daily routine chest radiography would adversely affect outcomes, such as mortality and length of stay (LOS), and identify a subgroup in which daily routine chest radiography might be beneficial. ⋯ Systematic but unselective daily routine chest radiography can likely be eliminated without increasing adverse outcomes in adult patients in ICUs. Further studies are necessary to identify the specific patient population that would benefit from daily routine chest radiographs.
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Review Meta Analysis
Toward understanding tight glycemic control in the ICU: a systematic review and metaanalysis.
Following publication of the Leuven Intensive Insulin Therapy Trial in 2001, tight glycemic control became the standard of care in ICUs around the world. Recent studies suggest that this approach may be flawed. The goal of this systematic review was to determine the benefits and risks of tight glycemic control in ICU patients and to explain the differences in outcomes among reported trials. ⋯ There is no evidence to support the use of intensive insulin therapy in general medical-surgical ICU patients who are fed according to current guidelines. Tight glycemic control is associated with a high incidence of hypoglycemia and an increased risk of death in patients not receiving parenteral nutrition.
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Intensive care medicine · Dec 2009
Meta AnalysisEarly enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials.
To determine whether the provision of early standard enteral nutrition (EN) confers treatment benefits to critically ill patients. ⋯ Although the detection of a statistically significant reduction in mortality is promising, overall trial quality was low, trial size was small, and the findings may be restricted to the patient groups enrolled into included trials. The results of this meta-analysis should be confirmed by the conduct of a large multi-centre trial enrolling diverse critically ill patient groups.