Articles: intensive-care-units.
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Critical care medicine · Mar 2006
Review Meta Analysis Comparative StudyMortality predictions in the intensive care unit: comparing physicians with scoring systems.
Risk-prediction models offer potential advantages over physician predictions of outcomes in the intensive care unit (ICU). Our systematic review compared the accuracy of ICU physicians' and scoring system predictions of ICU or hospital mortality of critically ill adults. ⋯ Observational studies suggest that ICU physicians discriminate between survivors and nonsurvivors more accurately than do scoring systems in the first 24 hrs of ICU admission. The overall accuracy of both predictions of patient mortality was moderate, implying limited usefulness of outcome prediction in the first 24 hrs for clinical decision making.
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Meta Analysis Comparative Study
Administration of antibiotics via the respiratory tract for the prevention of ICU-acquired pneumonia: a meta-analysis of comparative trials.
The administration of prophylactic antibiotics via the respiratory tract is one of several strategies for the prevention of ICU-acquired pneumonia. We systematically examined the available evidence regarding the effect of prophylactic antibiotics administered via the respiratory tract on the development of ICU-acquired pneumonia, mortality, colonization of the respiratory tract, emergence of antimicrobial resistance, and toxicity. ⋯ The limited available evidence supports that prophylactic administration of antibiotics via the respiratory tract is associated with reduction of occurrence of ICU-acquired pneumonia. However, there is evidence from non-comparative studies that this preventive strategy may lead to an increase in the emergence of resistant bacteria. Thus, further investigation, at least in ICU patients at high risk for development of ICU-acquired pneumonia is warranted, including a more systematic evaluation of issues related to the emergence of resistance.
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Review Meta Analysis
Immunonutrition in the intensive care unit. A systematic review and consensus statement.
To systematically review the effects of enteral nutrition with pharmaconutrients-enriched diets in critically ill patients and to establish recommendations for their use. ⋯ Considering the beneficial effects and the absence of detrimental ones, the use of diets enriched with pharmaconutrients could be recommended in ICU patients requiring enteral feeding. Nevertheless, more investigation is needed in this field in order to find the more appropriate population of patients that can benefit from this nutritional therapy.
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Review Meta Analysis Comparative Study
Acute renal failure in the intensive care unit: a systematic review of the impact of dialytic modality on mortality and renal recovery.
There is controversy about which dialytic modality should be used for the treatment of acute renal failure (ARF) in the intensive care unit. We performed a systematic review and meta-analysis to determine the relative risks (RRs) of mortality and renal recovery associated with intermittent hemodialysis (IHD) therapy compared with continuous renal replacement therapy (CRRT) in critically ill adults with ARF. ⋯ In comparison to IHD therapy, CRRT does not improve survival or renal recovery in unselected critically ill patients with ARF. Future studies should focus on well-defined subgroups of such patients using lessons learned from the trials in this meta-analysis. The high cost of chronic dialysis therapy and the relative instability of the RR for dialysis dependence suggest that future trials also should evaluate differences in renal recovery between dialytic modalities.
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To assess the effect of selective decontamination of the digestive tract on respiratory tract infections and survival of patients treated in an intensive care unit, we carried out a meta-analysis of clinical studies comparing patients treated with selective decontamination with untreated controls. From eleven trials (1489 patients), differences between observed and expected respiratory tract infections and mortality were compared, and odds ratios (ORs) calculated. Analysis was done according to study design. ⋯ By contrast, the mortality benefit was less clear. Studies with historical controls and randomised trials showed that mortality was not significantly different between treatment and control patients. The evidence from these studies is at best consistent with a very limited effect of selective decontamination of the digestive tract on survival of patients in the intensive care unit, despite a clear preventive effect on the occurrence of respiratory tract infections.