Articles: cations.
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The clinical benefits of intraoperative low tidal volume (LTV) mechanical ventilation with concomittent positive end expiratory pressure (PEEP) and intermittent recruitment maneuvers-termed "protective lung ventilation" (PLV)-have not been investigated systematically in otherwise healthy patients undergoing general anesthesia. ⋯ Intraoperative LTV ventilation in conjunction with PEEP and intermittent recruitment maneuvers is associated with significantly improved clinical pulmonary outcomes and reduction in length of hospital stay in otherwise healthy patients undergoing general surgery. Providers should consider application of all the 3 elements for a comprehensive protective ventilation strategy.
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Review Meta Analysis
Meta-analysis of negative-pressure wound therapy for closed surgical incisions.
Postoperative wound complications are common following surgical procedures. Negative-pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions. ⋯ Compared with standard postoperative dressings, NPWT significantly reduced the rate of wound infection and seroma when applied to closed surgical wounds. Heterogeneity between the included studies means that no general recommendations can be made yet.
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J Neurosurg Anesthesiol · Apr 2016
Review Meta AnalysisThe Cerebrovascular Response to Ketamine: A Systematic Review of the Animal and Human Literature.
The aim of the study was to perform a systematic review of the literature on the cerebrovascular/cerebral blood flow (CBF) effects of ketamine in both animal and human subjects. ⋯ Animal models indicate an increase in global CBF and rCBF with ketamine administration, with a trend to vasodilation of medium-sized intracranial vessels through a calcium-dependent mechanism. Human studies display an Oxford 2b, Grading of Recommendation Assessment Development and Education C, level of evidence to support a trend to increased global CBF and rCBF with ketamine administration in both healthy volunteers and elective surgical patients without neurological illness.
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Review Meta Analysis
Effect of Hospital Volume on Surgical Outcomes After Pancreaticoduodenectomy: A Systematic Review and Meta-analysis.
The aim of the study was to evaluate the relationship between hospital volume and outcome after pancreaticoduodenectomy (PD). ⋯ This meta-analysis included studies from different countries with disparate health care systems and provided strong evidence for an inverse association between higher hospital volume and lower mortality after PD. Variations in HVH cutoff values across studies majorly influenced the overall heterogeneity.
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Review Meta Analysis
Association of Hemodynamic Factors With Intracranial Aneurysm Formation and Rupture: Systematic Review and Meta-analysis.
Recent evidence suggests a link between the magnitude and distribution of hemodynamic factors and the formation and rupture of intracranial aneurysms. However, there are many conflicting results. ⋯ Pooled analyses of computational fluid dynamics models suggest that an increase in WSS and gradient oscillatory number may contribute to aneurysm formation, whereas low WSS is associated with ruptured aneurysms. The location of the aneurysm at the bifurcation or sidewall may influence the correlation of these hemodynamic factors.