Articles: critical-illness.
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Cochrane Db Syst Rev · Nov 2018
Meta AnalysisProtocol-directed sedation versus non-protocol-directed sedation in mechanically ventilated intensive care adults and children.
The sedation needs of critically ill patients have been recognized as a core component of critical care that is vital to assist recovery and ensure humane treatment. Evidence suggests that sedation requirements are not always optimally managed. Suboptimal sedation, both under- and over-sedation, have been linked to short-term (e.g. length of stay) and long-term (e.g. psychological recovery) outcomes. Strategies to improve sedation assessment and management have been proposed. This review was originally published in 2015 and updated in 2018. ⋯ There is currently limited evidence from RCTs evaluating the effectiveness of protocol-directed sedation on patient outcomes. The four included RCTs reported conflicting results and heterogeneity limited the interpretation of results for the primary outcomes of duration of mechanical ventilation and mortality. Further studies, taking into account differing contextual characteristics, are necessary to inform future practice. Methodological strategies to reduce the risk of bias need to be considered in future studies.
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J. Cardiothorac. Vasc. Anesth. · Oct 2018
Review Meta AnalysisContinuous Infusion versus Intermittent Bolus Injection of Furosemide in Critically Ill Patients: A Systematic Review and Meta-analysis.
Fluid overload is a common phenomenon seen in intensive care units (ICUs). However, there is no general consensus on whether continuous or bolus furosemide is safer or more effective in these hemodynamically unstable ICU patients. The aim of this meta-analysis was to examine the clinical outcomes of continuous versus bolus furosemide in a critically ill population in ICUs. ⋯ In this meta-analysis, continuous furosemide was associated with greater diuretic effect in total urine output as compared with bolus. Neither had any differences in mortality and changes of renal function tests. However, a large adequately powered randomized clinical trial is required to fill this knowledge gap.
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Review Meta Analysis Comparative Study
Effect of combined parenteral and enteral nutrition versus enteral nutrition alone for critically ill patients: A systematic review and meta-analysis.
The increased mortality rate and other poor prognosis make malnutrition a serious issue for adult critically ill patients in intensive care unit care. This study was to compare outcomes between combined parenteral and enteral nutrition and enteral nutrition alone for adult critically ill patients. ⋯ Receiving EN alone decreased the respiratory infections and length of days at hospital for critically ill patients. Combined PN and EN did not add up the potential risk from PN and EN on hospital mortality, length of days in ICU, duration of ventilatory support, albumin, and prealbumin.
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Review Meta Analysis
Prevalence and outcome of acute gastrointestinal injury in critically ill patients: A systematic review and meta-analysis.
The aim of the study was to investigate the prevalence and impact of acute gastrointestinal injury (AGI) on clinical outcomes in critically ill patients. ⋯ AGI is common in critically ill patients, mortality in critically ill patients with AGI is high, and severity of AGI is associated with mortality. The widespread clinical use of standard criteria with a severity gradation will facilitate the diagnosis and management of AGI in critically ill patients.
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J. Cardiothorac. Vasc. Anesth. · Oct 2018
Meta AnalysisSteroids and Survival in Critically Ill Adult Patients: A Meta-analysis of 135 Randomized Trials.
Corticosteroids have important effects on intermediate outcomes in critically ill patients, but their effect on survival is unknown. The objective of this meta-analysis was to analyze the effect on mortality of corticosteroids in critical and perioperative settings. ⋯ This meta-analysis documents the safety of corticosteroids in the overall critically ill population with the notable exception of brain injury patients, a setting where the authors confirmed their detrimental effect on survival. A possible beneficial effect of corticosteroids on survival was found among patients with respiratory diseases and in patients with bacterial meningitis.