Articles: critical-illness.
-
Einstein (Sao Paulo) · Oct 2014
Review Meta AnalysisShould we treat fever in critically ill patients? A summary of the current evidence from three randomized controlled trials.
Fever is a nonspecific response to various types of infectious or non-infectious insult and its significance in disease remains an enigma. Our aim was to summarize the current evidence for the use of antipyretic therapy in critically ill patients. We performed systematic review and meta-analysis of publications from 1966 to 2013. ⋯ Patients treated with antipyretic agents showed similar intensive care unit mortality (risk ratio 0.91, with 95% confidence interval 0.65-1.28) when compared with controls. The only difference observed was a greater decrease in temperature after 24 hours in patients treated with antipyretics (-1.70±0.40 versus - 0.56±0.25ºC; p=0.014). There is no difference in treating or not the fever in critically ill patients.
-
Cochrane Db Syst Rev · Sep 2014
Review Meta AnalysisGlutamine supplementation for critically ill adults.
Glutamine is a non-essential amino acid which is abundant in the healthy human body. There are studies reporting that plasma glutamine levels are reduced in patients with critical illness or following major surgery, suggesting that glutamine may be a conditionally essential amino acid in situations of extreme stress. In the past decade, several clinical trials examining the effects of glutamine supplementation in patients with critical illness or receiving surgery have been done, and the systematic review of this clinical evidence has suggested that glutamine supplementation may reduce infection and mortality rates in patients with critical illness. However, two recent large-scale randomized clinical trials did not find any beneficial effects of glutamine supplementation in patients with critical illness. ⋯ This review found moderate evidence that glutamine supplementation reduced the infection rate and days on mechanical ventilation, and low quality evidence that glutamine supplementation reduced length of hospital stay in critically ill or surgical patients. It seems to have little or no effect on the risk of mortality and length of ICU stay, however. The effects on the risk of serious side effects were imprecise. The strength of evidence in this review was impaired by a high risk of overall bias, suspected publication bias, and moderate to substantial heterogeneity within the included studies.
-
Cochrane Db Syst Rev · Sep 2014
Review Meta AnalysisAutomated weaning and SBT systems versus non-automated weaning strategies for weaning time in invasively ventilated critically ill adults.
Automated systems use closed-loop control to enable ventilators to perform basic and advanced functions while supporting respiration. SmartCare™ is a unique automated weaning system that measures selected respiratory variables, adapts ventilator output to individual patient needs by operationalizing predetermined algorithms and automatically conducts spontaneous breathing trials (SBTs) when predetermined thresholds are met. ⋯ Compared with non-automated weaning strategies, weaning with SmartCare™ significantly decreased weaning time, time to successful extubation, ICU stay and proportions of patients receiving ventilation for longer than seven days and 21 days. It also showed a favourable trend toward fewer patients receiving ventilation for longer than 14 days; however the estimated effect was imprecise. Summary estimates from our review suggest that these benefits may be achieved without increasing the risk of adverse events, especially reintubation; however, the quality of the evidence ranged from low to moderate, and evidence was derived from 10 small randomized controlled trials.
-
Critical care medicine · Sep 2014
Review Meta AnalysisLactate Clearance Is a Useful Biomarker for the Prediction of All-Cause Mortality in Critically Ill Patients: A Systematic Review and Meta-Analysis.
Lactate clearance has been widely investigated for its prognostic value in critically ill patients. However, the results are conflicting. The present study aimed to explore the diagnostic accuracy of lactate clearance in predicting mortality in critically or acutely ill patients. ⋯ Our study demonstrates that lactate clearance is predictive of lower mortality rate in critically ill patients, and its diagnostic performance is optimal for clinical utility.
-
Gen Hosp Psychiatry · Sep 2014
Review Meta AnalysisA meta-analysis of critically ill patients reveals several potential risk factors for delirium.
To investigate potential risk factors for delirium in critically ill patients through a meta-analysis of clinical observational studies. ⋯ Age, history of hypertension, clinical use of mechanical ventilation and higher APACHE II score are associated with increased risk of delirium in critically ill patients.