Articles: critical-illness.
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Cochrane Db Syst Rev · Jul 2014
Review Meta AnalysisDaily sedation interruption versus no daily sedation interruption for critically ill adult patients requiring invasive mechanical ventilation.
Daily sedation interruption (DSI) is thought to limit drug bioaccumulation, promote a more awake state, and thereby reduce the duration of mechanical ventilation. Available evidence has shown DSI to either reduce, not alter, or prolong the duration of mechanical ventilation. ⋯ We have not found strong evidence that DSI alters the duration of mechanical ventilation, mortality, length of ICU or hospital stay, adverse event rates, drug consumption, or quality of life for critically ill adults receiving mechanical ventilation compared to sedation strategies that do not include DSI. We advise that caution should be applied when interpreting and applying the findings as the overall effect of treatment is always < 1 and the upper limit of the CI is only marginally higher than the no-effect line. These results should be considered unstable rather than negative for DSI given the statistical and clinical heterogeneity identified in the included trials.
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Cochrane Db Syst Rev · Jun 2014
Review Meta AnalysisAutomated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children.
Automated closed loop systems may improve adaptation of mechanical support for a patient's ventilatory needs and facilitate systematic and early recognition of their ability to breathe spontaneously and the potential for discontinuation of ventilation. This review was originally published in 2013 with an update published in 2014. ⋯ Automated closed loop systems may result in reduced duration of weaning, ventilation and ICU stay. Reductions are more likely to occur in mixed or medical ICU populations. Due to the lack of, or limited, evidence on automated systems other than Smartcare/PS™ and Adaptive Support Ventilation no conclusions can be drawn regarding their influence on these outcomes. Due to substantial heterogeneity in trials there is a need for an adequately powered, high quality, multi-centre randomized controlled trial in adults that excludes 'simple to wean' patients. There is a pressing need for further technological development and research in the paediatric population.
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J. Cardiothorac. Vasc. Anesth. · Jun 2014
Review Meta AnalysisEarly Versus Late Initiation of Renal Replacement Therapy in Critically Ill Patients With Acute Kidney Injury After Cardiac Surgery: A Systematic Review and Meta-analysis.
To investigate the impact of early versus late renal replacement therapy (RRT) on mortality in patients with acute kidney injury (AKI) after cardiac surgery. ⋯ Early initiation of RRT for patients with AKI after cardiac surgery revealed lower 28-days mortality and shorter ICU length of stay. However, this was based on 11 studies of various qualities with very high heterogeneity of results. Defining treatment guidelines needs further research with a larger and better database.
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Review Meta Analysis
Is omega-3 fatty acids enriched nutrition support safe for critical ill patients? A systematic review and meta-analysis.
To systematically review the effects of omega-3 poly unsaturated fatty acids (FA) enriched nutrition support on the mortality of critically illness patients. ⋯ Omega-3 FA enriched nutrition support is safe. Due to the limited sample size of the included trials, further large-scale RCTs are needed.
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Minerva anestesiologica · May 2014
Review Meta AnalysisHigh volume hemofiltration in critically ill Patients - a systematic review and Meta-analysis.
High volume hemofiltration (HVHF) has been proposed as method for blood purification, especially under the condition of systemic inflammatory syndromes. Our goal was to evaluate the effects of HVHF in critically ill patients. ⋯ No clear overall beneficial effect of HVHF or PHVHF compared to standard volume hemofiltration can be detected.