Articles: critical-illness.
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Review Meta Analysis
Antithrombin III in critically ill patients: systematic review with meta-analysis and trial sequential analysis.
To evaluate the benefits and harms of antithrombin III in critically ill patients. ⋯ Antithrombin III cannot be recommended for critically ill patients based on the available evidence.
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Meta Analysis
Erythropoietin-receptor agonists in critically ill patients: a meta-analysis of randomized controlled trials.
Anemia and the need for red blood cell transfusions are common among patients admitted to intensive care units. Erythropoietin has been used to decrease the need for transfusions; however, its ability to improve clinical outcomes is unknown. We evaluated the effect of erythropoietin-receptor agonists on clinically important outcomes, including mortality, length of stay in hospital or intensive care unit, ventilator use, transfusion requirements and major adverse events. ⋯ At this time, we do not recommend the routine use of erythropoietin-receptor agonists in critically ill patients. The reduction in red blood cell transfusions per patient was very small, and there is insufficient evidence to determine whether this intervention results in clinically important benefits with acceptable risks.
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Review Meta Analysis
The use of pre- pro- and synbiotics in adult intensive care unit patients: systematic review.
This review investigated whether the administration of enteral pre-, pro- and synbiotics compared with controls in adult intensive care unit (ICU) patients reduced the incidence of nosocomial infections, length of ICU stay, hospital mortality and specifically pneumonia. ⋯ The use of pre- pro- or synbiotics in adult critically ill patients confers no statistically significant benefit in the outcome criteria studied. There is currently a lack of evidence to support the use of pre- pro- or synbiotics in patients admitted to adult ICUs, and a large well-designed trial is needed in this area.
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Review Meta Analysis
Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis.
Procalcitonin is widely reported as a useful biochemical marker to differentiate sepsis from other non-infectious causes of systemic inflammatory response syndrome. In this systematic review, we estimated the diagnostic accuracy of procalcitonin in sepsis diagnosis in critically ill patients. 18 studies were included in the review. Overall, the diagnostic performance of procalcitonin was low, with mean values of both sensitivity and specificity being 71% (95% CI 67-76) and an area under the summary receiver operator characteristic curve of 0.78 (95% CI 0.73-0.83). ⋯ Phase 3 studies showed significant heterogeneity because of variability in sample size (meta-regression coefficient -0.592, p=0.017), with diagnostic performance upwardly biased in smaller studies, but moving towards a null effect in larger studies. Procalcitonin cannot reliably differentiate sepsis from other non-infectious causes of systemic inflammatory response syndrome in critically ill adult patients. The findings from this study do not lend support to the widespread use of the procalcitonin test in critical care settings.
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Meta Analysis
Insulin infusion protocols for critically ill patients: a highlight of differences and similarities.
To discuss the major differences and similarities among the currently published insulin infusion protocols (IIPs) for critically ill patients. ⋯ Clinicians should evaluate the type of patients in their critical care units, the mean baseline glucose levels, and the available resources to determine the most appropriate and practical IIP for their institution.