Articles: critical-illness.
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Meta Analysis
Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials.
To test the hypothesis that albumin administration is not associated with excess mortality. ⋯ Overall, no effect of albumin on mortality was detected; any such effect may therefore be small. This finding supports the safety of albumin. The influence of methodologic quality on relative risk for death suggests the need for further well-designed clinical trials.
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Anesthesia and analgesia · Apr 2001
Meta Analysis Comparative StudyA lack of evidence of superiority of propofol versus midazolam for sedation in mechanically ventilated critically ill patients: a qualitative and quantitative systematic review.
Propofol and midazolam are often used for sedation in the intensive care unit. The aim of this systematic review was to estimate the efficacy and harm of propofol versus midazolam in mechanically ventilated patients. A systematic search (Medline, Cochrane Library, Embase, bibliographies), any language, up to June 1999 was performed for reports of randomized comparisons of propofol with midazolam. Data from 27 trials (1624 adults) were analyzed. The average duration of sedation varied between 4 and 339 h. In 10 trials, the duration of adequate sedation was longer with propofol (weighted mean difference 2.9 h; 95% confidence interval [CI], 0.2-5.6 h). In 13 trials (mostly postoperative), sedation lasted 4 to 35 h; in 9 of those, average weaning time from mechanical ventilation with propofol was 0.8-4.3 h; with midazolam it was 1.5-7.2 h (weighted mean difference 2.2 h [95% CI, 0.8 to 3.7 h]). In 8 trials, sedation lasted 54 to 339 h; there was a lack of evidence for difference in weaning times. Arterial hypotension (relative risk 2.5 [95% CI, 1.3 to 4.5]; number-needed-to-treat, 12), and hypertriglyceridemia (relative risk 12.1 [95%CI, 2.9 to 49.7]; number-needed-to-treat, 6) occurred more often with propofol. The duration of adequate sedation time is longer with propofol compared with midazolam. In postoperative patients with sedation <36 h, weaning is faster with propofol. ⋯ The duration of adequate sedation time is longer with propofol compared with midazolam. In postoperative patients with sedation < 36 h, weaning is faster with propofol.
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Meta Analysis Comparative Study
A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients.
Tracheostomy is one of the most commonly performed procedures in the patient receiving long-term mechanical ventilation. While percutaneous dilational tracheostomy (PDT) is becoming increasingly utilized as an alternative to conventional surgical tracheostomy, most literature evaluating these two techniques is neither prospective nor controlled. We performed a meta-analysis of available prospective controlled studies comparing PDT and surgical tracheostomy in critically ill patients to more fully understand the relative benefits and risks of these two procedures in this population. ⋯ Despite its popularity, there are currently only a limited number of small studies prospectively evaluating PDT and surgical tracheostomy. Our meta-analysis of these studies suggests potential advantages of PDT relative to surgical tracheostomy, including ease of performance, and lower incidence of peristomal bleeding and postoperative infection. If confirmed by additional, adequately powered prospective trials, these findings support PDT as the procedure of choice for the establishment of elective tracheostomy in the appropriately selected critically ill patient.
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Critical care medicine · Mar 2000
Meta AnalysisThe incidence of major morbidity in critically ill patients managed with pulmonary artery catheters: a meta-analysis.
The impact of pulmonary artery (PA) catheters on patient outcome has been questioned and their usage has become controversial. Meta-analysis on mortality has shown a trend for improved survival with PA catheter-guided therapy. We now perform a meta-analysis on morbidity from PA catheters in the published literature. ⋯ Meta-analysis of RCTs included in this study shows that there is a statistically significant reduction in morbidity using PA catheter-guided strategies.