Heart & lung : the journal of critical care
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Review Meta Analysis
The Effect of Massage on Acute Postoperative Pain in Critically and Acutely Ill Adults Post-thoracic Surgery: Systematic Review and Meta-analysis of Randomized Controlled Trials.
Critical care practice guidelines identify a lack of clear evidence on the effectiveness of massage for pain control. To assess the effect of massage on acute pain in critically and acutely ill adults post-thoracic surgery. Medline, Embase, CINAHL, PsychInfo, Web of Science, Scopus and Cochrane Library databases were searched. ⋯ Of these, nine evaluated massage in addition to standard analgesia, including 2 that compared massage to attention control/sham massage in the intensive care unit (ICU), 6 that compared massage to standard analgesia alone early post-ICU discharge, and 1 that compared massage to both attention control and standard care in the ICU. Patients receiving massage with analgesia reported less pain (0-10 scale) compared to attention control/sham massage (3 RCTs; N = 462; mean difference -0.80, 95% confidence interval [CI] -1.25 to -0.35; p < 0.001; I2 = 13%) and standard care (7 RCTs; N = 1087; mean difference -0.85, 95% CI -1.28 to -0.42; p < 0.001; I2 = 70%). Massage, in addition to pharmacological analgesia, reduces acute post-cardiac surgery pain intensity.
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Review Meta Analysis
The effect of N-acetylcysteine on exacerbations of chronic obstructive pulmonary disease: A meta-analysis and systematic review.
N-acetylcysteine (NAC) is an antioxidant and anti-inflammatory. Its effects on chronic obstructive pulmonary (COPD) outcomes, including exacerbation of and changes in lung function parameters, are controversial. To investigate the effects of NAC on COPD exacerbation and changes in lung function parameters in patients with COPD. ⋯ Long-term (≥6 months), but not short-term, NAC reduced exacerbation prevalence (RR = 0.85, 95% CI = 0.74-0.98, P = 0.024). NAC did not affect exacerbation rate, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), or inspiratory capacity (IC). Long-term NAC therapy may reduce risk of COPD exacerbation.
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Review Meta Analysis
The effect of N-acetylcysteine on exacerbations of chronic obstructive pulmonary disease: A meta-analysis and systematic review.
N-acetylcysteine (NAC) is an antioxidant and anti-inflammatory. Its effects on chronic obstructive pulmonary (COPD) outcomes, including exacerbation of and changes in lung function parameters, are controversial. To investigate the effects of NAC on COPD exacerbation and changes in lung function parameters in patients with COPD. ⋯ Long-term (≥6 months), but not short-term, NAC reduced exacerbation prevalence (RR = 0.85, 95% CI = 0.74-0.98, P = 0.024). NAC did not affect exacerbation rate, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), or inspiratory capacity (IC). Long-term NAC therapy may reduce risk of COPD exacerbation.
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Review Meta Analysis
De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: A meta-analysis.
To evaluate the impact of de-escalation therapy on clinical outcomes in patients with severe sepsis and/or septic shock. ⋯ Antibiotic de-escalation therapy has no detrimental impact on mortality in patients with severe sepsis and/or septic shock, as compared to the continuation of broad-spectrum antibiotics. Since de-escalation affords an opportunity to limit overuse of broad-spectrum antibiotics, it should be considered as an option in clinical practice.
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Review Meta Analysis
The effect of reintubation on ventilator-associated pneumonia and mortality among mechanically ventilated patients with intubation: A systematic review and meta-analysis.
This meta-analysis summarized the risks that reintubation impose on ventilator-associated pneumonia (VAP) and mortality. ⋯ Reintubation can represent a threat to survival and increase the risk of VAP. The risk of mortality after reintubation differs between planned and unplanned extubation. Extubation failure is associated with a higher risk of VAP in the cardiac surgery population than in the general population.