Critical care clinics
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Critical care clinics · Jul 1998
Meta AnalysisAn evidence-based approach to noninvasive ventilation in acute respiratory failure.
This article reviews the literature of noninvasive positive pressure ventilation (NPPV) in patients with acute respiratory failure. The article divides acute respiratory failure into the categories of primary ventilation failure and oxygenation failure, and examines various diagnostic groups within these categories. Although the use of NPPV for patients with acute respiratory failure of other etiologies requires further study, the authors conclude that there is sufficient evidence to support the use of NPPV in acute, severe exacerbations of chronic obstructive pulmonary disease.
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This article presents a systematic review of the prognostic factors in coma caused by hypoxia and anoxia, and traumatic head injury. In the case of anoxic coma, poor prognosis can be determined very accurately at the bedside by the lack of brainstem reflexes assessed at day three post-insult. ⋯ Evoked potentials performed within the first week detect approximately half of patients with a poor prognosis. EEG adds only a small amount of prognostic information.
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Critical care clinics · Jul 1998
Meta AnalysisAn evidence-based approach to pressure- and volume-limited ventilation strategies.
In summary, based on the evidence reviewed, clinicians should continue to adopt a pressure-limited ventilation strategy for patients with acute lung injury, but combine this strategy with relatively liberal use of PEEP. Critical care clinicians can look forward to more information about the degree of hypercapnia that can be safely permitted in the full reports of the RCTs reviewed and in related critical care literature.
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Critical care clinics · Jul 1998
Meta AnalysisNutritional support in the critically ill patients. A critical review of the evidence.
Providing nutritional support has become a standard component of managing critically ill patients. While many studies have documented that providing nutritional support can change nutritional outcomes (e.g., amino acid profile, weight gain, nitrogen balance), data are lacking that demonstrate that nutrition actually influences clinically importance endpoints. This article systematically reviews and critically appraises the literature, examining the relationship between nutritional support and infectious morbidity and mortality in the critically ill patient. In addition, evidence-based recommendations are made.
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Critical care clinics · Jul 1998
Meta AnalysisAn evidence-based evaluation of the use of sodium bicarbonate during cardiopulmonary resuscitation.
The use of bicarbonate is rooted in three decades of clinical experience and observational studies. For many years, bicarbonate passed the tried and true test for clinical therapies; however, administration of sodium bicarbonate during cardiac arrest and hypoxic acidosis has become increasingly controversial. The controversy provides an excellent opportunity to evaluate the impact an evidence-based approach might have on a common clinical practice. Is bicarbonate efficacious in the treatment of the severe acidosis that accompanies cardiac arrest during cardiopulmonary resuscitation (CPR)? Are the deleterious effects of bicarbonate clinically relevant? What is the evidence upon which a rational decision may be based? This review evaluates and ranks the evidence supporting the use of sodium bicarbonate in the therapy of acidosis associated with cardiac arrest during CPR.