Journal of critical care
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Journal of critical care · Apr 2020
Review Meta AnalysisPharmacological interventions to reduce edema following cardiopulmonary bypass: A systematic review and meta-analysis.
To compare the effectiveness of different types of pharmacological agents to reduce organ specific edema following cardiopulmonary bypass (CPB). ⋯ Overall, neutrophil inhibitors and direct modulators of endothelial barrier (PAR1, Tie2 signaling) most effectively reduced edema following CPB, in particular pulmonary edema. Future research should focus on a combination of these strategies to reduce edema and assess the effect on organ function and outcome following CPB.
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Journal of critical care · Apr 2020
Meta AnalysisKetamine sedation in mechanically ventilated patients: A systematic review and meta-analysis.
Ketamine use as a sedative agent in mechanically ventilated patients is increasing. This systematic review and meta-analysis collates existing literature and quantifies the impact of ketamine in mechanically ventilated patients. ⋯ The data regarding ketamine use in mechanically ventilated patients is limited in terms of quantity, methodological quality, and demonstrated clinical benefit. Ketamine may play a role as a sedative-sparing agent, but may be associated with harm. High-quality studies are needed before widespread adoption of ketamine earlier in the sedation pathway.
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Journal of critical care · Apr 2020
Multicenter Study Observational StudyAssociation of neuronal repair biomarkers with delirium among survivors of critical illness.
Delirium is prevalent but with unclear pathogenesis. Neuronal injury repair pathways may be protective. We hypothesized that higher concentrations of neuronal repair biomarkers would be associated with decreased delirium in critically ill patients. ⋯ During critical illness, higher UCHL1 plasma concentration is associated with lower prevalence of delirium; BDNF plasma concentration is not associated with delirium. Clinical trial number: NCT00392795; https://clinicaltrials.gov/ct2/show/NCT00392795.
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Journal of critical care · Apr 2020
Comparative StudyLongitudinal comparative trial of antibiotic cycling and mixing on emergence of gram negative bacterial resistance in a pediatric medical intensive care unit.
To compare antibiotic mixing vs. cycling with respect to acquisition of resistance and PICU mortality. ⋯ Acquisition of resistance was significantly lower in both mixing and cycling as compared to baseline phase. Both were similar with respect to risk of antibiotic resistance as well as incidence of HCAI and PICU mortality.
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Journal of critical care · Apr 2020
ReviewManagement of civilians with penetrating brain injury: A systematic review.
There has been a dramatic increase in penetrating gunshot-inflicted civilian penetrating brain injuries (cvPBI). We undertook a systematic review with exclusive focus on the management of cvPBI. ⋯ Limited amount of published work is clinically meaningful; this systematic review identified key knowledge gaps.