Journal of critical care
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Journal of critical care · Oct 2017
ReviewInterventions affecting mortality in critically ill and perioperative patients: A systematic review of contemporary trials.
Confounders in randomized controlled trials (RCTs) reporting significant effects on mortality in critically ill patients using non-surgical techniques have not been systematically explored. We aimed to identify factors unrelated to the reported intervention that might have affected the findings and robustness of such trials. ⋯ These observations imply that major systematic biases exist and affect trial findings irrespective of the intervention being studied.
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Journal of critical care · Oct 2017
ReviewExtracorporeal membrane oxygenation (ECMO) as a treatment strategy for severe acute respiratory distress syndrome (ARDS) in the low tidal volume era: A systematic review.
To evaluate the hospital survival in patients with severe ARDS managed with ECMO and low tidal volume ventilation as compared to patients managed with low tidal volume ventilation alone. ⋯ Given the lack of studies with appropriate control groups, our confidence in a difference in outcome between the two therapies remains weak. Future studies on the use of ECMO for severe ARDS are needed to clarify the role of ECMO in this disease.
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Journal of critical care · Oct 2017
ReviewExtracorporeal membrane oxygenation (ECMO) as a treatment strategy for severe acute respiratory distress syndrome (ARDS) in the low tidal volume era: A systematic review.
To evaluate the hospital survival in patients with severe ARDS managed with ECMO and low tidal volume ventilation as compared to patients managed with low tidal volume ventilation alone. ⋯ Given the lack of studies with appropriate control groups, our confidence in a difference in outcome between the two therapies remains weak. Future studies on the use of ECMO for severe ARDS are needed to clarify the role of ECMO in this disease.
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Journal of critical care · Oct 2017
Review Meta AnalysisSystematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit.
To compare clinical outcomes among critically ill adults with acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT), intermittent hemodialysis (IHD) or sustained low efficiency dialysis (SLED). ⋯ We did not find a definitive advantage for any RRT modality on short-term patient or kidney survival. Well-designed, adequately-powered trials are needed to better define the role of RRT modalities for treatment of critically ill patients with AKI.
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Journal of critical care · Oct 2017
Review Meta AnalysisTherapeutic effect of beta-blocker in patients with traumatic brain injury: A systematic review and meta-analysis.
β-Blocker exposure has been shown to reduce mortality in traumatic brain injury (TBI); however, the efficacy of β-blockers remains inconclusive. Therefore, a meta-analysis was conducted in this paper to evaluate the safety and efficacy of β-blocker therapy on patients with TBI. ⋯ The meta-analysis demonstrates that β-blockers are effective in lowering mortality in patients with TBI. However, β-blocker therapy has markedly increased the infection rate and requires a longer period of ventilator support, intensive care management as well as length of stay.