Journal of critical care
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Journal of critical care · Oct 2022
Review Meta AnalysisProphylactic acid suppressants in patients with primary neurologic injury: A systematic review and meta-analysis of randomized controlled trials.
Neurocritical care patients are at risk of stress-induced gastrointestinal ulceration. We performed a systematic review and meta-analysis of stress ulcer prophylaxis (SUP) in critically ill adults admitted with a primary neurologic injury. ⋯ In neurocritical care patients, the overall high or unclear risk of bias of individual trials, the low event rates, and modest sample sizes preclude strong clinical inferences about the utility of SUP.
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Journal of critical care · Oct 2022
Multicenter StudyCharacteristics and outcomes of autologous hematopoietic stem cell transplant recipients admitted to intensive care units: A multicenter study.
Studies of critically ill hematopoietic stem cell transplantation (HSCT) recipients have mainly been single-center and focused on allogenic HSCT recipients. We aimed to describe a cohort of autologous HSCT with an unplanned intensive care unit (ICU) admission. ⋯ In this large cohort of critically ill autologous HSCT recipients, mechanical ventilation was the only organ support-therapy associated with increased mortality in autologous HSCT recipients.
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Journal of critical care · Oct 2022
ReviewAgreement between subcostal and transhepatic longitudinal imaging of the inferior vena cava for the evaluation of fluid responsiveness: A systematic review.
Assessment of fluid-responsiveness is a key aspect of daily management in critically ill patients. Non-invasive evaluation of the variation of inferior vena cava (IVC) diameter during ventilation may provide useful information. However, a standard sagittal IVC visualization from the subcostal (SC) region is not always feasible. An alternative method to visualize the IVC is a coronal trans-hepatic (TH) approach. ⋯ An overview of the included studies suggests that longitudinal TH and SC assessment of IVC size and respiratory variation are not interchangeable. New studies with accurate data reporting and appropriate statistical analysis are needed to define proper cut-offs for fluid responsiveness when using TH approach for IVC visualization.
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Journal of critical care · Oct 2022
ReviewPitfalls and pearls with drug dosing in the critically ill obese patient: 10 statements to guide ICU practitioners.
Obesity is highly prevalent in ICU patients presenting a number of challenges, one of which is drug dosing. There are limited high-quality data describing drug dosing in obesity, which can lead to dosing strategies that are suboptimal. ⋯ A generalized framework for decision making specific for obese patients is available that describes a step-by-step approach for constructing dosing regimens. This manuscript will build on that framework by providing pitfalls and pearls for clinicians to consider when making dosing decisions in critically ill patients with severe obesity.
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Journal of critical care · Oct 2022
Observational StudyPropofol versus midazolam sedation in patients with cardiogenic shock - an observational propensity-matched study.
Benzodiazepines are recommended as first line sedative agent in ventilated cardiogenic shock patients, although data regarding the optimal sedation strategy are sparse. The aim of this study was to investigate the hemodynamic effects of propofol versus midazolam sedation in our cardiogenic shock registry. ⋯ In this observational cohort study, sedation with propofol in comparison to midazolam was linked to a reduced dose of catecholamines, decreased mortality and bleeding rates for patients with cardiogenic shock. Based on this study and in contrast to current recommendations, propofol should be given consideration for sedation in cardiogenic shock patients.