Critical care medicine
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Critical care medicine · May 2012
Review Meta AnalysisA systematic review and meta-analysis of clinical trials of thyroid hormone administration to brain dead potential organ donors.
To review all published clinical studies of thyroid hormone administration to brain-dead potential organ donors. ⋯ The findings of this systematic review do not support a role for routine administration of thyroid hormone in the brain-dead potential organ donor. Existing recommendations regarding the use of thyroid hormone in marginal donors are based on low-level evidence.
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Critical care medicine · May 2012
Randomized Controlled Trial Multicenter StudyOccurrence and impact of intracranial pressure elevation during treatment of severe intraventricular hemorrhage.
Elevated intracranial pressure is one of the proposed mechanisms leading to poor outcomes in patients with intraventricular hemorrhage. We sought to characterize the occurrence and significance of intracranial hypertension in severe intraventricular hemorrhage requiring extraventricular drainage. ⋯ Intracranial pressure is not frequently elevated during monitoring and drainage with an extraventricular drainage in patients with severe intraventricular hemorrhage, although intracranial pressure >30 mm Hg predicts higher short-term mortality. Thrombolytic therapy may reduce the frequency of high intracranial pressure events. Intracranial pressure elevation appears to be significantly correlated with extraventricular drainage placement in the ventricle with greatest clot volume.
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Critical care medicine · May 2012
Meta AnalysisMeta-analysis of subclavian insertion and nontunneled central venous catheter-associated infection risk reduction in critically ill adults.
Catheter-associated infections are common, costly, and potentially lethal. The impact of catheter insertion site on infection risk remains controversial. We aimed to establish whether nontunneled central venous catheters inserted in the subclavian vein are associated with lower risk of catheter-associated infection compared to femoral or internal jugular vein insertion. ⋯ Shortcomings in study design, including channeling, confounding bias, and study heterogeneity, may limit the interpretation of our preliminary study results. Our analysis suggests that the subclavian site may be associated with a lower risk of catheter-associated infection. However, a large, randomized, controlled trial comparing each catheter site complication is warranted before the subclavian site can be unequivocally recommended as a first choice for central venous catheter insertion.