Critical care medicine
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Critical care medicine · Dec 2014
Review Meta AnalysisTransfusion Triggers for Guiding RBC Transfusion for Cardiovascular Surgery: A Systematic Review and Meta-Analysis.
Restrictive red cell transfusion is recommended to minimize risk associated with exposure to allogeneic blood. However, perioperative anemia is an independent risk factor for adverse outcomes after cardiovascular surgery. The purpose of this systematic review and meta-analysis is to determine whether perioperative restrictive transfusion thresholds are associated with inferior clinical outcomes in randomized trials of cardiovascular surgery patients. ⋯ Further randomized controlled trials are necessary to determine the optimal transfusion strategy for patients undergoing cardiovascular surgery.
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Critical care medicine · Dec 2014
Review Meta AnalysisTidal Volume and Mortality in Mechanically Ventilated Children: A Systematic Review and Meta-Analysis of Observational Studies.
To determine whether tidal volume is associated with mortality in critically ill, mechanically ventilated children. ⋯ A relationship between tidal volume and mortality in mechanically ventilated children could not be identified, irrespective of the severity of disease. The significant heterogeneity observed in the pooled analyses necessitates future studies in well-defined patient populations to understand the effects of tidal volume on patient outcome.
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Critically ill patients are usually unable to maintain adequate volitional intake to meet their metabolic demands. As such, provision of nutrition is part of the medical care of these patients. This review provides detail and interpretation of current data on specialized nutrition therapy in critically ill patients, with focus on recently published studies. ⋯ Current evidence suggests that enteral nutrition, started as soon as possible after acute resuscitative efforts, may serve therapeutic roles beyond providing calories and protein. Although many new studies have further advanced our knowledge in this area, the appropriate level of standardization has not yet been achieved for nutrition therapy, as it has in other areas of critical care. Protocolized nutrition therapy should be modified for each institution based on available expertise, local barriers, and existing culture in the ICU to optimize evidence-based nutrition care for each critically ill patient.