Shock : molecular, cellular, and systemic pathobiological aspects and therapeutic approaches : the official journal the Shock Society, the European Shock Society, the Brazilian Shock Society, the International Federation of Shock Societies
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Meta Analysis
The Diagnostic and Prognostic Value of Supar in Patients With Sepsis: A Systematic Review and Meta-Analysis.
Soluble urokinase-type plasminogen activator receptor (suPAR) has the potential to diagnose infectious diseases. Due to the lack of reliable biomarkers and the importance of timely diagnosis for sepsis treatment, we conducted this systematic review and meta-analysis to evaluate the value of suPAR diagnosis and prognosis for sepsis. ⋯ suPAR is a feasible biomarker for timely diagnosis and prognosis of sepsis. Compared with effective value of procalcitonin (PCT) identified by previous meta-analysis, suPAR has similar clinical guiding value, whereas suPAR exhibits higher specificity, which can facilitate the deficiencies of PCT. suPAR also shows a diagnostic value in differentiating sepsis from SIRS. Considering the lack of biomarkers for sepsis and the similar clinical value of suPAR and PCT, suPAR should be considered as a biomarker in clinical practice for sepsis.
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Meta Analysis
Norepinephrine vs Vasopressin: Which Vasopressor Should Be Discontinued First in Septic Shock? A Meta-Analysis.
Patients with septic shock in whom norepinephrine (NE) infusion alone is insufficient to raise blood pressure require the concomitant administration of vasopressin (VP). However, current guidelines do not advise clinicians as to which vasoactive agent to discontinue first once the patient's septic shock begins to resolve. Moreover, there is controversial data guiding clinicians on how to discontinue vasopressors for septic shock patients who are receiving a combination therapy of NE and VP. ⋯ In adults with septic shock treated with concomitant VP and NE therapy, discontinuing VP first may lead to a higher incidence of hypotension but is not associated with mortality or ICU LOS. Further prospective studies with larger sample sizes are warranted.
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Meta Analysis
Does Fenoldopam Protect Kidney in Cardiac Surgery? A Systemic Review and Meta-Analysis With Trial Sequential Analysis.
To assess the benefits and harms of fenoldopam for nephroprotective effects in adult patients undergoing cardiac surgery. ⋯ Low-dose dopamine offers transient improvements in renal physiology, but no good evidence shows that it offers important clinical benefits to patients with or at risk for acute renal failure.Among patients treated with fenoldopam, there was a decrease in AKI and an increased incidence of hypotension, had no significant effect on RRT or mortality. Given that most studies were small and the definition of AKI was variable between studies, there is not enough evidence to support the systematic use of fenoldopam in cardiac surgery.
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Corticosteroids may reduce length of ICU stay in patients with septic shock.
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Review Meta Analysis
An Open Lung Strategy in the Management of Acute Respiratory Distress Syndrome: A systematic review and meta-analysis.
An open lung strategy (OLS) that includes positive end expiratory pressure and recruitment maneuvers during mechanical ventilation is probably an important treatment method in patients with acute respiratory distress syndrome (ARDS). However, the effect of OLS is unknown. We therefore hypothesized that patients with ARDS may benefit from OLS treatment. ⋯ Results from this systematic review and meta-analysis suggest that OLS during mechanical ventilation significantly reduces mortality among patients with ARDS.