Minerva anestesiologica
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Minerva anestesiologica · Nov 2016
Perioperative haemodynamic goal-directed therapy and mortality: systematic review and meta-analysis with meta regression.
Recent data found that perioperative goal directed therapy (GDT) was effective only in higher control mortality rates (>20%) with a relatively high heterogeneity that limited the strength of evidence. The aim of the present meta-analysis was to clearly understand which high risk patients may benefit of GDT. ⋯ The present meta-analysis, adopting the meta-regression technique, suggests that GDT significantly reduces mortality even when the event control rate is >10%.
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Minerva anestesiologica · Nov 2016
ReviewFailure of statins in ARDS: the quest for the "Holy Grail" continues.
Experimental and clinical observational studies have shown potential benefits of statin administration in the acute respiratory distress syndrome (ARDS) by modulating inflammation and preventing worsening respiratory function. More recently, two randomized clinical trials failed to demonstrate an improved survival of ARDS patients treated with statins. In the first study, conducted by the ARDS Network, 745 patients with sepsis‑associated ARDS were randomized within 48-hours of onset to receive either rosuvastatin or placebo. ⋯ There was no significant difference between the study groups for number of ventilator‑free days (primary outcome, 13±10 in the simvastatin vs. 12±10 in the placebo group, P=0.21) or 28-day mortality (22% vs. 27%, respectively; P=0.23). No significant difference in serious adverse events was reported between groups. Herein, we discuss the main reasons for these negative findings and consider where there could be a role for statins in ARDS patients.