Systematic reviews
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Journal abstracts including those reporting systematic reviews (SR) should contain sufficiently clear and accurate information for adequate comprehension and interpretation. The aim was to compare the quality of reporting of abstracts of SRs including meta-analysis published in high-impact general medicine journals before and after publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for abstracts (PRISMA-A) released in April 2013. ⋯ Not surprisingly, the quality of reporting did not improve in 2014 and suboptimally improved in 2015. There is still room for improvement to meet the standards of PRISMA-A guidelines. Stricter adherence to these guidelines by authors, reviewers, and journal editors is highly warranted and will surely contribute to a better reporting.
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Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug pharmacokinetic limitations and minimize oversedation, thereby shortening the duration of mechanical ventilation. At present, it is unclear which strategy is most effective, as few have been directly compared. Our review will use network meta-analysis (NMA) to compare and rank sedation strategies to determine their efficacy and safety for mechanically ventilated patients. ⋯ PROSPERO CRD42016037480.
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Delirium is characterized by acute changes in mental status including inattention, disorganized thinking, and altered level of consciousness, and is highly prevalent in critically ill adults. Delirium has adverse consequences for both patients and the healthcare system; however, at this time, no effective treatment exists. The identification of effective prevention strategies is therefore a clinical and research imperative. An important limitation of previous reviews of delirium prevention is that interventions were considered in isolation and only direct evidence was used. Our systematic review will synthesize all existing data using network meta-analysis, a powerful statistical approach that enables synthesis of both direct and indirect evidence. ⋯ PROSPERO CRD42016036313.
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Sedation is an important consideration in the care of the neurocritically ill patient. It provides anxiety and relief, facilitates procedures and nursing tasks, and minimizes intolerance of mechanical ventilation. Alpha-2 agonists such as dexmedetomidine and clonidine have been shown to be an effective alternative in the general critical care population by reducing duration of mechanical ventilation and length of stay in the intensive care unit (ICU), as compared to traditional sedative agents such as propofol or benzodiazepines. However, there is a paucity of literature detailing their utility and safety in neurocritical care, a population that presents unique considerations for management of global and cerebral hemodynamics, agitation, and facilitation of neurological assessments. The objective of this review is to assess the efficacy and safety of alpha-2 agonists for non-procedural sedation in mechanically ventilated brain-injured patients. ⋯ PROSPERO CRD42016037045.
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Meta Analysis
Viscoelastic testing for hepatic surgery: a systematic review with meta-analysis-a protocol.
Viscoelastic tests, including thromboelastography (TEG) and rotational thromboelastometry (ROTEM), provide a global assessment of haemostatic function at the point of care. The use of a TEG or ROTEM system to guide blood product administration has been shown in some surgical settings to reduce transfusion requirements. The aim of this review is to evaluate all published evidence regarding viscoelastic testing in the setting of hepatic surgery. ⋯ PROSPERO CRD42016036732.