Articles: intensive-care-units.
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Meta Analysis
Anticoagulation therapy in hospitalized patients with COVID-19: a meta-analysis of randomized clinical trials.
Thromboembolic events are common in hospitalized patients with COVID-19, suggesting that SARS-CoV-2 infection may be related to a prothrombotic state. Several clinical trials evaluating different anticoagulation strategies were developed. Thus, we proposed conducting a meta-analysis of randomized clinical trials that evaluated the efficacy and safety of therapeutic anticoagulation with heparins in hospitalized patients with COVID-19. ⋯ This meta-analysis did not show a reduction in all-cause mortality in hospitalized patients with COVID-19 who received anticoagulation with heparin at a therapeutic dose compared to those who received a prophylactic/intermediate dose, as well as no significant differences were found in the need of intensive care unit admission or use of non-invasive ventilation. There was, however, a reduction in thromboembolic events, pulmonary embolism, and increased bleeding (Tab. 1, Fig. 5, Ref. 31). Keywords: COVID-19, anticoagulation, heparins, meta-analysis.
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Pediatr Crit Care Me · Jan 2023
Multicenter StudyAdverse Events in Pediatric Critical Care Nonsurvivors With a Low Predicted Mortality Risk: A Multicenter Case Control Study.
Some patients with a low predicted mortality risk in the PICU die. The contribution of adverse events to mortality in this group is unknown. The aim of this study was to estimate the occurrence of adverse events in low-risk nonsurvivors (LN), compared with low-risk survivors (LS) and high-risk PICU survivors and nonsurvivors, and the contribution of adverse events to mortality. ⋯ Significant and preventable adverse events were found in low-risk PICU nonsurvivors. 76.5% of LN had one or more adverse events. In 30.4% of LN, an adverse event contributed to mortality.
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Anaesth Intensive Care · Jan 2023
Oral midodrine does not expedite liberation from protracted vasopressor infusions: A case-control study.
Vasopressor dependence is a common problem affecting patients in the recovery phase of critical illness, often necessitating intensive care unit (ICU) admission and other interventions which carry associated risks. Midodrine is an orally administered vasopressor which is commonly used off-label to expedite weaning from vasopressor infusions and facilitate discharge from ICU. We performed a single-centre, case-control study to assess whether midodrine accelerated liberation from vasopressor infusions in patients who were vasopressor dependent. ⋯ Midodrine use in cases was not associated with faster weaning of intravenous (IV) vasopressors (26 h versus 24 h for controls, P = 0.51), ICU or hospital length of stay after adjustment for confounders. Midodrine did not affect mean heart rate but was associated with bradycardia. This case-control study demonstrates that midodrine has limited efficacy in expediting weaning from vasopressor infusions in patients who have already received relatively prolonged courses of these infusions.
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In critically ill patients, acute kidney injury (AKI) is a common complication with very high mortality rates. Several studies indicated that statin therapy, primarily due to its so-called pleiotropic effects, may beneficially affect the course of the disease, otherwise leading to significant clinical complications. However, both the original research as well as available meta-analyses on these associations report equivocal results. This leaves open a question whether pre- and perioperative statins might prevent AKI and improve overall prognosis in patients undergoing surgery. ⋯ Our analysis showed a significant association between statin therapy and overall mortality of critically ill surgical patients diagnosed with AKI, while at the same time the use of statins did not affect the length of their stay in ICU.
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In many rural trauma systems injured patients are initially evaluated at a local hospital, and once stabilized transferred to a trauma center for definitive care. In the U.S. most trauma transfers occur as emergency department (ED) to ED transfers, however there is little evidence to guide systems in whether this is beneficial. We implemented a practice change in August 2018, changing from commonly admitting trauma transfers directly to the floor, to a protocol for ED to ED transfer for all trauma patients. We aimed to evaluate this practice change and its effects on outcomes and ED length of stay. ⋯ Implementing an ED pitstop protocol for trauma transfers led to decreased direct admissions, without increasing the ED length of stay, and less need for delayed imaging.