2015 Dec - Interventions for treating gas gangrene

Yang Z, Hu J, Qu Y, Sun F, Leng X, Li H, Zhan S.; Cochrane Database Syst Rev. 2015 Dec 3;12:CD010577. [Epub ahead of print] Review.

BACKGROUND: Gas gangrene is a rapidly progressive and severe disease that results from bacterial infection, usually as the result of an injury; it has a high incidence of amputation and a poor prognosis. It requires early diagnosis and comprehensive treatments, which may involve immediate wound debridement, antibiotic treatment, hyperbaric oxygen therapy, Chinese herbal medicine, systemic support, and other interventions. The efficacy and safety of many of the available therapies have not been confirmed.

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2015 Dec - The accuracy of presepsin for the diagnosis of sepsis from SIRS: a systematic review and meta-analysis

Zheng Z, Jiang L, Ye L, Gao Y, Tang L, Zhang M. Ann Intensive Care. 2015 Dec;5(1):48. Epub 2015 Dec 8.

BACKGROUND: Sepsis is a common condition that has a high mortality and morbidity that need prompt diagnosis and treatment. Biomarkers like Soluble CD14 subtype (sCD14-ST, presepsin) may be useful in identifying patients with sepsis and its diagnostic superiority has been confirmed by several preliminary studies. The aim of this study was systematically and quantitatively to evaluate the value of presepsin for the diagnosis of sepsis through the method of meta-analysis.

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2015 Nov - Cerebral salt wasting after traumatic brain injury: a review of the literature

Leonard J, Garrett RE, Salottolo K, Slone DS, Mains CW, Carrick MM, Bar-Or D.; Scand J Trauma Resusc Emerg Med. 2015 Nov 11;23(1):98.

Electrolyte imbalances are common among patients with traumatic brain injury (TBI). Cerebral salt wasting (CSW) is an electrolyte imbalance characterized by hyponatremia and hypovolemia. Differentiating the syndrome of inappropriate antidiuretic hormone and CSW remains difficult and the pathophysiological mechanisms underlying CSW are unclear.

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2015 Nov - Prone position for acute respiratory failure in adults

Bloomfield R, Noble DW, Sudlow A.; Cochrane Database Syst Rev. 2015 Nov 13;11:CD008095. [Epub ahead of print]

BACKGROUND: Acute hypoxaemia de novo or on a background of chronic hypoxaemia is a common reason for admission to intensive care and for provision of mechanical ventilation. Various refinements of mechanical ventilation or adjuncts are employed to improve patient outcomes. Mortality from acute respiratory distress syndrome, one of the main contributors to the need for mechanical ventilation for hypoxaemia, remains approximately 40%. Ventilation in the prone position may improve lung mechanics and gas exchange and could improve outcomes.

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2015 Nov - Randomized Pilot Trial of Endotracheal Tubes to Prevent Ventilator-Associated Pneumonia

Deem S, Yanez D, Sissons-Ross L, Elrod-Broeckel JA, Daniel S, Treggiari M.; Ann Am Thorac Soc. 2015 Nov 2. [Epub ahead of print]

INTRODUCTION: Ventilator-associated pneumonia (VAP) is a prevalent and expensive nosocomial infection related to instrumentation of the airway with an endotracheal tube (ETT), enabling microaspiration of contaminated secretions. Modification of the ETT design to reduce microaspiration and/or biofilm formation may play an important role in VAP prevention. However, there is insufficient evidence to provide strong recommendations regarding the use of modified ETT and unaddressed safety concerns. We performed a pilot, randomized controlled trial comparing two modified ETTs designed specifically to prevent VAP, with the standard ETT to test the feasibility of and inform planning for a large, pivotal randomized trial.

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2015 Nov - Meta-analysis of colloids versus crystalloids in critically ill, trauma and surgical patients

Qureshi SH, Rizvi SI, Patel NN, Murphy GJ.; Br J Surg. 2015 Nov 2. doi: 10.1002/bjs.9943. [Epub ahead of print]

BACKGROUND: There is uncertainty regarding the safety of different volume replacement solutions. The aim of this study was systematically to review evidence of crystalloid versus colloid solutions, and to determine whether these results are influenced by trial design or clinical setting.

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2015 Nov - Endovascular vs medical management of acute ischemic stroke

Chen CJ, Ding D, Starke RM, Mehndiratta P, Crowley RW, Liu KC, Southerland AM, Worrall BB.; Neurology. 2015 Nov 4. pii: 10.1212/WNL.0000000000002176. [Epub ahead of print]

OBJECTIVE: To compare the outcomes between endovascular and medical management of acute ischemic stroke in recent randomized controlled trials (RCT).

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2015 Nov - Early Magnesium Treatment After Aneurysmal Subarachnoid Hemorrhage: Individual Patient Data Meta-Analysis

Dorhout Mees SM, Algra A, Wong GK, Poon WS, Bradford CM, Saver JL, Starkman S, Rinkel GJ, van den Bergh WM; writing groups of MASH-I, IMASH, MASH-II, MASH and FAST-MAG; Collaborators.Stroke. 2015 Nov;46(11):3190-3.

BACKGROUND AND PURPOSE: Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Trials of magnesium treatment starting <4 days after symptom onset found no effect on poor outcome or DCI in SAH. Earlier installment of treatment might be more effective, but individual trials had not enough power for such a subanalysis. We performed an individual patient data meta-analysis to study whether magnesium is effective when given within different time frames within 24 hours after the SAH.

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2015 Oct - The traditional vs “1:1:1” approach debate on massive transfusion in trauma should not be treated as a dichotomy

Ho AM, Holcomb JB, Ng CS, Zamora JE, Karmakar MK, Dion PW.; Am J Emerg Med. 2015 Oct;33(10):1501-4.

Traditional transfusion guidelines suggest that fresh frozen plasma (FFP) should be given based on laboratory or clinical evidence of coagulopathy or acute loss of 1 blood volume. This approach tends to result in a significant lag time between the first units of erythrocytes and FFP in trauma requiring massive transfusion. In severe trauma, observational studies have found an association between increased survival and aggressive use of FFP and platelets such that FFP:platelet:erythrocyte ratio approaches 1:1:1 to 2 from the first units of erythrocytes given.

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2015 Sep - Thrombolytic therapy for pulmonary embolism

Hao Q, Dong BR, Yue J, Wu T, Liu GJ.; Cochrane Database Syst Rev. 2015 Sep 30;9:CD004437

BACKGROUND: Thrombolytic therapy (powerful anticoagulation drugs) is usually reserved for patients with clinically serious or massive pulmonary embolism (PE). Evidence suggests that thrombolytic agents may dissolve blood clots more rapidly than heparin and reduce the death rate associated with PE. However, there are still concerns about the possible risk of adverse effects of thrombolytic therapy, such as major or minor haemorrhages. This is the second update of the Cochrane review first published in 2006.

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2015 Sep - Aggressive Blood Pressure Lowing Therapy in Patients with Acute Intracerebral Hemorrhage is Safe: A Systematic Review and Meta-analysis

Pan C, Hu Y, Liu N, Zhang P, Zhang YP, Aimaiti M, Deng H, Tang YX, Xu F, Zhu SQ, Tang ZP.; Chin Med J (Engl). 2015 20th Sep;128(18):2524-2529.

BACKGROUND: The influence of blood pressure (BP) lowering on intracerebral hemorrhage (ICH) patients is unclear. To assess the safety and efficacy of aggressive antihypertensive therapies in acute ICH patients, we carried out a systematic review and meta-analysis.

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2016 Oct - Meta-analysis of the association between preoperative anaemia and mortality after surgery

Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM.; Br J Surg. 2015 Oct;102(11):1314-24.

BACKGROUND: Numerous published studies have explored associations between anaemia and adverse outcomes after surgery. However, there are no evidence syntheses describing the impact of preoperative anaemia on postoperative outcomes.

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2015 Sep -Branched-chain amino acids for people with hepatic encephalopathy

Gluud LL, Dam G, Les I, Córdoba J, Marchesini G, Borre M, Aagaard NK, Vilstrup H.; Cochrane Database Syst Rev. 2015 Sep 17;9:CD001939.

BACKGROUND: Hepatic encephalopathy is a brain dysfunction with neurological and psychiatric changes associated with liver insufficiency or portal-systemic shunting. The severity ranges from minor symptoms to coma. A Cochrane systematic review including 11 randomised clinical trials on branched-chain amino acids (BCAA) versus control interventions has evaluated if BCAA may benefit people with hepatic encephalopathy.

OBJECTIVES: To evaluate the beneficial and harmful effects of BCAA versus any control intervention for people with hepatic encephalopathy.

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2015 Aug - Clinical management for patients admitted to a critical care unit with severe sepsis or septic shock

Cheung WK, Chau LS, Mak II, Wong MY, Wong SL, Tiwari AF.; Intensive Crit Care Nurs. 2015 Aug 17

BACKGROUND: The Surviving Sepsis Campaign promotes the use of norepinephrine as the first-line inotropic support for patients presenting with severe sepsis or septic shock in cases of persistent hypotension, despite adequate fluid resuscitation. However, there is little published evidence on how much noradrenaline is administered to such patients when admitted to the intensive care unit (ICU). The authors report the clinical management of this group of patients, with a special focus on the total amount and duration of norepinephrine infusion required.

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2015 Aug - High-volume plasma exchange in patients with acute liver failure: An open randomised controlled trial

Larsen FS, Schmidt LE, Bernsmeier C, Rasmussen A, Isoniemi H, Patel VC, Triatafyllou E, Bernal W, Auzinger G, Shawcross D, Eefsen M, Bjerring PN, Clemmesen JO, Hockerstedt K, Frederiksen HJ, Hansen BA, Antoniades CG, Wendon J.; J Hepatol. 2015 Aug 29. pii: S0168-8278(15)00590-5. doi: 10.1016/j.jhep.2015.08.018. [Epub ahead of print]

BACKGROUND: Acute liver failure (ALF) results in cardiovascular instability, renal failure, brain oedema and death either due to irreversible shock, cerebral herniation or development of multiple organ failure. High-volume plasma exchange (HVP), defined as exchange of 8-12 or 15% of ideal body weight with fresh fozen plasmain case series improves systemic, cerebral and splanchnic parameters.

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2015 Sep - Comparison of hydroxyethyl starch colloids with crystalloids for surgical patients: A systematic review and meta-analysis

Raiman M, Mitchell CG, Biccard BM, Rodseth RN. Eur J Anaesthesiol. 2015 Sep 8. [Epub ahead of print]

BACKGROUND: Fluid therapy is one of the most ubiquitous medical therapeutic interventions. There is a debate over whether colloids or crystalloids are better for fluid resuscitation. Recent large trials and meta-analyses suggest no mortality benefit and possible harm with hydroxyethyl starch (HES) use. However, these trials were conducted in critically ill and septic patients and their applicability to perioperative patients has been challenged.

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2015 Sep - Developments in the management and treatment of pulmonary embolism

Limbrey R, Howard L.; Eur Respir Rev. 2015 Sep;24(137):484-97. [Review]

Pulmonary embolism (PE) is a serious and costly disease for patients and healthcare systems. Guidelines emphasise the importance of differentiating between patients who are at high risk of mortality (those with shock and/or hypotension), who may be candidates for thrombolytic therapy or surgery, and those with less severe presentations.

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2015 Aug - Safety and efficacy of digoxin: systematic review and meta-analysis of observational and controlled trial data

Ziff OJ, Lane DA, Samra M, Griffith M, Kirchhof P, Lip GY, Steeds RP, Townend J, Kotecha D.; BMJ. 2015 Aug 30;351:h4451

OBJECTIVE: To clarify the impact of digoxin on death and clinical outcomes across all observational and randomised controlled trials, accounting for study designs and methods.

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2015 Aug - Changes in the Attitude and Practice Toward End-of-Life Care: Perspective of Chinese Physicians in Medical Department

Lam KW, Yeung KW, Lai KY, Cheng F.; Am J Hosp Palliat Care. 2015 Aug;32(5):549-54.

INTRODUCTION: End-of-life care is affected by the attitude and cultural influence of doctors.

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2015 Aug - Inferior Vena Cava Thrombosis Related to Hypothermia Catheter: Report of 20 Consecutive Cases

Reccius A, Mercado P, Vargas P, Canals C, Montes J.; Neurocrit Care. 2015 Aug;23(1):72-7.

BACKGROUND: Temperature management using endovascular catheters is an established therapy in neurointensive care. Nonetheless, several case series have reported a high rate of thrombosis related to the use of endovascular hypothermia catheters.

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