Abstract:
BACKGROUND:The efficacy of low-dose hydrocortisone therapy in the management of septic shock remains controversial in critical care for many years. Hence, we performed this meta-analysis of randomized controlled trials (RCTs) with trial sequential analysis (TSA) to evaluate its effect on clinical outcome among adult patients with septic shock. METHODS:We identified relevant RCTs published from inception to March 7, 2018 comparing low-dose hydrocortisone with placebo or no intervention in adults admitted to the intensive care unit (ICU) for septic shock. Meta-analyses were performed for the primary and secondary outcomes. The risk of bias was assessed using the Cochrane Collaboration's instrument. Trial sequential analysis was used to pool the results from the included studies for the primary outcomes. RESULTS:Thirteen studies were retrieved by our literature search strategy. There were no significant differences in 28-day mortality (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.81-1.00; P = .05) and hospital mortality (OR = 0.91, 95% CI = 0.82-1.02; P = .09) between the 2 groups, which were confirmed by TSA. However, there was a significant improvement in shock reversal in the hydrocortisone group (OR = 1.33, 95% CI = 1.02-1.72; P = .03). Furthermore, subgroup analyses revealed that hydrocortisone plus fludrocortisone statistically reduced the rate of 28-day mortality (OR = 0.79, 95% CI = 0.64-0.97; P = .03), ICU mortality (OR = 0.77, 95% CI = 0.63-0.95; P = .02), and hospital mortality (OR = 0.77, 95% CI = 0.63-0.95; P = .01) in comparison with the placebo, the results were also confirmed by TSA. CONCLUSION:Among adult patients with septic shock, the use of low-dose hydrocortisone compared with control did not confer overall survival benefits, albeit improving shock reversal rate. The benefit of reducing 28-day mortality, ICU mortality, and hospital mortality was observed in combination use of hydrocortisone and fludrocortisone.
journal_name
J Intensive Care Medjournal_title
Journal of intensive care medicineauthors
Lyu QQ,Chen QH,Zheng RQ,Yu JQ,Gu XHdoi
10.1177/0885066618803062subject
Has Abstractpub_date
2020-10-01 00:00:00pages
971-983issue
10eissn
0885-0666issn
1525-1489journal_volume
35pub_type
杂志文章abstract:INTRODUCTION:Visualization of B-lines via lung ultrasound provides a non-invasive estimation of pulmonary hydration. Extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) assessed by transpulmonary thermodilution (TPTD) represent the most validated parameters of lung water and alveoloc...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066620967655
更新日期:2020-11-05 00:00:00
abstract::The management of the critically ill patients with asthma can be rather challenging. Potentially devastating complications relating to this presentation include hypoxemia, worsening bronchospasm, pulmonary aspiration, tension pneumothorax, dynamic hyperinflation, hypotension, dysrhythmias, and seizures. In contrast to...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066617740079
更新日期:2018-09-01 00:00:00
abstract::A systematic review of the literature was conducted to determine if the administration of methylene blue in humans improves hemodynamic status and/or outcome in patients with septic shock. Studies were identified from MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials database. The review included...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066606290671
更新日期:2006-11-01 00:00:00
abstract::The treatment of sepsis is an ongoing challenge for clinicians; despite the wide choice of effective antibiotics to treat infection, sepsis remains the leading cause of morbidity and mortality for patients admitted to an intensive care unit. Dysregulation of the immune response is now recognized to be a key factor in ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066611425759
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVE::To analyze the management and outcome of patients with refractory respiratory failure complicating severe Legionella pneumonia rescued with extracorporeal membrane oxygenation (ECMO) in our Center. DESIGN AND SETTING::Observational study of patients with refractory respiratory failure treated with ECMO in H...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066617700121
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:Aspiration past the tracheal tube cuff has been recognized to be a risk factor for the development of ventilator-associated pneumonia (VAP). This study investigated the effect of closed tracheal suctioning on aspiration of fluid past the tracheal tube cuff in an in vitro benchtop model. METHODS:High-volume ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066610392516
更新日期:2011-09-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of high-flow nasal cannula oxygen (HFNO) therapy on hospital length of stay (LOS) and postoperative pulmonary complications (PPCs) in adult postoperative patients. DATA SOURCES:PubMed, Embase, the Cochrane Library, Web of Science of Studies, China National Knowledge Index, and Wan Fang...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066618817718
更新日期:2020-10-01 00:00:00
abstract::Decision-making for the hospitalized dying and critically ill is often characterized by an understanding of autonomy that leads to clinical care and outcomes that are antithetical to patients' preferences around suffering and quality of life. A better understanding of autonomy will facilitate the ultimate goal of a pa...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619870458
更新日期:2020-11-01 00:00:00
abstract:PURPOSE:We evaluated the effects of after-hours/nighttime patient transfers out of the ICU on patient outcomes, by performing a systematic review and meta-analysis (PROSPERO CRD 42017074082). DATA SOURCES:MEDLINE, PubMed, EMBASE, Google Scholar, CINAHL, and the Cochrane Library from 1987-November 2019. Conference abst...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066620984410
更新日期:2020-12-28 00:00:00
abstract:BACKGROUND:Cognitive impairment after sepsis is an important clinical problem. Determinants of postseptic cognitive impairment are not well understood. We thus undertook a systems biology approach to exploring a possible role for apolipoprotein E (APOE) in postseptic cognitive impairment. DESIGN:Prospective, observati...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619897604
更新日期:2020-01-09 00:00:00
abstract:BACKGROUND:Use of checklists brings about improvements in a variety of patient outcomes. Nevertheless, whether compliance with a nurse-led intensive care unit (ICU) checklist produces the same effect is currently unknown. METHODS:This is a retrospective analysis of data obtained during the implementation of a quality ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066614533910
更新日期:2016-05-01 00:00:00
abstract::Primary and acquired abdominal pathology accounts for a significant proportion of sepsis and SIRS in the ICU population. Abdominal processes often present a difficult diagnostic dilemma in the truly critically ill patient who, due to hemodynamic instability or severe acute respiratory distress syndrome (ARDS) requirin...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066613492102
更新日期:2015-07-01 00:00:00
abstract::We report the success rate and complications of peripherally inserted central catheters (PICCs) in patients hospitalized in an intensive care unit (ICU). We performed a cohort study in the ICU of a large tertiary care, university-affiliated community hospital. All ICU patients for whom their attending physicians reque...
journal_title:Journal of intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1177/088506669601100107
更新日期:1996-01-01 00:00:00
abstract:OBJECTIVES:We report the case of a 28-year-old patient with systemic lupus erythematosus (SLE) with rapid onset of dyspnea and hemoptysis found to have diffuse alveolar hemorrhage (DAH) with refractory hypoxemia successfully treated with venovenous extracorporeal membrane oxygenation (ECMO). The discussion includes cli...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066612464335
更新日期:2014-03-01 00:00:00
abstract::The authors retrospectively review their experience with low immunoglobulin G (IgG) levels in a pediatric ICU population over a 12-month period. The total IgG level was below the normal for age in 14 of the 20 patients. The 14 patients with a low IgG level were younger and weighed less when compared with the 6 patient...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066603255905
更新日期:2003-09-01 00:00:00
abstract::Pulmonary embolus (PE) is estimated to cause 200 000 to 300 000 deaths annually. Many deaths occur in hemodynamically unstable patients and the estimated mortality for inpatients with hemodynamic instability is between 15% and 25%. The diagnosis of PE in the critically ill is often challenging because the presentation...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066610392658
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:Agitation is common in the intensive care unit (ICU). Although antipsychotics are frequently used as first-line therapy, chlorpromazine has fallen out of favor due to risk of cardiovascular complications and severe hypotension. Although chlorpromazine is used anecdotally, there is a lack of data regarding it...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066618818787
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:Atrial fibrillation (AF) portends poor prognoses in intensive care unit patients with sepsis. However, AF research is challenging: Previous studies demonstrate that International Classification of Disease (ICD) codes may underestimate the incidence of AF, but chart review is expensive and often not feasible....
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619866172
更新日期:2019-10-01 00:00:00
abstract:PURPOSE:To characterize physicians' stated practices in the treatment of patients with severe acute alcohol withdrawal syndrome (sAAWS) and to use intravenous (IV) phenobarbital as an adjuvant treatment for sAAWS. METHODS:A multidisciplinary, cross-sectional, self-administered survey at 2 large academic centers specia...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619847119
更新日期:2020-11-01 00:00:00
abstract::Early predictors of prognosis in comatose patients post cardiac arrest help inform decisions surrounding continuation or withdrawal of treatment and provide a framework on which to better inform relatives of the likely outcome. Markers defined prior to the widespread use of therapeutic hypothermia post arrest may no l...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066613511045
更新日期:2018-04-01 00:00:00
abstract::Intracerebral hemorrhage (ICH) in patients with oral anticoagulation therapy is an increasingly prevalent problem in large part due to the aging population and the increased use of anticoagulants for patients at high risk of thrombosis. Warfarin has been virtually the only outpatient anticoagulant choice until fairly ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066613488732
更新日期:2015-02-01 00:00:00
abstract:PURPOSE:Atrial fibrillation (AF) is common in the intensive care unit (ICU), notably in patients with septic shock for whom inflammation is an already identified risk factor. The aim of this study was to evaluate the effect of low-dose hydrocortisone on AF occurrence in patients with septic shock. METHODS:We performed...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066617696847
更新日期:2019-03-01 00:00:00
abstract::The purpose of this study was to analyze the relationship of intrahospital transport patterns with patient throughput and outcomes in an oncological intensive care unit. We retrospectively reviewed all patients admitted to a closed medical-surgical intensive care unit at a cancer center between January 1, 2004 and Dec...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066608329946
更新日期:2009-03-01 00:00:00
abstract::Video laryngoscopy has demonstrated utility in airway management. For the present case series, we report the use of video laryngoscopy to evaluate the airway of critically ill, mechanically ventilated patients, as a means to reduce the risk of immediate postextubation stridor by assessing the degree of laryngeal edema...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066612437528
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVE:To describe intubation practices and duration of mechanical ventilation in children with status asthmaticus admitted from emergency departments (ERs) to pediatric intensive care units (PICUs). DESIGN:Retrospective cohort study using the Virtual PICU Performance System database (VPS, LLC) of children with sta...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066613476446
更新日期:2014-05-01 00:00:00
abstract:UNLABELLED:While clinicians' management of severe sepsis and septic shock has been positively influenced by a number of clinical research studies in the last decade, challenges remain regarding early hemodynamic optimization as envisioned in the Surviving Sepsis Campaign's (SSC) resuscitation bundle (RB). We examined t...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066610392499
更新日期:2011-09-01 00:00:00
abstract::Cardiac transplantation has now become accepted therapy for the treatment of end-stage heart disease in both children and adults, and literally thousands of patients are bearers of cardiac grafts. Because of these patients' susceptibility to infections, rejection, coronary disease, and malignancy, as well as to serio...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/088506669100600201
更新日期:1991-03-01 00:00:00
abstract:PURPOSE:We previously developed a bedside model (I-TRACH), which used commonly obtained data at the time of intubation to predict the duration of mechanical ventilation (MV). We now sought to validate this in a prospective trial. METHODS:A prospective, observational study of 225 consecutive adult medical intensive car...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066616679974
更新日期:2018-10-01 00:00:00
abstract::Antibacterial resistance is increasing throughout the world, while the development of new agents is slowly progressing. In addition, the increasing prevalence of fluoroquinolone resistance may force many practitioners to choose an aminoglycoside agent in gram-negative regimens. Aminoglycosides are bactericidal agents ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066610377968
更新日期:2010-11-01 00:00:00
abstract:BACKGROUND:SARS-CoV2 can cause pulmonary failure requiring prolonged invasive mechanical ventilation (MV). Lung protective ventilation strategies are recommended in order to minimize ventilator induced lung injury. Whether patients with COVID-19 have the same risk for complications including barotrauma is still unknown...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066620954364
更新日期:2020-09-22 00:00:00