Abstract:
BACKGROUND:Intravenous crystalloid solutions are administered commonly for critically ill patients. We performed this meta-analysis of randomized trials with trial sequential analysis (TSA) to evaluate effects of chloride content of intravenous crystalloid solutions on clinical outcomes among critically ill adult patients. METHODS:Electronic databases were searched up to June 1, 2018, for randomized trials of use of balanced crystalloids versus 0.9% saline solutions in critically ill adult patients. The outcome variables included mortality, renal outcomes, serum content alterations and organ function. Subgroup analysis was conducted according to patient settings, types or volume of crystalloid fluid, or among sepsis versus non-sepsis, TBI versus non-TBI or subpopulations by the categories of baseline kidney function. Random errors were evaluated by trial sequential analysis. RESULTS:Eight studies with 19,301 patients were analyzed. A trend of in-hospital survival benefit with no statistical difference could be observed with balanced crystalloids compared with 0.9% saline (RR 0.92, 95% CI 0.85-1.0, p = 0.06). The use of balanced crystalloid solutions was associated with longer RRT-free days (SMD 0.09, 95% CI 0.06-0.12, p < 0.001), less risk of increase in serum concentrations of chloride (SMD - 1.23, 95% CI - 1.59 to - 0.87, p < 0.001) and sodium (SMD - 1.28, 95% CI - 1.65 to - 0.92, p < 0.001), less risk of decline in serum base deficit (SMD - 0.58, 95% CI - 0.98 to - 0.18, p = 0.004), longer ventilator-free days (SMD 0.08, 95% CI 0.05-0.11, p < 0.001) and vasopressor-free days (SMD 0.04, 95% CI 0.00-0.07, p = 0.02). Subgroup analysis showed that balanced crystalloid solutions were associated with a reduced in-hospital mortality rate among septic patients (RR 0.86, 95% CI 0.75-0.98; p = 0.02) and non-traumatic brain injury patients (RR 0.90, 95% CI 0.82-0.99, p = 0.02), while the TSA results indicated a larger sample size is still in need. CONCLUSIONS:Limited evidence supported statistical survival benefit with balanced crystalloid solutions, while it benefited in reducing organ support duration and fluctuations in serum electrolyte and base excess and was associated with decreased in-hospital mortality in subpopulation with sepsis and non-TBI. Large-scale rigorous randomized trials with better designs are needed to provide robust evidence for clinical management. Trial registration The protocol for this meta-analysis was registered on PROSPERO: International prospective register of systematic reviews (CRD42018102661), https://www.crd.york.ac.uk/prospero/#recordDetails.
journal_name
Ann Intensive Carejournal_title
Annals of intensive careauthors
Xue M,Zhang X,Liu F,Chang W,Xie J,Xu J,Yang Y,Qiu Hdoi
10.1186/s13613-019-0506-ysubject
Has Abstractpub_date
2019-02-13 00:00:00pages
30issue
1issn
2110-5820pii
10.1186/s13613-019-0506-yjournal_volume
9pub_type
杂志文章abstract:BACKGROUND:Changeovers of norepinephrine infusion pumps (CNIPs) frequently lead to haemodynamic instability. The aim of this study was to identify risk factors for haemodynamic instability associated with CNIP, independent of the method used to perform the relay. METHODS:We performed a prospective study, in a universi...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-016-0139-3
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:The data on incidence, clinical presentation, and outcomes of ventilator-associated pneumonia (VAP) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia requiring mechanical ventilation (MV) are limited. We performed this retrospective cohort study to assess frequency, clinical characteristi...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-020-00775-4
更新日期:2020-11-23 00:00:00
abstract:BACKGROUND:Despite advances in supportive care, moderate-severe acute respiratory distress syndrome (ARDS) is associated with high mortality rates, and novel therapies to treat this condition are needed. Compelling pre-clinical data from mouse, rat, sheep and ex vivo perfused human lung models support the use of human ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-014-0022-z
更新日期:2014-07-03 00:00:00
abstract:BACKGROUND:Patients in the intensive care unit (ICU) are more prone to drug-drug interactions (DDIs). The software and charts that indicate all interactions may not be proper for clinical usage. This study aimed to identify the main drug classes associated with clinically significant DDIs in cardiothoracic ICU and cate...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-015-0086-4
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:The Lung Injury Score (LIS) remains a commonly utilized measure of lung injury severity though the additive value of LIS to predict ARDS outcomes over the recent Berlin definition of ARDS, which incorporates severity, is not known. METHODS:We tested the association of LIS (in which scores range from 0 to 4,...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/2110-5820-4-4
更新日期:2014-02-18 00:00:00
abstract:BACKGROUND:The choice of empirical antimicrobial therapy for pneumonia in intensive care unit (ICU) is a challenge, since pneumonia is often related to multidrug-resistant pathogens, particularly extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E). To prevent the overuse of broad-spectrum antimicrobial ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-017-0237-x
更新日期:2017-12-01 00:00:00
abstract::In the past, the only treatment of acute exacerbations of obstructive diseases with hypercapnic respiratory failure refractory to medical treatment was invasive mechanical ventilation (IMV). Considerable technical improvements transformed extracorporeal techniques for carbon dioxide removal in an attractive option to ...
journal_title:Annals of intensive care
pub_type: 杂志文章,评审
doi:10.1186/s13613-019-0551-6
更新日期:2019-07-02 00:00:00
abstract::This review examines the available evidence for targeting a specific mean arterial pressure (MAP) in sepsis resuscitation. The clinical data suggest that targeting an MAP of 65-70 mmHg in patients with septic shock who do not have chronic hypertension is a reasonable first approximation. Whereas in patients with chron...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-015-0085-5
更新日期:2015-12-01 00:00:00
abstract::The majority of resuscitated patients present with underlying cardiac disease, and out of these myocardial infarction is most common. Immediate interventional treatment is recommended and routinely requires dual antiplatelet therapy including aspirin and a P2Y12-inhibitor. Therapeutic hypothermia or target temperature...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0366-x
更新日期:2018-02-21 00:00:00
abstract:BACKGROUND:Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS-CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-017-0350-x
更新日期:2018-01-10 00:00:00
abstract:BACKGROUND:Extracorporeal cardiopulmonary resuscitation (ECPR) has been considered in selected candidates with potentially reversible causes during a limited period. Candidate selection and the identification of predictable conditions are important factors in determining outcomes during CPR in the emergency department ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-017-0309-y
更新日期:2017-08-30 00:00:00
abstract:BACKGROUND:Noninvasive ventilation (NIV) is the first-line treatment of adult patients with exacerbations of cystic fibrosis (CF). High-flow nasal oxygen therapy (HFNT) might benefit patients with hypoxemia and can reduce physiological dead space. We hypothesized that HFNT and NIV would similarly reduce work of breathi...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0432-4
更新日期:2018-09-05 00:00:00
abstract:BACKGROUND:The clinical interest of using bubble humidification of oxygen remains controversial. This study was designed to further explore whether delivering dry oxygen instead of bubble-moistened oxygen had an impact on discomfort of ICU patients. METHODS:This randomized multicenter non-inferiority open trial includ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0472-9
更新日期:2018-12-17 00:00:00
abstract:: Critically ill adult patients often require multiple examinations in the hospital and need transport from one department to another, or even between hospitals. However, to date, no guidelines exist regarding optimum practices for transport of these fragile patients. We present recommendations for intrahospital transp...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/2110-5820-2-1
更新日期:2012-02-03 00:00:00
abstract:BACKGROUND:We performed a meta-analysis of randomized controlled trials (RCTs) to determine if daily bathing with chlorhexidine decreased hospital-acquired BSIs in critically ill patients. METHODS:We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases to identify randomized contr...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-015-0073-9
更新日期:2015-12-01 00:00:00
abstract::Pharmacological interventions are commonly considered in acute respiratory distress syndrome (ARDS) patients. Inhaled nitric oxide (iNO) and neuromuscular blockers (NMBs) are used in patients with severe hypoxemia. No outcome benefit has been observed with the systematic use of iNO. However, a sometimes important impr...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/2110-5820-3-20
更新日期:2013-07-03 00:00:00
abstract:BACKGROUND:Optimal anti-bacterial activity of meropenem requires maintenance of its plasma concentration (Cp) above the minimum inhibitory concentration (MIC) of the pathogen for at least 40% of the dosing interval (fT > MIC > 40). We aimed to determine whether a 3-h extended infusion (EI) of meropenem achieves fT > MI...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-019-0622-8
更新日期:2020-01-10 00:00:00
abstract:BACKGROUND:Lactate is a robust prognostic marker for the outcome of critically ill patients. Several small studies reported that metformin users have higher lactate levels at ICU admission without a concomitant increase in mortality. However, this has not been investigated in a larger cohort. We aimed to determine whet...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-020-00652-0
更新日期:2020-03-26 00:00:00
abstract:BACKGROUND:Data on respiratory mechanics of COVID-19 ARDS patients are scarce. Respiratory mechanics and response to positive expiratory pressure (PEEP) may be different in obese and non-obese patients. METHODS:We investigated esophageal pressure allowing determination of transpulmonary pressures (PL ) and elastances ...
journal_title:Annals of intensive care
pub_type: 信件
doi:10.1186/s13613-020-00745-w
更新日期:2020-10-01 00:00:00
abstract:UNLABELLED: BACKGROUND:A history of prolonged and excessive consumption of alcohol increases the risk for infections. The goal of this study was to investigate circulating white blood cells (WBC) differentiated by flow cytometry and neutrophil CD64 expression in excessive alcohol drinkers versus abstinent or moderate ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/2110-5820-2-50
更新日期:2012-12-31 00:00:00
abstract:BACKGROUND:Many maneuvers assessing fluid responsiveness (minifluid challenge, lung recruitment maneuver, end-expiratory occlusion test, passive leg raising) are considered as positive when small variations in cardiac index, stroke volume index, stroke volume variation or pulse pressure variation occur. Pulse contour a...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-019-0590-z
更新日期:2019-10-11 00:00:00
abstract::The 2018 Paris Intensive Care symposium entitled "Update in Neurocritical Care" was organized in Paris, June 21-22, 2018, under the auspices of the French Intensive Care Society. This 2-day post-graduate educational symposium comprised several chapters, aiming first to provide all-board intensivists with current stand...
journal_title:Annals of intensive care
pub_type: 杂志文章,评审
doi:10.1186/s13613-019-0523-x
更新日期:2019-04-16 00:00:00
abstract:: Cancer is a leading cause of death in children. In the past decades, there has been a marked increase in overall survival of children with cancer. However, children whose treatment includes hematopoietic stem cell transplantation still represent a subpopulation with a higher risk of mortality. These improvements in m...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/2110-5820-2-14
更新日期:2012-06-12 00:00:00
abstract:BACKGROUND:Aneurysmal subarachnoid hemorrhage (SAH) is a serious condition associated with high mortality rates and long-term disability. We investigated the impact of fluid balance on neurologic outcome after adjustment for possible confounders related to intensive care therapy and extra-cerebral organ failure during ...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-016-0128-6
更新日期:2016-12-01 00:00:00
abstract:INTRODUCTION:Capillary leak in critically ill patients leads to interstitial edema. Fluid overload is independently associated with poor prognosis. Bedside measurement of intra-abdominal pressure (IAP), extravascular lung water index (EVLWI), fluid balance, and capillary leak index (CLI) may provide a valuable prognost...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/2110-5820-2-S1-S1
更新日期:2012-07-05 00:00:00
abstract:BACKGROUND:As the population ages and cancer therapies improve, there is an increased call for elderly cancer patients to be admitted to the intensive care unit (ICU). This study aimed to assess short-term survival and prognostic factors in critically ill patients with solid tumors aged ≥65 years. METHODS:We conducted...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-017-0250-0
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:The consequences of the ageing population concerning ICU hospitalisation need to be adequately described. We believe that this discussion should be disease specific. A focus on respiratory infections is of particular interest, because it is strongly associated with old age. Our objective was to assess trends...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0430-6
更新日期:2018-08-15 00:00:00
abstract::Anemia and red blood cell (RBC) transfusion occur frequently in hospitalized patients with cardiac disease. In this narrative review, we report the epidemiology of anemia and RBC transfusion in hospitalized adults and children (excluding premature neonates) with cardiac disease, and on the outcome of anemic and transf...
journal_title:Annals of intensive care
pub_type: 杂志文章,评审
doi:10.1186/2110-5820-4-16
更新日期:2014-06-02 00:00:00
abstract:BACKGROUND:The use of novel sepsis biomarkers has increased in recent years. However, their prognostic value with respect to illness severity has not been explored. In this work, we examined the ability of mid-regional proadrenomedullin (MR-proADM) in predicting mortality in sepsis patients with different degrees of or...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-017-0238-9
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:In randomised controlled trials, procalcitonin (PCT)-guided antibiotic treatment has been proven to significantly reduce length of antibiotic therapy in intensive care unit (ICU) patients. However, concern was raised on low protocol adherence and high rates of overruling, and thus the value of PCT-guided tre...
journal_title:Annals of intensive care
pub_type: 杂志文章
doi:10.1186/s13613-018-0415-5
更新日期:2018-06-04 00:00:00