Glutamine dipeptide-supplemented parenteral nutrition improves the clinical outcomes of critically ill patients: A systematic evaluation of randomised controlled trials

2017 ◽  
Vol 17 ◽  
pp. 75-85 ◽  
Author(s):  
Peter Stehle ◽  
Björn Ellger ◽  
Dubravka Kojic ◽  
Astrid Feuersenger ◽  
Christina Schneid ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomised Controlled Trials ◽  
Systematic Evaluation ◽  
Controlled Trials ◽  
Randomised Controlled

Classification and effectiveness of different oxygenation goals in mechanically ventilated critically ill patients: network meta-analysis of randomised controlled trials

2021 ◽  
pp. 2002928
Author(s):  
Xu Zhao ◽  
Huaping Xiao ◽  
Feng Dai ◽  
Daniel Brodie ◽  
Lingzhong Meng
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Credible Interval ◽  
Controlled Trials ◽  
Survival Curves ◽  
Mechanically Ventilated ◽  
Secondary Outcomes ◽  
Randomised Controlled

BackgroundThe optimal oxygenation in mechanically ventilated critically ill patients remains unclear.MethodsRandomised controlled trials investigating different oxygenation goal-directed mechanical ventilation in critically ill adult patients were eligible. The trinary classification classified oxygenation goals into conservative (PaO2=55–90 mmHg), moderate (PaO2=90–150 mmHg), and liberal (PaO2>150 mmHg). The quadruple classification further divided the conservative goal from the trinary classification into far-conservative (PaO2=55–70 mmHg) and conservative (PaO2=70–90 mmHg) goals. The primary outcome was 30-day mortality. The secondary outcomes included intensive care unit, hospital, and 90-day mortalities. The effectiveness was estimated by the relative risk (RR) and 95% credible interval (CrI) using network meta-analysis and visualised using SUCRA scores and survival curves.ResultsWe identified eight eligible studies involving 2532 patients. There were no differences between conservative and moderate goals (RR, 1.08; 95% CrI, 0.85 to 1.36; moderate quality), between moderate and liberal goals (RR, 0.83; 95% CrI, 0.61 to 1.10, low quality), and between conservative and liberal goals (RR, 0.89; 95% CrI, 0.61 to 1.30, low quality) based on the trinary classification. No differences in secondary outcomes among the different goals. The results were consistent between the trinary and quadruple classifications. The SUCRA scores and survival curves suggested that the moderate goal in the trinary and quadruple classifications and the conservative goal in the quadruple classification may be superior to the liberal and far-conservative goals.ConclusionsDifferent oxygenation goals do not lead to different mortalities in mechanically ventilated critically ill patients. The potential superiority of maintaining PaO2 in the range of 70–150 mmHg remains to be validated.

scholarly journals Mucoactive agents for acute respiratory failure in the critically ill: a systematic review and meta-analysis

Thorax ◽  
2020 ◽  
Vol 75 (8) ◽  
pp. 623-631 ◽  
Author(s):  
Rohan Anand ◽  
Daniel F McAuley ◽  
Bronagh Blackwood ◽  
Chee Yap ◽  
Brenda ONeill ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomised Controlled

PurposeAcute respiratory failure (ARF) is a common cause of admission to intensive care units (ICUs). Mucoactive agents are medications that promote mucus clearance and are frequently administered in patients with ARF, despite a lack of evidence to underpin clinical decision making. The aim of this systematic review was to determine if the use of mucoactive agents in patients with ARF improves clinical outcomes.MethodsWe searched electronic and grey literature (January 2020). Two reviewers independently screened, selected, extracted data and quality assessed studies. We included trials of adults receiving ventilatory support for ARF and involving at least one mucoactive agent compared with placebo or standard care. Outcomes included duration of mechanical ventilation. Meta-analysis was undertaken using random-effects modelling and certainty of the evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation.ResultsThirteen randomised controlled trials were included (1712 patients), investigating four different mucoactive agents. Mucoactive agents showed no effect on duration of mechanical ventilation (seven trials, mean difference (MD) −1.34, 95% CI −2.97 to 0.29, I2=82%, very low certainty) or mortality, hospital stay and ventilator-free days. There was an effect on reducing ICU length of stay in the mucoactive agent groups (10 trials, MD −3.22, 95% CI −5.49 to −0.96, I2=89%, very low certainty).ConclusionOur findings do not support the use of mucoactive agents in critically ill patients with ARF. The existing evidence is of low quality. High-quality randomised controlled trials are needed to determine the role of specific mucoactive agents in critically ill patients with ARF.PROSPERO registration numberCRD42018095408.

scholarly journals Stability of ARDS subphenotypes over time in two randomised controlled trials

Thorax ◽  
2018 ◽  
Vol 73 (5) ◽  
pp. 439-445 ◽  
Author(s):  
Kevin Delucchi ◽  
Katie R Famous ◽  
Lorraine B Ware ◽  
Polly E Parsons ◽  
B Taylor Thompson ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Outcomes ◽  
Randomised Controlled Trials ◽  
Latent Class ◽  
Lung Protective Ventilation ◽  
Controlled Trials ◽  
Transition Analysis ◽  
Class 1 ◽  
Randomised Controlled ◽  
Over Time

RationaleTwo distinct acute respiratory distress syndrome (ARDS) subphenotypes have been identified using data obtained at time of enrolment in clinical trials; it remains unknown if these subphenotypes are durable over time.ObjectiveTo determine the stability of ARDS subphenotypes over time.MethodsSecondary analysis of data from two randomised controlled trials in ARDS, the ARMA trial of lung protective ventilation (n=473; patients randomised to low tidal volumes only) and the ALVEOLI trial of low versus high positive end-expiratory pressure (n=549). Latent class analysis (LCA) and latent transition analysis (LTA) were applied to data from day 0 and day 3, independent of clinical outcomes.Measurements and main resultsIn ALVEOLI, LCA indicated strong evidence of two ARDS latent classes at days 0 and 3; in ARMA, evidence of two classes was stronger at day 0 than at day 3. The clinical and biological features of these two classes were similar to those in our prior work and were largely stable over time, though class 2 demonstrated evidence of progressive organ failures by day 3, compared with class 1. In both LCA and LTA models, the majority of patients (>94%) stayed in the same class from day 0 to day 3. Clinical outcomes were statistically significantly worse in class 2 than class 1 and were more strongly associated with day 3 class assignment.ConclusionsARDS subphenotypes are largely stable over the first 3 days of enrolment in two ARDS Network trials, suggesting that subphenotype identification may be feasible in the context of clinical trials.

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