scholarly journals Anticoagulation strategies in critical care for the treatment of atrial fibrillation: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037591
Author(s):  
Brian Johnston ◽  
Alexandra Nelson ◽  
Alicia C Waite ◽  
Gedeon Lemma ◽  
Ingeborg Welters
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Critical Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Critical Care Setting

IntroductionAtrial fibrillation (AF) is the most common cardiac arrhythmia in critically ill patients and is associated with an increased risk of thromboembolic events and mortality. Oral anticoagulation for thromboembolism prophylaxis is a key component of managing AF in the general population and is recommended by National Institute for Health and Care Excellence guidelines. However, assessment tools used to aid decision making about anticoagulation have not yet been validated in the critical care setting. There is a paucity of data assessing the impact of anticoagulation strategies on clinical outcomes in critically ill patients with AF. We present a protocol for a systematic review and meta-analysis to evaluate the effectiveness of anticoagulation strategies for AF used specifically in critical care.Methods and analysisWe will conduct a systematic review of the literature by searching MEDLINE, EMBASE, CENTRAL and PubMed databases for articles published from January 1990 to October 2019. Studies reporting anticoagulation strategies for AF in adults (>18 years) admitted to a general critical care setting will be assessed for inclusion. Outcomes of interest will include (1) percentage of patients started on anticoagulation in critical care for AF, (2) incidence of thromboembolism, (3) incidence of bleeding events, (4) intensive care unit (ICU) mortality, (5) hospital mortality, (6) ICU length of stay and (7) hospital length of stay. We will conduct a meta-analysis of trials. Risk of bias will be assessed using the Cochrane Risk of Bias tool for randomised trials or the Newcastle-Ottawa Risk of Bias assessment tool for non-randomised studies. This protocol and subsequent systematic review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.Ethics and disseminationThis proposed systematic review will include data extracted from published studies; therefore, ethical approval is not required. The results of this review will be published in clinical specialty journals and presented at international meetings and conferences.Trial registration numberCRD42020158237.

Anticonvulsants: Pharmacotberapeutic Issues in the Critically Ill Patient

1991 ◽  
Vol 2 (4) ◽  
pp. 639-656 ◽  
Author(s):  
Robert E. Dupuis ◽  
Jorge Miranda-Massari
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critical Care Setting ◽  
Critically Ill Patient ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Epilepsy Treatment

Critically ill patients often have or develop conditions that make them susceptible to seizures and epilepsy. Treatment frequently involves the use of anticonvulsants. In order to use these effectively, the critical care nurse must be aware of the indications and controversies surrounding their use, the pathophysiologic conditions that impact on the disposition, and appropriate dosing and monitoring of these agents in the critical care setting

scholarly journals Incorporating repeated measurements into prediction models in the critical care setting: a framework, systematic review and meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joost D. J. Plate ◽  
Rutger R. van de Leur ◽  
Luke P. H. Leenen ◽  
Falco Hietbrink ◽  
Linda M. Peelen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critical Care ◽  
Care Setting ◽  
Prediction Models ◽  
Meta Analysis ◽  
Repeated Measurements ◽  
Critical Care Setting ◽  
Annual Number ◽  
Observation Window ◽  
Raw Data

Abstract Background The incorporation of repeated measurements into multivariable prediction research may greatly enhance predictive performance. However, the methodological possibilities vary widely and a structured overview of the possible and utilized approaches lacks. Therefore, we [1] propose a structured framework for these approaches, [2] determine what methods are currently used to incorporate repeated measurements in prediction research in the critical care setting and, where possible, [3] assess the added discriminative value of incorporating repeated measurements. Methods The proposed framework consists of three domains: the observation window (static or dynamic), the processing of the raw data (raw data modelling, feature extraction and reduction) and the type of modelling. A systematic review was performed to identify studies which incorporate repeated measurements to predict (e.g. mortality) in the critical care setting. The within-study difference in c-statistics between models with versus without repeated measurements were obtained and pooled in a meta-analysis. Results From the 2618 studies found, 29 studies incorporated multiple repeated measurements. The annual number of studies with repeated measurements increased from 2.8/year (2000–2005) to 16.0/year (2016–2018). The majority of studies that incorporated repeated measurements for prediction research used a dynamic observation window, and extracted features directly from the data. Differences in c statistics ranged from − 0.048 to 0.217 in favour of models that utilize repeated measurements. Conclusions Repeated measurements are increasingly common to predict events in the critical care domain, but their incorporation is lagging. A framework of possible approaches could aid researchers to optimize future prediction models.

New-onset atrial fibrillation is associated with increased mortality in critically ill patients: a systematic review and meta-analysis

2018 ◽  
Vol 74 (2) ◽  
pp. 162-169 ◽  
Author(s):  
Napatt Kanjanahattakij ◽  
Pattara Rattanawong ◽  
Parasuram Krishnamoorthy ◽  
Benjamin Horn ◽  
Pakawat Chongsathidkiet ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Onset Atrial Fibrillation ◽  
New Onset

scholarly journals Risk of Clinically Relevant Venous Thromboembolism in Critically Ill Patients With COVID-19: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Johannes Gratz ◽  
Marion Wiegele ◽  
Mathias Maleczek ◽  
Harald Herkner ◽  
Herbert Schöchl ◽  
...  
Keyword(s):  
Systematic Review ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
English Language ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Individual Risk ◽  
Bleeding Events

Background: Early during the course of the ongoing COVID-19 pandemic, reports suggested alarmingly high incidences for thromboembolic events in critically ill patients with COVID-19. However, the clinical relevance of these events was not reported in several studies. Additionally, more recent research showed contradictory results and suggested substantially lower rates of venous thromboembolism. Thus, the aim of the present study was to summarize evidence on the incidence of clinically relevant venous thromboembolism (VTE)—defined as VTE excluding isolated subsegmental pulmonary embolism (PE) and distal deep vein thrombosis (DVT)—in adult critically ill patients with COVID-19.Methods: We performed a systematic review of studies reporting the incidence of clinically relevant PE and/or DVT in critically ill patients with COVID-19. Scientific reports published in the English language between January and October 2020 were included. We conducted a random-effects model meta-analysis to calculate incidence estimates of clinically relevant VTE and bleeding events. We also performed exploratory meta-regression and subgroup analyses of different diagnostic approaches and additional factors that possibly influenced the incidence of these outcomes.Results: Fifty-four articles (5,400 patients) fulfilled the predefined inclusion criteria, of which 41 had a high risk of bias. The majority of included patients were male, > 60 years, and overweight. Twenty-one studies reported the use of prophylactic doses of heparin. Pooled incidences for clinically relevant PE were estimated at 8% (95% CI, 4–11%), for proximal DVT at 14% (95% CI, 9–20%), and—after exclusion of studies with a high risk of bias—for the composite outcome of VTE at 18% (95% CI, 13–24%). Clinically relevant bleeding occurred at a rate of 6% (95% CI, 2–9%).Conclusions: We summarized currently available data on the rate of clinically relevant VTE in critically ill patients with COVID-19. Pooled incidence estimates were lower than those reported by previous review articles. In the absence of evidence-based anticoagulation guidelines for critically ill patients with COVID-19, the results of our study provide clinically important information for an individual risk-benefit assessment in this context.Registration: The study protocol was prospectively registered in PROSPERO on June 22, 2020 (CRD42020193353; https://www.crd.york.ac.uk/prospero).

scholarly journals The effect of opioids on gastrointestinal function in the ICU

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Yun Yan ◽  
Yu Chen ◽  
Xijing Zhang
Keyword(s):  
Critical Care ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Potential Risk ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critical Care Setting ◽  
Gastrointestinal Function ◽  
Opioid Antagonists

AbstractGastrointestinal (GI) dysfunction is common in the critical care setting and is highly associated with clinical outcomes. Opioids increase the risk for GI dysfunction and are frequently prescribed to reduce pain in critically ill patients. However, the role of opioids in GI function remains uncertain in the ICU. This review aims to describe the effect of opioids on GI motility, their potential risk of increasing infection and the treatment of GI dysmotility with opioid antagonists in the ICU setting.

Effect of enteral immunomodulatory nutrition formula on mortality and critical care parameters in critically ill patients: A systematic review with meta‐analysis

2021 ◽  
Author(s):  
Mahsa Malekahmadi ◽  
Naseh Pahlavani ◽  
Safieh Firouzi ◽  
Zachary S. Clayton ◽  
Sheikh Mohammed Shariful Islam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis

scholarly journals Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: systematic review and network meta-analysis

BMJ ◽  
2020 ◽  
pp. l6744 ◽  
Author(s):  
Ying Wang ◽  
Zhikang Ye ◽  
Long Ge ◽  
Reed A C Siemieniuk ◽  
Xin Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Bleeding Prophylaxis ◽  
Risk Patients

AbstractObjectiveTo determine, in critically ill patients, the relative impact of proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), sucralfate, or no gastrointestinal bleeding prophylaxis (or stress ulcer prophylaxis) on outcomes important to patients.DesignSystematic review and network meta-analysis.Data sourcesMedline, PubMed, Embase, Cochrane Central Register of Controlled Trials, trial registers, and grey literature up to March 2019.Eligibility criteria for selecting studies and methodsWe included randomised controlled trials that compared gastrointestinal bleeding prophylaxis with PPIs, H2RAs, or sucralfate versus one another or placebo or no prophylaxis in adult critically ill patients. Two reviewers independently screened studies for eligibility, extracted data, and assessed risk of bias. A parallel guideline committee (BMJ Rapid Recommendation) provided critical oversight of the systematic review, including identifying outcomes important to patients. We performed random-effects pairwise and network meta-analyses and used GRADE to assess certainty of evidence for each outcome. When results differed between low risk and high risk of bias studies, we used the former as best estimates.ResultsSeventy two trials including 12 660 patients proved eligible. For patients at highest risk (>8%) or high risk (4-8%) of bleeding, both PPIs and H2RAs probably reduce clinically important gastrointestinal bleeding compared with placebo or no prophylaxis (odds ratio for PPIs 0.61 (95% confidence interval 0.42 to 0.89), 3.3% fewer for highest risk and 2.3% fewer for high risk patients, moderate certainty; odds ratio for H2RAs 0.46 (0.27 to 0.79), 4.6% fewer for highest risk and 3.1% fewer for high risk patients, moderate certainty). Both may increase the risk of pneumonia compared with no prophylaxis (odds ratio for PPIs 1.39 (0.98 to 2.10), 5.0% more, low certainty; odds ratio for H2RAs 1.26 (0.89 to 1.85), 3.4% more, low certainty). It is likely that neither affect mortality (PPIs 1.06 (0.90 to 1.28), 1.3% more, moderate certainty; H2RAs 0.96 (0.79 to 1.19), 0.9% fewer, moderate certainty). Otherwise, results provided no support for any affect on mortality, Clostridium difficile infection, length of intensive care stay, length of hospital stay, or duration of mechanical ventilation (varying certainty of evidence).ConclusionsFor higher risk critically ill patients, PPIs and H2RAs likely result in important reductions in gastrointestinal bleeding compared with no prophylaxis; for patients at low risk, the reduction in bleeding may be unimportant. Both PPIs and H2RAs may result in important increases in pneumonia. Variable quality evidence suggested no important effects of interventions on mortality or other in-hospital morbidity outcomes.Systematic review registrationPROSPERO CRD42019126656.

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