ICU EBM
Evidence Library
In patients who are in refractory cardiac arrest, does protocolised management involving mechanical CPR, Hypothermia, ECMO and early reperfusion improve survival rate?
CHEER works in ECMO centre. Protocolised resus, EMS & in hosp. 92% ROSC, 54% neuro
In patients with moderate or severe traumatic brain injury does the administration of erythropoietin compared with placebo improve neurological outcome at 6 months after injury?
No diff mort, DVT (approx 16-18% both groups!)
In patients with traumatic brain injury (TBI), does hypothermia (32-35°C) and standard care compared to standard care alone reduce death and major disability at 6 months after injury?
Therapeutic hypoT > increase mortality, worse neuro o/c. Fargility index 3
In Intensive Care patients undergoing intubation does apneic oxygenation during laryngoscopy increase the lowest arterial oxygen saturation experienced by patients
In patients with acute hypoxaemic respiratory failure, does high-flow oxygen through nasal cannula, compared with standard oxygen delivered through a facemask or non-invasive positive-pressure ventilation, prevent intubation?
HFNC non-inferior to face mask or NIV. HFNC > dec ICU 7 90d mort, improves comfort
Does the regular administration of paracetamol to critically ill patients with fever and known or suspected infection, affect the number of ICU-free days?
No diff ICU free days, mort. Mild dec Temp.?sig ICU LOS (inc non-survivors, dec survive)
In critically ill patients requiring continuous renal replacement therapy (CRRT), does regional anticoagulation with citrate prolong circuit life compared to heparin and protamine?
Citrate - longer circuit life, fewer A/Es. No change mortality, ICU LOS, cytokines, rbcs
In patients taking dabigatran, who present with serious bleeding or require urgent surgery/intervention is idarucizumab safe and efficacious for the reversal of anticoagulation?
Clotting tests normalised immed with 2.5g Drug company. No control. ? Safety data
In patients with out-of-hospital (OOH) cardiac arrest does a target temperature management (TTM) of 33°C vs. 36°C improve cognitive function
No difference in cognitive function 33v36 degrees at 6 months
In patients presenting to the Emergency Department with chest pain, does the HEART Pathway compared with usual care, reduce objective cardiac testing?
In brain-dead organ donors does the use of protocolised fluid therapy compared to usual care improve the number of organs transplanted?
Protocol>more fluid, less pressors. No diff in no. organs transplanted, 1yr recip survival
In critically ill adults, does restriction of non-protein calories (permissive underfeeding) compared to standard feeding reduce mortality at 90 days?
Safe. No survival benefit. Small benefit poss but study too small
Does High-flow therapy by nasal cannula (HFNC) improve the efficiency of preoxygenation before intubation compared with a high fraction-inspired oxygen facial mask (HFFM)
HFNC > no more effective than face mask. Many method & stat concerns
In adult patients with septic shock, does early goal-directed therapy (EGDT) compared with standard therapy reduce mortality at 90 days?
No diff in 90d mort. EGDT not cost effective
In patients with severe trauma and predicted to require massive transfusion, does the use of a transfusion protocol using a 1:1:1 ratio of plasma to platelets to red blood cells …
Does a nurse-implemented, goal-directed sedation protocol result in fewer ventilator days in children with acute respiratory failure?
No difference - duration MV, mortality
In adult patients that are in cardiac arrest, do uninterrupted chest compressions compared to chest compressions interrupted for manual ventilation improve survival, neurological recovery or the rate of adverse events?
No benefit cont over interrupted compressions (only to 6 mins - then airway & 30:2)
In critically ill patients, does the use of a balanced crystalloid solution compared to normal saline effect the incidence of acute kidney injury?
No increased risk AKI, RRT - only 2L given on avg
#N/A
Early surg not recommended. Underpowered, int & ext validity issues
In patients with intraabdominal sepsis and who have received adequate source control, does a fixed short course of antibiotics result in similar treatment success compared to a longer duration of …
No benefit 4d vs 8d with adeq source control (underpowered)
#N/A
Reduced mortality in critically ill patients with paracetamol. Sig diff b/w groups
Therapeutic hypothermia in children who have return of spontaneous circulation after an out-of-hospital cardiac arrest does not improve survival with good function at 1 year compared with therapeutic normothermia
No diff mortality or neuro function at 12m
In critically ill patients with refeeding syndrome, does restricting caloric intake compared with unrestricted caloric feeding, reduce the composite outcome of ICU length of stay, overall survival time and mortality …
Increased survival, reduced 60d mortality. Fewer resp infections
In adults undergoing cardiac surgery, does a restrictive transfusion strategy (Hb > 75 g/l) compared to a liberal transfusion strategy (Hb > 90 g/l) lead to fewer infections and ischaemic …
No diff infections or ischaemic events (primary o/c). Mild inc 90d mortality (??why)
