ICU EBM
Evidence Library
In patients with moderate Pulmonary Embolism (PE), does low dose thrombolysis + anticoagulation, compared with anticoagulation alone, reduce pulmonary artery pressure at 28 months?
Safe. Reduced PASP at 28 months. Old (anatomical) definitions PHT. No mort power
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No monitoring > nont inferior, inc vomit w/o VAP. Control > inc intolerance (def 250ml)
Does High Frequency Oscillatory Ventilation (HFOV), compared with conventional ventilation, improve 30 day mortality in patients with ARDS?
HFOV > no 30d mort difference, improved oxygenation
Does High Frequency Oscillatory Ventilation (HFOV) improve mortality in patients with new onset moderate-severe ARDS compared with standard ventilation?
HFOV > inc mort, less refractory hypoxaemia; more NMB, sedation, vasoactive drugs
Does the early application of prone positioning improve mortality in severe ARDS?
Early & prolonged prone MV > dec 28d & 90d mort.Inc card arrest supine, else no diff Cx
Is short-term (5 days) systemic glucocorticoid treatment in patients with COPD exacerbation as good as conventional (14 days) treatment in clinical outcome and does it decrease the overall exposure to …
No diff exac in next 6m, all cause mort, clin or subj o/c. No diff in steroid Cx
In mechanically ventilated adult patients with a high risk of prolonged ventilation, does early tracheostomy compared with late tracheostomy reduce mortality at 30 days?
No benefit early over delayed (mort, MV, LOS). >50% no longer indicated after D10
In adults that suffer an out-of-hospitals (OOH) cardiac arrest of presumed cardiac cause, does induced therapeutic hypothermia targeting 36°C compared to 33°C reduce mortality or reduce neurological deficit?
No diff mortality (all cause) or neuro (mRS, CPC). Not gen to long downtime
In patients who present with an upper gastrointestinal (GI) bleed, does a restrictive transfusion goal compared with a liberal transfusion goal affect mortality?
24hr endoscopy!! Reduced 45d mort & unstable rebleed in restrictive grp (Child A, B).
In patients in cardiac arrest, does vasopressin + epinephrine during CPR combined with steroid supplementation during and after CPR, improve survival to discharge with a good neurological outcome, in comparison …
Improve ROSC, survival & neuro outcome. 55% in crit care area. 25% hypoT only.
In critically ill adults with severe sepsis, does 6% hydroxyethyl starch (HES) compared to Ringer's acetate reduce the incidence of death or end stage kidney failure?
HES - increased mortality (90d), RRT, blood transfusion
In patients treated with therapeutic hypothermia following cardiac arrest, can clinical examination, neuronspecific enolase (NSE), and median nerve somatosensory-evoked potentials (SEPs) predict poor outcome?
Poor outcome: clinical tests at 72hrs, NSE & SSEP N20. Multimodal to be safe
In critically ill patients requiring fluid resuscitation, does 6% hydroxyethyl starch (6% HES) compared to 0.9% sodium chloride (Saline) reduce mortality at 90 days?
HES - increased AKI > RRT, blood products. No mortality difference.
Does early nasojejunal feeding improve the delivery of enteral nutrition in comparison to nasogastric nutrition in critically ill patients experiencing poor gastric motility?
70% target in both groups. Mild bleeding more in NJ. Prokinetics in both groups prn
Initial trophic vs full enteral feeding in patients with acute lung injury
No diff vent-free days, 60d mort, organ-failure free days, ICU-free days, infection
In patients with acute MI and cardiogenic shock, does intraaortic balloon counterpulsation (IABP) vs. medical therapy alone improve mortality?
No benefit. No increased complications with IABP. High x-over rate
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Question not recorded
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Inc CI induced by passive leg riase & end expiratory oclusion pressure. PPV poor
In adult intensive care patients requiring mechanical ventilation, is dexmedetomidine inferior to propofol or midazolam in achieving target sedation level?
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No diff 28d & 90d mort., incl subgroups. More non-serious bleeding
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In patients who are mechanically ventilated and sedated with opioids and / or benzodiazepines, do daily sedative interruptions reduce the duration until extubation?
