THE START OF ICU, 2018
GLYCAEMIC CONTROLS POST TBI
A SYSTEMATIC REVIEW OF HOW TO IMPROVE SUCCESS IN ICU INTUBATIONS
PROPOFOL FOR THE PROMOTION OF SLEEP IN ADULT ICU PATIENTS
In mechanically ventilated patients with septic shock, low dose hydrocortisone INFUSION for up to 7 days does not reduce or increase mortality at 90 days.
Secondary outcomes = patients in the hydrocortisone group had a reduced time to resolution of shock, reduced duration of ICU but not hospital stay, reduced time to cessation of mechanical ventilation and a reduction in the use of blood transfusion.
LOW rate of adverse events, but they were significantly increased in the hydrocortisone group.
Glycaemic control targets
after traumatic brain injury:
a systematic review
"Intensive glycaemic control does not reduce mortality in patients with TBI but greatly increases the risk of hypoglycaemia. A signal toward improved neurological outcome with intensive glycaemic control in patients post TBI warrants investigation. This may be best undertaken using safer approaches to glycaemic control that reduce the risk of hypoglycaemia, using stratified blood sugar targets that take account of physiological heterogeneity in patients with TBI."
- Possible beneficial role of pre-oxygenation with NIV and/or HFNC
- The effect of the ramped position in increasing the number of intubation attempts,
- The negative impact of thiopental on blood pressure,
- Possible efficacy of post-intubation muscle relaxation in increasing arterial PaO2.
- No other significant effect was found in the use of a checklist, choice of drugs, neuromuscular blockers, and use of videolaryngoscopy (the latter being associated with severe adverse effects in four trials).
- Further research in this poorly explored area is required.
This was a systematic review. Authors reported 'very low quality evidence' in 4 small RCT's. Study results not consistant.
Benzos: The study with flunitrazepam reported fewer awakenings of reduced duration with propofol but similar total sleep time in each group and the study with midazolam reported no difference in sleep quality. Midazolam use reported higher levels of anxiety and depression in both studies it was featured in.
One study: reported no improvement in duration of sleep with propofol but participants woke up less often and for shorter lengths of time and described their sleep quality as being improved with propofol.
No study reported on side effects.
AUTHORS CONCLUDE: We were unable to collect sufficient evidence to determine whether propofol given at night to adults in the ICU improves quality and quantity of their sleep, as a way of helping recovery.
WHAT THE TRIALS & SYSTEMATIC REVIEWS SAID
In patients with septic shock, does hydrocortisone compared with placebo, reduce 90 day mortality?
Cabrini, Landoni et al; Critical Care 2018 22:6
Hermanides, Plummer et al. Critical Care 2018 22:11
Lewis, Schofield-Robinson et al. Cochrane Database of Systematic Reviews 2018,
CD012454. DOI: 10.1002/14651858.CD012454.pub2.
Venkatesh. NEJM 2018; published on line first 19th January 2018 DOI: 10.1056/NEJMoa1705835
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