The present review concluded remarkable globe clinical achievements in the field of critical care medicine during 2013. Briefly, new international sepsis management guideline, high frequency oscillatory ventilation, hydroxyethyl starch, immune-nutritional therapy, fecal transplantation and infection controlling became the highlighting topics. Additionally, it is also worthy to note the apparent disparity in the results between meta-analyses suggesting a treatment advantage and following large-scale randomized trials that have failed to detect such differences in treatment outcomes. Nonetheless, we still expect the emerging of ongoing investigations may provide clarity in these areas.
01/2013; 25(1):8-13. DOI:10.3760/cma.j.issn.2095-4352.2013.01.004
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 01/2012; 24(1):4-9.
To assess the efficacy and safety of proton pump inhibitor (PPI) and histamine-2 receptor antagonist (H(2)RA) in intensive care unit patients for stress ulcer prophylaxis.
A systematic search of MEDLINE (1966 to March 2009), Ebsco and CNKI was made. Two reviewers were assigned to assess the quality of studies and extracted data independently. Six items were evaluated for each trial (patient selection, patient characteristics, randomization, blinding, definition of bleeding and of pneumonia). Disagreements were resolved through discussion. RevMan 4.2.2 software developed by the cochrane collaboration was used for Meta-analysis.
Four series of clinical use involving 771 patients were included. Meta-analysis showed that the incidence of clinically significant bleeding was significantly lower in the PPI group (2.2% vs. 6.8%) as compared to H(2)RA group [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.21 to 0.96, P=0.04]. There was no significant difference of the incidence of nosocomial pneumonia (10.0% vs. 9.9%, OR 1.03, 95%CI 0.63 to 1.70, P=0.89) and mortality (14.5% vs. 14.3%,OR 1.17, 95%CI 0.76 to 1.80, P=0.47) between two groups.
In comparison with H(2)RA, PPI is more effective in the prevention of stress ulcer bleeding (SUB) in patients under intensive care. There is no significant difference in the incidence of nosocomial pneumonia and mortality between two groups. There were very few randomized controlled clinical trials on prevention of stress ulcer, and these findings were based on a small number of patients, therefore a steadfast conclusion cannot presently be reached. More randomized, multicenter studies with sufficient sample size are warranted.
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 04/2010; 22(4):221-5.