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- Leone, Marc, et al.
(författare)
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Update in antibiotic therapy in intensive care unit : report from the 2019 Nîmes International Symposium
- 2019
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Ingår i: Anaesthesia Critical Care & Pain Medicine. - : Elsevier BV. - 2352-5568. ; 38:6, s. 647-656
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Forskningsöversikt (refereegranskat)abstract
- The 2019 Nîmes International Symposium in Antibiotic Therapy Optimisation aimed at determining the best approaches of a number of the antibiotic management strategies for critically ill patients. Experts reviewed the latest literature relating to requirements for an optimal antibiotic stewardship program, risks of sub-therapeutic dosing of antibiotics in critically ill patients, persisting issues about efficiency of combination therapy and the value of de-escalation, new perspectives of pharmacokinetics, drug toxicities including collateral damages-associated with antibiotics, the place of nebulisation of antibiotics, management of patients receiving extracorporeal therapies and the place of new antibiotics. In this paper, each of these issues is discussed with key messages presented after a brief review of evidence.
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- Pruszczyk, Andrzej, et al.
(författare)
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Mortality in patients with septic cardiomyopathy identified by longitudinal strain by speckle tracking echocardiography: An updated systematic review and meta-analysis with trial sequential analysis
- 2024
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Ingår i: ANAESTHESIA CRITICAL CARE & PAIN MEDICINE. - : ELSEVIER FRANCE-EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER. - 2352-5568. ; 43:2
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Forskningsöversikt (refereegranskat)abstract
- Background: Septic cardiomyopathy is associated with poor outcomes but its definition remains unclear. In a previous meta-analysis, left ventricular (LV) longitudinal strain (LS) showed significant prognostic value in septic patients, but findings were not robust due to a limited number of studies, differences in effect size and no adjustment for confounders. Methods: We conducted an updated systematic review (PubMed and Scopus up to 14.02.2023) and metaanalysis to investigate the association between LS and survival in septic patients. We included studies reporting global (from three apical views) or regional LS (one or two apical windows). A secondary analysis evaluated the association between LV ejection fraction (EF) and survival using data from the selected studies. Results: We included fourteen studies (1678 patients, survival 69.6%) and demonstrated an association between better performance (more negative LS) and survival with a mean difference (MD) of -1.45%[-2.10, -0.80] (p < 0.0001; I-2 = 42%). No subgroup differences were found stratifying studies according to number of views used to calculate LS (p = 0.31; I-2 = 16%), severity of sepsis (p = 0.42; I-2 = 0%), and sepsis criteria (p = 0.59; I-2 = 0%). Trial sequential analysis and sensitivity analyses confirmed the primary findings. Grade of evidence was low. In the included studies, thirteen reported LVEF and we found an association between higher LVEF and survival (MD = 2.44% [0.44,4.45]; p = 0.02; I-2 = 42%). Conclusions: We confirmed that more negative LS values are associated with higher survival in septic patients. The clinical relevance of this difference and whether the use of LS may improve understanding of septic cardiomyopathy and prognostication deserve further investigation. The association found between LVEF and survival is of unlikely clinical meaning. Registration: PROSPERO number CRD42023432354 (c) 2023 The Author(s). Published by Elsevier Masson SAS on behalf of Societefranc,aise d'anesthesie et de reanimation (Sfar).
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