Colloids versus crystalloids for fluid resuscitation in critically ill people
Sharon R Lewis, Michael W Pritchard, David JW Evans, Andrew R Butler, Phil Alderson, Adrew F Smith, Ian Roberts
Using starches, dextrans, albumin or Fresh Frozen Plasma (FFP) (moderate‐quality evidence), or gelatins (low‐quality evidence), versus crystalloids probably makes little or no difference to mortality. Starches probably slightly increase the need for blood transfusion and Renal Replacement Therapy (RRT) (moderate‐quality evidence), and albumin or FFP may make little or no difference to the need for renal replacement therapy (low‐quality evidence). Evidence for blood transfusions for dextrans, and albumin or FFP, is uncertain. Similarly, evidence for adverse events is uncertain.
Antibiotics for exacerbation of chronic obstructive pulmonary disease
Daniela J Vollenweider, Anja Frei, Claudia A Steurer-Stey, Judith Garcia-Aymerich, Milo A Puhan
Researchers have found that antibiotics have some effect on inpatients and outpatients, but these effects are small, and they are inconsistent for some outcomes (treatment failure) and absent for other outcomes (mortality, length of hospital stay). Analyses show a strong beneficial effect of antibiotics among ICU patients. These inconsistent effects call for research into clinical signs and biomarkers that can help identify patients who would benefit from antibiotics, while sparing antibiotics for patients who are unlikely to experience benefit and for whom downsides of antibiotics (side effects, costs, and multi‐resistance) should be avoided.
Tranexamic acid for patients with nasal haemorrhage (epistaxis)
Jonathan Joseph, Pablo Martinez-Devesa, Jenny Bellorini, Martin J Burton
There is probably a reduction in the risk of re‐bleeding with the use of either oral or topical tranexamic acid in addition to usual care in adult patients with epistaxis, compared to placebo with usual care (moderate-quality evidence) . However, the quality of evidence relating solely to topical tranexamic acid is low (one study only), so we are uncertain whether or not topical tranexamic acid is effective in stopping bleeding in the 10‐day period after a single application.
Adrenaline and vasopressin for cardiac arrest
Judith Finn, Ian Jacobs, Teresa A Williams, Simon Gates, Gavin D Perkins
This review provides moderate‐quality evidence that standard‐dose adrenaline compared to placebo improves return of spontaneous circulation, survival to hospital admission and survival to hospital discharge, but low‐quality evidence that it did not affect survival with a favourable neurological outcome. Very low ‐quality evidence found that high‐dose adrenaline compared to standard‐dose adrenaline improved return of spontaneous circulation and survival to admission. Vasopressin compared to standard dose adrenaline improved survival to admission but not return of spontaneous circulation, whilst the combination of adrenaline and vasopressin compared with adrenaline alone had no effect on these outcomes. Neither standard dose adrenaline, high‐dose adrenaline,vasopressin nor a combination of adrenaline and vasopressin improved survival with a favourable neurological outcome.
Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema
Nicolas Berbenetz, Yongjun Wang, James Brown, Charlotte Godfrey, Mahmood Ahmad, Flávia MR Vital, Pier Lambiase, Amitava Banerjee, Ameet Bakhai, Matthew Chong
This review provides support for continued clinical application of NPPV for Acute Cardiogenic Pulmonary Edema (ACPE), to improve outcomes such as hospital mortality and intubation rates. Non-invasive Positive Pressure Ventilation is a safe intervention with similar adverse event rates to Standard Medical Care (SMC) alone. Additional research is needed to determine if specific subgroups of people with ACPE have greater benefit of NPPV compared to SMC. Future research should explore the benefit of NPPV for ACPE patients with hypercapnia.
Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack
Zhivko Zhelev, Greg Walker, Nicholas Henschke, Jonathan Fridhandler, Samuel Yip
In the field, Cincinnati Prehospital Stroke Scale (CPSS) had consistently the highest sensitivity and, therefore, should be preferred to other scales. Further evidence is needed to determine its absolute accuracy and whether alternatives scales, such as Melbourne Ambulance Stoke Scale (MASS) and Recognition Of Stroke In Emergency Department (ROSIER), which might have comparable sensitivity but higher specificity, should be used instead, to achieve better overall accuracy. In the Emergency Room, ROSIER should be the test of choice, as it was evaluated in more studies than Face Arm Speech Time (FAST) and showed consistently high sensitivity.
Artemether for severe malaria
Ekpereonne B Esu, Emmanuel E Effa, Oko N Opie, Martin M Meremikwu
Artemether appears to be more effective than quinine in children and adults. Artemether compared to artesunate has not been extensively studied, but in adults it appears inferior. These findings are consistent with the World Health Organisation recommendations that artesunate is the drug of choice, but artemether is acceptable when artesunate is not available.
Buffered solutions versus 0,9% saline for resuscitation in critically ill adults and children
Alba M Antequera Martín, Jesus A Barea Mendoza, Alfonso Muriel, Ignacio Sáez, Mario Chico‐Fernández, José M Estrada‐Lorenzo, Maria N Plana
There is no effect of buffered solutions on preventing in‐hospital mortality compared to 0.9% saline solutions in critically ill patients. The certainty of evidence for this finding was high, indicating that further research would detect little or no difference in mortality. The effects of buffered solutions and 0.9% saline solutions on preventing acute kidney injury were similar in this setting. The certainty of evidence for this finding was low, and further research could change this conclusion.
Community first responders for out-of-hospital cardiac arrest in adults and children
Tomas Barry, Maeve C Doheny, Siobhán Masterson, Niall Conroy, Jan Klimas, Ricardo Segurado, Mary Codd, Gerard Bury
Moderate‐quality evidence shows that context‐specific Community First Responders (CFR) interventions result in increased rates of Cardio Pulmonary Ressuscitation (CPR) or defibrillation performed before Emeegency Medical Service ( EMS) arrival. It remains uncertain whether this can translate to significantly increased rates of overall patient survival. When possible, further high‐quality Randomized Controlled Trials (RCTs) that are adequately powered to measure changes in survival should be conducted. The included studies did not consider survival with good neurological function. This outcome should be included routinely wherever survival is measured.