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AKI Substantially Affects Prognosis of Patients With Cirrhosis

A systematic review and meta-analysis in Alimentary Pharmacology and Therapeutics compared the mortality rates of patients with cirrhosis with AKI versus without AKI. A total of 59 studies of cirrhosis patients (1,153,193 with AKI and 4,630,814 without AKI) were included in the meta-analysis. Patients with cirrhosis who developed AKI had significantly higher mortality rates. AKI staging correlated with mortality risk, with higher stages indicating higher mortality rates. The timing of AKI development played a crucial role in patient prognosis, with community-acquired and hospital-acquired AKI associated with different effects on the mortality risks.

Adjunctive Midodrine Therapy May Improve Outcomes in Critically Ill Patients

A systematic review and meta-analysis in Critical Care Medicine evaluated the efficacy of midodrine as an adjunctive therapy in critically ill patients with vasopressor-dependent shock. Seven RCTs and 10 observational studies met inclusion criteria. The analysis showed adjunctive midodrine may decrease ICU length of stay, IV vasopressor support duration, and ICU and hospital mortality. However, the findings were based on very low certainty of evidence. While midodrine may provide benefit for patient-centered outcomes, due to increased risk of adverse events including bradycardia, further large-scale studies are needed to inform and guide its routine use in the ICU.

Hyperoxia May Contribute to Unfavorable Outcomes in Patients With Non-Traumatic Subarachnoid Hemorrhage

A systematic review and meta-analysis in the Journal of Clinical Neuroscience explored the association between hyperoxia exposure and unfavorable outcomes in patients with non-traumatic subarachnoid hemorrhage (SAH). Nine articles were included in the review. Hyperoxia exposure was associated with increased risk of adverse composite outcome of death or unfavorable functional neurologic outcome (OR, 1.61; 95% CI, 1.19-2.16), poor functional neurologic outcome alone (OR, 1.79; 95% CI, 1.33-2.42), and development of delayed cerebral ischemia (OR, 2.63; 95% CI, 1.79-3.85). Trials using restrictive oxygen therapy among patients with SAH were suggested.

Early Low-Dose Hydrocortisone Can Reduce In-Hospital Mortality in Patients With Septic Shock

A systematic review and meta-analysis in Medicine (Baltimore) assessed the impact of the timing of low-dose hydrocortisone adjuvant therapy initiation on clinical outcomes in patients with septic shock. Seven trials, with a total of 3063 patients, were included. The results of the meta-analysis demonstrated that patients who received early low-dose hydrocortisone treatment had lower ICU and hospital mortality rates compared to patients who received late treatment. There were no notable disparities in the rates of CRRT, reversing shock, and length of ICU stay. The authors noted that additional extensive RCTs are required to validate the findings.

Restrictive Transfusion Does Not Improve Outcomes in Critically Ill Patients With TBI

A systematic review and meta-analysis in the Annals of Intensive Care evaluated the impact of restrictive compared to liberal red blood cell transfusion strategies among critically ill adult patients with moderate to severe TBI. Five randomized controlled trials involving 1528 patients were included in the analysis. The results of the meta-analysis demonstrated that restrictive transfusion, compared to liberal transfusion, had no impact on mortality (RR, 1.00; 95% CI, 0.80-1.24) or unfavorable neurologic outcome at 6 months (RR, 1.06; 95% CI, 0.94-1.20).

Short-Acting Beta-Blockers Do Not Reduce Short-Term Mortality in Patients With Sepsis and Persistent Tachycardia

A meta-analysis in Critical Care (London, England) evaluated the potential impact of treatment with short-acting beta-blockers on mortality in adult septic patients. A total of 7 studies with 854 patients were included. The results of the meta-analysis demonstrated that short-acting beta-blockers did not significantly reduce short-term mortality compared to the control treatment in patients with sepsis and persistent tachycardia (risk difference, ‒0.10; 95% CI; ‒0.22 to 0.02; P = 0.11). The authors noted that future studies should provide extensive hemodynamic data to enable characterization of cardiac function before and during treatment.

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