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| 21. |
Steroid controversy in sepsis and septic shockA meta-analysis |
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Critical Care Medicine,
Volume 23,
Issue 7,
1995,
Page 1294-1303
Rolf MSc Lefering,
Edmund A. M. PhD Neugebauer,
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摘要:
ObjectiveThe use of corticosteroids in patients with sepsis or septic shock has been controversial for many decades. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to assess the clinical evidence and to evaluate treatment effects in specific subgroups of patients.DesignMeta-analysis.Data SourcesA comprehensive search of the literature revealed 49 publications investigating the effect of corticosteroids in patients with sepsis and septic shock.Study SelectionOnly ten of the 49 publications were prospective, randomized, controlled trials with an exact description of dosage and regimen.Date ExtractionTreatment effects on mortality were calculated as rate differences in each study (negative values favor steroids), and were combined with respect to the variability in each study.Data SynthesisOnly one study showed a significantly positive effect of steroid treatment. Overall, no positive effect was observed: -0.2% (95% confidence interval: -9.2, 8.8). There were no differences observed when comparing low- vs. high-dose or type of corticosteroid used. Comparing patients with proven Gram-positive or Gram-negative infection showed a slight but not significant difference. The Gram-negative group demonstrated better outcome (-5.6% vs. 1.8%). A quality rating of each trial showed a remarkable increase in quality over time. Adverse events (gastroin-testinal bleeding, secondary infections, hyperglycemia) were not more frequent in patients treated with steroids compared with controls.ConclusionsNo overall beneficial effect of corticosteroids in patients with septic shock was observed; however, there is some evidence for a positive effect in patients with Gramnegative septicemia.(Crit Care Med 1995; 23:1294-1303)
ISSN:0090-3493
出版商:OVID
年代:1995
数据来源: OVID
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| 22. |
Prolonged Propofol Sedation in the Critical Care Unit |
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Critical Care Medicine,
Volume 23,
Issue 7,
1995,
Page 1304-1305
Joseph MD Mirenda,
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ISSN:0090-3493
出版商:OVID
年代:1995
数据来源: OVID
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| 23. |
Development of Effective Therapies for Sepsis |
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Critical Care Medicine,
Volume 23,
Issue 7,
1995,
Page 1305-1306
Michael MD Booke,
Lillian D. RN Traber,
Daniel L. PhD Traber,
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ISSN:0090-3493
出版商:OVID
年代:1995
数据来源: OVID
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| 24. |
Confirmation of Endotracheal Tube Position |
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Critical Care Medicine,
Volume 23,
Issue 7,
1995,
Page 1306-1307
Takashi MD Asai,
Keith FRCA Barclay,
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ISSN:0090-3493
出版商:OVID
年代:1995
数据来源: OVID
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| 25. |
Confirmation of Endotracheal Tube Position |
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Critical Care Medicine,
Volume 23,
Issue 7,
1995,
Page 1307-1308
David E. MD Schwartz,
Jeremy A. MD Liberman,
Neal H. MD Cohen,
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ISSN:0090-3493
出版商:OVID
年代:1995
数据来源: OVID
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| 26. |
Isoflurane Sedation in Pediatric Intensive Care |
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Critical Care Medicine,
Volume 23,
Issue 7,
1995,
Page 1308-1309
K. L. MD Kong,
Sheila M. MD Willatts,
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ISSN:0090-3493
出版商:OVID
年代:1995
数据来源: OVID
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| 27. |
Principles of Critical CareCompanion Handbook |
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Critical Care Medicine,
Volume 23,
Issue 7,
1995,
Page 1309-1310
William T. MD Peruzzi,
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ISSN:0090-3493
出版商:OVID
年代:1995
数据来源: OVID
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| 28. |
Catheter Ablation of Arrhythmias |
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Critical Care Medicine,
Volume 23,
Issue 7,
1995,
Page 1310-1310
Cynthia M. MD Tracy,
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ISSN:0090-3493
出版商:OVID
年代:1995
数据来源: OVID
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