Critical Care Medicine www.ccmjournal.org e793 hospitalization and intensive care are mostly covered by the national insurance program. Further well-designed studies are warranted to clarify the causes of sex difference in outcomes following cardiac arrest.
A bstract Objectives The objective of this review was to compare the effectiveness of Colistin monotherapy and combination therapy for the treatment of multidrug-resistant gram-negative bacterial infections. Data sources PubMed, Cochrane Library. Study eligibility, interventions, and exclusions In this systematic review, we included all retrospective and prospective studies and randomized controlled trials (RCTs) that compared intravenous polymyxin monotherapy and combination therapy with any other antibiotic for treating multidrug-resistant infections. Studies using inhaled polymyxins with 5 or less than 5 patients were excluded. The primary outcome was 30-day all-cause mortality and if not reported at day 30 we extracted and documented the closest time point. Both crude outcome rates and adjusted effect estimates were extracted for mortality. Study appraisal, data extraction and synthesis Search string used was “(Colistin OR polymyxin) AND ( Enterobacteriaceae OR Klebsiella OR Acinetobacter OR Escherichia coli OR Pseudomonas ) AND (random OR prospective OR retrospective OR cohort OR observational OR blind).” Thirty-nine studies were included in our analysis; out of which 6 RCTs were included and 9 studies used carbapenem as the adjunctive antibiotic. Each study was screened and reviewed for eligibility independently by two authors and data extrapolated on an Excel sheet. Results The meta-analysis of polymyxin monotherapy vs. combination therapy in multidrug-resistant infections yielded an odds ratio (OR) of 0.81 (95% confidence interval [CI]: 0.65–1.01) with minimal heterogeneity ( I 2 = 40%), whereas pooled analysis of this comparison in studies that included carbapenem as combination therapy yielded an OR of 0.64 (CI: 0.40–1.03; I 2 = 62%). Likewise, the pooled analysis of the RCTs yielded an OR of 0.82 (95% CI: 0.58–1.16, I 2 = 22%). All these showed no statistical significance. However, it was seen that polymyxin combination therapy was more effective in multidrug-resistant infections compared to polymyxin monotherapy. The effectiveness was more glaring when carbapenems were used as the combination drug instead of any other antibiotic and more so in many in vitro studies that used polymyxin combination therapy. Conclusion Although statistically insignificant, it would be prudent to use polymyxin combination therapy to treat multidrug-resistant gram-negative bacilli (GNB) infection over monotherapy with preference to use carbapenem as the adjunct alongside polymyxins. How to cite this article Samal S, Mishra SB, Pat...
BackgroundMany COVID19 pneumonia patients progress to Acute respiratory distress syndrome and end up in Intensive Care Units. Given that it is a novel viral infection, the progress of the disease, its management and associated outcomes are yet to be studied in detail. ARDS associated with COVID 19 is the same as before or different and the timing of intubation in such patients is a topic up for debate. This survey aimed to assess the opinion regarding management of COVID 19 ARDS and the timing of intubation in those patients.Methods292 clinicians including anesthesiologists, intensivists and others involved in managing COVID 19 ARDS patients at various centres were surveyed with web-based questionnaire cross sectionally within the time period of 10th June 2020 to 31st August 2020 after taking prior consent. Their responses were recorded and analyzed with statistical software IBM SPSS version 25.0.Results Among 292 included participants, 172 were intensivist, 84 were anesthesiologists and rest were others. Most of the intensivists (51.2%) had seen more than 100 COVID 19 severe ARDS patients. Around 82% of clinicians were agreed that COVID 19 ARDS was different from another form of ARDS. 67.1% of participants were agreed with patient induced self-inflicted injury could have happened in this disease. Likewise, around 91.8% of doctors involved in managing patients were believed that HFNC could be helpful if there were falling of saturation. 37% of participants were not agreed with early intubation, which may increase the risk of mortality and nosocomial infections.Conclusions and RelevanceThere was confusion in most doctors with intubation timing even if there was an indication for intubation. These confusions may be due to non-availability of specific recommendation regarding intubation in COVID 19 severe ARDS patients. However, most of the literature recommended for early intubation in these patients when indicated.
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