The following search will find 9 articles when copied and pasted and run in PubMed. You may start with the Woodruff Health Sciences Center Library homepage at http://health.library.emory.edu/ and then click “PubMed” or you may use this direct link to Emory’s instance of PubMed at http://www.ncbi.nlm.nih.gov/sites/entrez?otool=emorylib.
24172057[uid] OR 23817826[uid] OR 20398302[uid] OR 19531035[uid] OR 17983362[uid] OR 10392220[uid] OR 22897811[uid] OR 22559080[uid] OR 23314584[uid]
The systematic reviews identified below include slightly different findings, so a review of the objective of each review, as well as the patient populations in the included studies, will be important for extrapolating results to a specific setting. Guidelines were identified in DynaMed and in PubMed.
Evidence summary resources
From Mechanical Ventilation entry. In: DynaMed Plus.
Under Adjunctive Therapies > Other Supportive Care
From Joanna Briggs
Oral Hygiene Care: Acute Care Setting. Chu WH. [Evidence Summaries], AN: JBI5215, 2013.
References a systematic review (Cochrane 2013) concluded that use of chlorhexidine was associated with reduction in rate of VAP in adult, but not pediatric, patients.
Oral Care. [Recommended Practices, AN: JBI5264, 2013.
References a systematic review (Am J Crit Care 2007) concluding that toothbrushes can be a source of contamination and should be kept clean.
PubMed
View the results of a search for relevant systematic reviews and meta-analyses:
(“Pneumonia, Ventilator-Associated/prevention and control”[Mesh] OR “Respiration, Artificial/adverse effects”[Mesh]) AND (“Anti-Infective Agents, Local”[nm] OR “oral hygiene”[MeSH Terms]) AND (Meta-Analysis[ptyp] OR systematic[sb])
Additional guideline
A search of DynaMed and Joanna Briggs did not identify RCTs or other documents that referenced RCTs evaluating family presence during resuscitation.
A PubMed search of resuscitation AND family – Filtered by Randomized Controlled Trial only identified one RCT. Removing the filter and adding “randomized OR random” as search terms did not identify additional studies.
Family presence during cardiopulmonary resuscitation.
Jabre P, et al. N Engl J Med. 2013 Mar 14;368(11):1008-18. doi: 10.1056/NEJMoa1203366.
PMID: 23484827
There are also quasi-experimental studies included in these search results.
Searches of PubMed, Embase, and CINAHL yielded this one meta-analysis and two systematic reviews.
Kim, Sang-Hyun, et al. “Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure: a systematic review and meta-analysis.” Anesthesiology 120.5 (2014):1080-1097.
Twenty-eight studies with 919 patients were included in this systematic review. “The overall random-effect pooled bias and SD were -1.6 ± 12.2 mmHg (95% limits of agreement -25.5 to 22.2 mmHg) for systolic arterial pressure, 5.3 ± 8.3 mmHg (-11.0 to 21.6 mmHg) for diastolic arterial pressure, and 3.2 ± 8.4 mmHg (-13.4 to 19.7 mmHg) for mean arterial pressure. In 14 studies focusing on currently commercially available devices, bias and SD were -1.8 ± 12.4 mmHg (-26.2 to 22.5 mmHg) for systolic arterial pressure, 6.0 ± 8.6 mmHg (-10.9 to 22.9 mmHg) for diastolic arterial pressure, and 3.9 ± 8.7 mmHg (-13.1 to 21.0 mmHg) for mean arterial pressure.
CONCLUSIONS: The results from this meta-analysis found that inaccuracy and imprecision of continuous noninvasive arterial pressure monitoring devices are larger than what was defined as acceptable. This may have implications for clinical situations where continuous noninvasive arterial pressure is being used for patient care decisions.”
Ben Sivarajan, V, and DesmondBohn. “Monitoring of standard hemodynamic parameters: heart rate, systemic blood pressure, atrial pressure, pulse oximetry, and end-tidal CO2.” Pediatric critical care medicine 12.4 Suppl (2011):S2-S11.
The conclusion of this systematic review states, “literature would suggest that invasive arterial monitoring is the current standard for monitoring in the setting of shock. The use of heart rate, electrocardiography, and atrial pressure monitoring is advantageous in specific clinical scenarios (postoperative cardiac surgery); however, the evidence for this is based on numerous case series only.”
Chatterjee, Arjun, et al. “Results of a survey of blood pressure monitoring by intensivists in critically ill patients: a preliminary study.” Critical care medicine 38.12 (2010):2335-2338.
“Eight hundred eighty individuals received an invitation to complete the survey and 149 responded. We found that 71% (105 of 149) of intensivists estimated the correct cuff size rather than measuring arm circumference directly. In hypotensive patients, 73% of respondents (108 of 149) reported using noninvasive blood pressure measurement measurements for patient management. In patients on a vasopressor medication, 47% (70 of 149) of respondents reported using noninvasive blood pressure measurement for management.”
Five articles were found in PubMed that are either a systematic review or meta-analysis.
Conde-Agudelo A, Belizán JM, Diaz-Rossello J. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev. 2016 Aug 23;(8):CD002771. doi: 10.1002/14651858.CD002771.pub4.
McCall EM, Alderdice F, Halliday HL, Jenkins JG, Vohra S. Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD004210.
Renfrew MJ, Craig D, Dyson L, McCormick F, Rice S, King SE, Misso K, Stenhouse E, Williams AF. Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis. Health Technol Assess. 2009 Aug;13(40):1-146, iii-iv.
McInnes RJ, Chambers J. Infants admitted to neonatal units–interventions to improve breastfeeding outcomes: a systematic review 1990-2007. Matern Child Nutr. 2008 Oct;4(4):235-63.
Smith KM. Sleep and kangaroo care: clinical practice in the newborn intensive care unit: where the baby sleeps…J Perinat Neonatal Nurs. 2007 Apr-Jun;21(2):151-7.
A search within Joanna Briggs for “kangaroo mother care low birth” will find the following two items.
Kangaroo Mother Care: Low Birth Weight Infants. [Recommended Practices]. AN: JBI6047. Year of Publication: 2013.
Hitch, Danielle. Kangaroo Mother Care: Low Birth Weight Infants. [Evidence Summaries]. AN: JBI6046. Year of Publication: 2013.
Updated link to Cochrane systematic review 10/12/2017 ldt
Bottom line: No published evidence compares monitoring frequency (eg, q4, q8, etc.) to determine what is safest and most effective for monitoring dosage of neuromuscular blocking agents. Professional recommendations advocate every 2-12 hours.
Summary: ASA. Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration. Anesthesiology. 2009; 110(2): 218-230.
Page 221 begins review of recommendations and evidence for effectiveness of methods for detecting respiratory depression, and on p. 222, recommendation by expert consensus for monitoring after single injection and continuous infusion depend on class of drugs (neuraxial lipophilic opioids v. neuraxial hydrophilic opioids), clinical condition of patient and concurrent medications.
AACN Procedure Manual for Critical Care, 6th ed. [In print at EUH]
Recommends train of four (TOF) testing every 4-8 hours during infusion after patient is stable and after optimal dose for neuromuscular blockade is achieved (p. 310.) References guidelines (see below.)
Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med. 2002;30:142-156.
In the monitoring section, the guidelines recommend monitoring but do not provide specifics. They do however, cite a study (Kleinpell) that surveys ICUs about their practices, as well as one prospective study (Strange) that compares TOF to clinical assessment and one retrospective study (Frankel) about implementing standards for monitoring in a surgical unit.
(“Monitoring, Physiologic”[MAJR]) AND “Neuromuscular Blockade”[MAJR] AND (train-of-four OR electric stimulation) AND (prospective study OR observational study OR cohort study OR comparison study)
Here is a PubMed search for comparison and cohort studies evaluating train-of-four. Some are evaluating specific devices or stimulation methods. Baumann (2004) and Strange (1997) address the use of the TOF itself.
There is also an RCT by Rudis (1997) that compares clinical assessment to TOF for reduction in dose of neuromuscular nondepolarizing agent to maintain paralysis .
Reviewed by John Nemeth 4/14
DynaMed, a good source for locating the most current guidelines.
Mechanical ventilation: The guidelines seem to be about when to wean, or how to prevent ventilator-associated pneumonia
ARDS: the only one I saw specifically addressing oxygen therapy was from American Association of Respiratory Care (2001).
Professional organization websites:
Society for Critical Care Medicine
http://www.learnicu.org/pages/guidelines.aspx
Did not locate any guidelines on respiratory failure that mention HFOV
American Association for Respiratory Care
A paper (2007) on the site – http://www.rcjournal.com/contents/09.07/09.07.1224.pdf – indicates that at that time the technique was not included in any AARC guidelines.
Did not locate any other guidelines on the site that address use of HFOV.
AACN Procedure Manual for Critical Care (in EUH Branch Library), 2011. Indicates that there has not been enough evidence to show superiority of HFOV over conventional modes of ventilation in patients with ARDS (p. 278).
Evidence Matters 