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Nutrition in Clinical Practice :... Jun 2018The aim of this study was to systematically review the effect of permissive underfeeding/trophic feeding on the clinical outcomes of critically ill patients. A...
Permissive or Trophic Enteral Nutrition and Full Enteral Nutrition Had Similar Effects on Clinical Outcomes in Intensive Care: A Systematic Review of Randomized Clinical Trials.
The aim of this study was to systematically review the effect of permissive underfeeding/trophic feeding on the clinical outcomes of critically ill patients. A systematic review of randomized clinical trials to evaluate the mortality, length of stay, and mechanical ventilation duration in patients randomized to either hypocaloric or full-energy enteral nutrition was performed. Data sources included PubMed and Scopus and the reference lists of the articles retrieved. Two independent reviewers participated in all phases of this systematic review as proposed by the Cochrane Handbook, and the review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 7 randomized clinical trials that included a total of 1,717 patients were reviewed. Intensive care unit length of stay and mechanical ventilation duration were not statistically different between the intervention and control groups in all randomized clinical trials, and mortality rate was also not different between the groups. In conclusion, hypocaloric enteral nutrition had no significantly different effects on morbidity and mortality in critically ill patients when compared with full-energy nutrition. It is still necessary to determine the safety of this intervention in this group of patients, the optimal amount of energy provided, and the duration of this therapy.
Topics: Critical Care; Critical Illness; Enteral Nutrition; Humans; Length of Stay; Nutritional Status; Randomized Controlled Trials as Topic; Respiration, Artificial; Treatment Outcome
PubMed: 29377333
DOI: 10.1002/ncp.10001 -
The Science of the Total Environment Jun 2023The potential for chemical contaminant exposure to interact with other stressors to affect animal behavioral responses to environmental variability is of mounting...
The potential for chemical contaminant exposure to interact with other stressors to affect animal behavioral responses to environmental variability is of mounting concern in the context of anthropogenic environmental change. We systematically reviewed the avian literature to evaluate evidence for contaminant-by-environment interactive effects on animal behavior, as birds are prominent models in behavioral ecotoxicology and global change research. We found that only 17 of 156 (10.9 %) avian behavioral ecotoxicological studies have explored contaminant-by-environment interactions. However, 13 (76.5 %) have found evidence for interactive effects, suggesting that contaminant-by-environment interactive effects on behavior are understudied but important. We draw on our review to develop a conceptual framework to understand such interactive effects from a behavioral reaction norm perspective. Our framework highlights four patterns in reaction norm shapes that can underlie contaminant-by-environment interactive effects on behavior, termed exacerbation, inhibition, mitigation and convergence. First, contamination can render individuals unable to maintain critical behaviors across gradients in additional stressors, exacerbating behavioral change (reaction norms steeper) and generating synergy. Second, contamination can inhibit behavioral adjustment to other stressors, antagonizing behavioral plasticity (reaction norms shallower). Third, a second stressor can mitigate (antagonize) toxicological effects of contamination, causing steeper reaction norms in highly contaminated individuals, with improvement of performance upon exposure to additional stress. Fourth, contamination can limit behavioral plasticity in response to permissive conditions, such that performance of more and less contaminated individuals converges under more stressful conditions. Diverse mechanisms might underlie such shape differences in reaction norms, including combined effects of contaminants and other stressors on endocrinology, energy balance, sensory systems, and physiological and cognitive limits. To encourage more research, we outline how the types of contaminant-by-environment interactive effects proposed in our framework might operate across multiple behavioral domains. We conclude by leveraging our review and framework to suggest priorities for future research.
Topics: Animals; Behavior, Animal; Birds; Ecotoxicology
PubMed: 37003321
DOI: 10.1016/j.scitotenv.2023.163169 -
European Journal of Vascular and... Jun 2018The incidence of spinal cord ischaemia (SCI) and subsequent paraplegia after thoracic endovascular aneurysm repair (TEVAR) and thoraco-abdominal endovascular aneurysm... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The incidence of spinal cord ischaemia (SCI) and subsequent paraplegia after thoracic endovascular aneurysm repair (TEVAR) and thoraco-abdominal endovascular aneurysm repair is estimated to be between 2.5% and 8%. The aim of this review is to provide an overview of SCI preventive strategies in TEVAR and thoraco-abdominal repair and recommend an optimal strategy.
METHODS
Medline, Embase, and the Cochrane Library were searched for studies on TEVAR, thoraco-abdominal endovascular repair, and the use of SCI preventive measures. The review was reported according to the PRISMA statement.
RESULTS
The final analysis included 43 studies (7168 patients). All studies are cohort studies (non-comparative cohorts n = 37, comparative cohorts n = 6) and largely performed retrospectively (n = 27). The included studies had an average MINORS score of 9 (range 6-13) for non-comparative studies and 15.5 (range 12-18) for comparative studies. Transient SCI occurred in 5.7% (450/7,168, 95% CI 4.5-6.9%), permanent SCI in 2.2% (232/7,168, 95% CI 1.6-2.8%). There was a trend towards increased SCI incidence for more "high risk" cohorts. Avoidance of hypotension resulted in a slightly lower permanent SCI rate 1.8% (102/4216, 95% CI 1.2-2.3%) than the overall cohort. A very low SCI estimate (transient and permanent) was found in the subgroup of studies (2 studies, n = 248) using (mild) peri-operative hypothermia (transient SCI 0.8%, permanent SCI 0.4%). In the subgroup using temporary permissive endoleak, there was a transient SCI estimate (15.4%), with a permanent SCI estimate of 4.8%. The remaining preventive measures did not significantly impact transient or permanent SCI estimates.
CONCLUSION
Low overall transient and permanent SCI rates are achieved during endovascular thoracic and thoraco-abdominal aortic repair. Based on the presented data, the use of selective spinal fluid drainage in high risk patients seems justified. Peri-operative hypotension should be avoided and treated where possible. The use of mild hypothermia is promising in small cohorts, but requires further evaluation. Further high quality data are essential to establish a definitive preventive strategy.
Topics: Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Endovascular Procedures; Epidemiologic Methods; Humans; Postoperative Complications; Spinal Cord Ischemia
PubMed: 29525741
DOI: 10.1016/j.ejvs.2018.02.002