Shock


COCHRANE SYSTEMATIC REVIEW: Continuous versus intermittent infusions of antibiotics for the treatment of severe acute infections
Implications for practice: Unclear
Review Overview: : No differences in mortality, infection recurrence, clinical cure, super-infection post–therapy, and safety outcomes were reported when continuous infusions of intravenous antibiotics were compared with traditional intermittent infusions of antibiotics. However, the wide confidence intervals suggest that beneficial or harmful effects cannot be ruled out for all outcomes. Therefore, the current evidence is insufficient to recommend the widespread adoption of continuous infusion antibiotics in the place of intermittent infusions of antibiotics. Additional large prospective randomized trials, with consistent and complete reporting of clinical outcome measures, conducted with concurrent pharmacokinetic and pharmacodynamic studies in special populations, are required to determine whether adoption of continuous antibiotic infusions is warranted in specific circumstances.
LINK to Cochrane Library: Issue 6, 2013 and Issue 3, 2013 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008481.pub2/abstract


COCHRANE SYSTEMATIC REVIEW: Timing and volume of fluid administration for patients with bleeding
Implications for practice: Further randomised controlled trials are needed to establish the most effective fluid resuscitation strategy.
Review Overview: The authors searched for relevant medical research reports and found six randomised controlled trials involving a total of 2128 people. In each study, people with uncontrolled bleeding were randomly assigned to receive one treatment or another. Three studies were about the amount of fluid given (more or less), and three studies were about giving fluid at different times following injury (sooner or later). The authors were interested in finding out which treatments were better, to reduce deaths and to enable blood clotting. Blood clotting was measured by prothrombin time and partial thromboplastin time during fluid administration. The review of trials found that there is uncertainty about the best time to give fluid and what volume of fluid should be given. While increasing fluids will maintain blood pressure, it may also worsen bleeding by diluting clotting factors in the blood.
LINK to Cochrane Library: Issue 3, 2014 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002245.pub2/abstract


COCHRANE SYSTEMATIC REVIEW: Tranexamic acid for upper gastrointestinal bleeding
Implications for practice: Tranexamic acid reduces mortality in GI bleeds
Review Overview: Transexamic acid is an antifibrinolytic agent. The trials found a beneficial effect of transexamic acid on mortality when compared with placebo but not on any of the remaining outcome measures assessed including bleeding.
LINK to Cochrane Library: Issue 1, 2012 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006640.pub2/pdf/abstract


COCHRANE SYSTEMATIC REVIEW: Colloid solutions for fluid resuscitation
Implications for practice: Different types of colloids appear equally effective
Review Overview: A person who has experienced heavy bleeding may go into shock due to loss of fluid. Colloids and crystalloids are two types of solutions used to replace lost blood plasma. This review of the effectiveness of different colloid solutions included 70 trials, 24 of which had adequate allocation concealment. The colloid solutions examined were equally safe and effective.
LINK to Cochrane Library: Issue 1 2008 http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001319/frame.html


COCHRANE SYSTEMATIC REVIEW: Colloids versus crystalloids for fluid resuscitation in critically ill patients
Implications for practice: Colloids and crystalloids appear equally effective, but colloids are more expensive
Review Overview: Colloid solutions are widely used to replace fluid in critically ill patients. There is ongoing debate about the relative effectiveness of the more expensive colloids as compared to crystalloid fluids. The results of this review based on 65 trials show that in comparison to crystalloid fluids, colloids did not improve the survival of patients with trauma, burns or following surgery.
LINK to Cochrane Library: Issue 4 2007 http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000567/frame.html


COCHRANE SYSTEMATIC REVIEW: Pharmacological interventions for hypertensive emergencies
Implications for practice: Unlikely to be effective in reducing morbidity or mortality
Review Overview: There is controversy as to when and which blood pressure drugs to use in hypertensive emergencies such as heart attack or stroke. A review of 15 trials, which included seven drug classes, concluded that anti-hypertensive drugs do not reduce mortality or morbidity in patients with hypertensive emergencies. There were minor differences in the degree of blood pressure lowering between drug classes; however, the clinical significance is unknown.
LINK to Cochrane Library: Issue 1 2008 http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003653/frame.html