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Báo cáo y học: "Recently published papers: Changing bandwagons, innovations and questioning dogma"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Recently published papers: Changing bandwagons, innovations and questioning dogma. | Available online http ccforum.eom content 13 3 157 Commentary Recently published papers Changing bandwagons innovations and questioning dogma Jonathan Ball General Intensive Care Unit St George s Hospital London SW17 0QT UK Corresponding author Jonathan Ball jball@sgul.ac.uk Published 22 June 2009 Critical Care 2009 13 157 doi 10.1186 cc7897 This article is online at http ccforum.com content 13 3 157 2009 BioMed Central Ltd Abstract This issue s Recently published papers commentary considers the popular and muddy waters of glycaemic control stops briefly to ponder the incidence of pulmonary embolus in acute exacerbations of chronic obstructive pulmonary disease promotes novel studies in the areas of traumatic brain injury and extracorporeal circuits and rounds off with a potentially dogma-challenging study in cardiac arrest. And the answer is . Optimal glycaemic management continues to be the focus of many authors research efforts with at least seven noteworthy papers published during the past 2 months. Despite this burgeoning body of work many controversies remain. The first study to consider is the so-called NICE-SUGAR collaboration between the Canadian Australian and New Zealand trials groups 1 . An excellent and pragmatic design was employed and 6 104 patients were recruited and randomized to glycaemic targets of 4.5 to 6.0 mmol l 80 to 110 mg dl or 10.0mmol l 180mg dl . An evidencebased feeding guideline was used that favoured enteral nutrition and glycaemic monitoring was preferentially performed by arterial blood analysis. A myriad of end-points and analyses were performed but the headline result was a statistically significant higher 90-day mortality in the group with the 4.5 to 6.0 mmol l target 27.5 versus 24.9 predominantly attributed to cardiovascular causes. The Kaplan-Meier curves show that the groups separate roughly between days 20 and 40. The authors conclusion rightly stresses that a universal target of 4.5 to 6.0 mmol l cannot be recommended over