scholarly journals Comparison between Multiple Doses and Single-Dose Steroids in Preventing the Incidence of Reintubation after Extubation among Critically Ill Patients: A Network Meta-Analysis

2021 ◽  
Vol 10 (13) ◽  
pp. 2900
Author(s):  
Chiwon Ahn ◽  
Min Kyun Na ◽  
Kyu-Sun Choi ◽  
Tae Ho Lim ◽  
Bo-Hyoung Jang ◽  
...  
Keyword(s):  
Single Dose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Included Study ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
High Dose ◽  
Multiple Doses ◽  
Intravenous Steroids

This study aimed to determine the frequency of prophylactic steroid administration to prevent reintubation after extubation in critically ill patients. We systematically searched MEDLINE, Embase and Cochrane Library for studies regarding the preventive use of multiple doses or single-dose steroids prior to extubation on July 2020 and conducted a network meta-analysis (NMA) to compare these interventions. To assess the risk of bias of each included study, version 2 of the Cochrane risk-of-bias tool for randomized trials was used. Nine randomized control trials comprising 2098 patients with comparisons of the three interventions were included. Use of multiple doses and single doses of intravenous steroids administration showed a significantly lower rate of reintubation compared with placebo (odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.25–0.72; OR: 0.31, 95% CI: 0.14–0.69). However, the comparison between multiple doses and single doses showed no significant differences (OR: 1.22, 95% CI: 0.32–4.74). According to the surface under the cumulative ranking curve statistic, the treatments should be ranked as follows: single dose (87.1%), high dose (62.8%) and placebo (0.1%). This NMA showed that the multiple doses were not statistically superior to the single dose in lowering the incidence of reintubation after extubation in critically ill patients. Therefore, use of a single-dose steroid can reduce the incidence of reintubation.

scholarly journals Comparison between Multiple doses and Single-dose Steroids in Preventing the Incidence of Reintubation after Extubation among Critically ill Patients: A Network Meta-analysis

2021 ◽  
Author(s):  
Chiwon Ahn ◽  
Min Kyun Na ◽  
Tae Ho Lim ◽  
Bo-Hyoung Jang ◽  
Wonhee Kim ◽  
...  
Keyword(s):  
Single Dose ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Included Study ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
High Dose ◽  
Multiple Doses ◽  
Randomized Control

Abstract This study aimed to determine the frequency of prophylactic steroid administration to prevent reintubation after extubation in critically ill patients. We systematically searched MEDLINE, Embase, and Cochrane Library for studies regarding the preventive use of multiple doses or single-dose steroids prior to extubation on July 2020, and conducted a network meta-analysis (NMA) to compare these interventions. To assess the risk of bias of each included study, version 2 of the Cochrane risk-of-bias tool for randomized trials was used. Nine randomized control trials comprising 2,098 patients with comparisons of the three interventions were included. Use of multiple doses and single doses showed a significantly lower rate of reintubation compared with placebo (odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.25–0.72; OR: 0.31, 95% CI: 0.14–0.69). However, the comparison between multiple doses and single doses showed no significant differences (OR: 1.22, 95% CI: 0.32–4.74). According to the surface under the cumulative ranking curve statistic, the treatments should be ranked as follows: single dose (87.1%), high dose (62.8%), and placebo (0.1%). This NMA showed that the multiple doses were not statistically superior to the single dose in lowering the incidence of reintubation after extubation in critically ill patients. Therefore, use of a single-dose steroid can reduce the incidence of reintubation.

Hypophosphatemia and Outcomes in ICU: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 088506662094027
Author(s):  
Jeremy Cheuk Kin Sin ◽  
Lillian King ◽  
Emma Ballard ◽  
Stacey Llewellyn ◽  
Kevin B. Laupland ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Icu Length Of Stay ◽  
Newcastle Ottawa Scale

Purpose: Hypophosphatemia is reported in up to 5% of hospitalized patients and ranges from 20% to 80% in critically ill patients. The consequences of hypophosphatemia for critically ill patients remain controversial. We evaluated the effect of hypophosphatemia on mortality and length of stay in intensive care unit (ICU) patients. Methods: MEDLINE, EMBASE, Cochrane Library (Reviews and Trials), and PubMed were searched for articles in English. The primary outcome was mortality and secondary outcome was length of stay. The quality of evidence was graded using a modified Newcastle-Ottawa Scale. Results: Our search yielded 828 articles and ultimately included 12 studies with 7626 participants in the analysis. Hypophosphatemia was associated with increased hospital length of stay (2.19 days [95% CI, 1.74-2.64]) and ICU length of stay (2.22 days [95% CI, 1.00-3.44]) but not mortality (risk ratio: 1.13 [95% CI, 0.98-1.31]; P = .09). Conclusions: Hypophosphatemia in ICU was associated with increased hospital and ICU length of stay but not all-cause mortality. Hypophosphatemia appears to be a marker of disease severity. Limited number of available studies and varied study designs did not allow for the ascertainment of the effect of severe hypophosphatemia on patient mortality.

scholarly journals High-dose versus low-dose haemofiltration for the treatment of critically ill patients with acute kidney injury: an updated systematic review and meta-analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e014171 ◽  
Author(s):  
Peng Li ◽  
Li-ping Qu ◽  
Dong Qi ◽  
Bo Shen ◽  
Yi-mei Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Meta Analysis ◽  
Kidney Injury ◽  
High Dose

ObjectiveThe purpose of this study was to perform a systematic review and meta-analysis to evaluate the effect of high-dose versus low-dose haemofiltration on the survival of critically ill patients with acute kidney injury (AKI). We hypothesised that high-dose treatments are not associated with a higher risk of mortality.DesignMeta-analysis.SettingRandomised controlled trials and two-arm prospective and retrospective studies were included.ParticipantsCritically ill patients with AKI.InterventionsContinuous renal replacement therapy.Primary and secondary outcome measuresPrimary outcomes: 90-day mortality, intensive care unit (ICU) mortality, hospital mortality; secondary outcomes: length of ICU and hospital stay.ResultEight studies including 2970 patients were included in the analysis. Pooled results showed no significant difference in the 90-mortality rate between patients treated with high-dose or low-dose haemofiltration (pooled OR=0.90, 95% CI 0.73 to 1.11, p=0.32). Findings were similar for ICU (pooled OR=1.12, 95% CI 0.94 to 1.34, p=0.21) and hospital mortality (pooled OR=1.03, 95% CI 0.81 to 1.30, p=0.84). Length of ICU and hospital stay were similar between high-dose and low-dose groups. Pooled results are not overly influenced by any one study, different cut-off points of prescribed dose or different cut-off points of delivered dose. Meta-regression analysis indicated that the results were not affected by the percentage of patients with sepsis or septic shock.ConclusionHigh-dose and low-dose haemofiltration produce similar outcomes with respect to mortality and length of ICU and hospital stay in critically ill patients with AKI.This study was not registered at the time the data were collected and analysed. It has since been registered on 17 February 2017 athttp://www.researchregistry.com/, registration number: reviewregistry211.

scholarly journals Effect of Preemptive Acetaminophen on Opioid Consumption: A Meta-Analysis

2021 ◽  
pp. E153-E160
Keyword(s):  
General Anesthesia ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Potential Method ◽  
Included Study ◽  
Risk Of Bias ◽  
Opioid Consumption ◽  
Preemptive Analgesia ◽  
Cochrane Library ◽  
Pain Scores

BACKGROUND: Strategies for reducing postoperative opioid consumption have been explored in many recent studies, due in large part to the recent opioid epidemic. Preemptive analgesia has been proposed as a potential method, but its use is still controversial. OBJECTIVES: This review aimed to evaluate the efficacy of a single dose of acetaminophen as preemptive analgesia for patients undergoing general anesthesia. STUDY DESIGN: A meta-analysis of randomized controlled trials (RCTs). SETTING: The electronic databases of PubMed, EMBASE, Cochrane Library, and the Web of Science were searched. The protocol was previously registered in the PROSPERO database under the registration number CRD 42020165634. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. RCTs that compared preemptive acetaminophen with placebo in surgical patients receiving general anesthesia were included. The risk of bias for each included study was independently assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Six studies with 563 patients were included. Overall, the studies showed a reduction in 24-hour opioid consumption (standardized mean difference [SMD], –1.45; 95% confidence interval [CI], –2.36 to –0.55; P = 0.002), pain scores at 12 hours postoperatively (SMD, –0.86; 95% CI, –1.25 to –0.48; P < 0.0001), and a lower incidence of postoperative nausea (risk ratio [RR] 0.45; 95% CI, 0.34–0.58; P < 0.001) and vomiting (RR 0.39; 95% CI, 0.22–0.72; P = 0.002). LIMITATIONS: The major limitation of this meta-analysis relates to the risk of bias in the limited number of included studies. CONCLUSIONS: Preemptive acetaminophen administration significantly reduces opioid consumption within the initial 24 hours following general anesthesia, with lower pain scores at 12 hours after surgery, and less nausea and vomiting. However, well-conducted RCTs are still needed. KEY WORDS: Acetaminophen, preemptive analgesia, perioperative pain management, postoperative opioid consumption, opioid-related side effects

P0625CONTINUOUS RENAL REPLACEMENT THERAPY WITHOUT ANTICOAGULATION IN CRITICALLY ILL PATIENTS AT HIGH RISK OF BLEEDING-A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Shiren Sun ◽  
Wei Zhang ◽  
Ming Bai ◽  
Lijuan Zhao ◽  
Xiaolan Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Replacement Therapy ◽  
High Risk ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Cochrane Library ◽  
Risk Of Bleeding

Abstract Background and Aims Continuous renal replacement therapy (CRRT) has been widely used in the critical care setting and anticoagulation is usually necessitated. However, critically ill patients are commonly at incremental risk of bleeding, which contributed to the hesitation of anticoagulant use for CRRT in clinical practice. The current guideline recommended CRRT proceed without anticoagulation in patients with contraindication to citrate and increased bleeding risk. Nevertheless, the efficacy of anticoagulation-free CRRT remains inconsistent. Therefore, the purpose of our present systematic review is to evaluate the efficacy and safety of anticoagulant-free CRRT based on the current literatures. Method We conducted a comprehensive search of PubMed (US National Library of Medicine, Bethesda, MD, USA), Cochrane Library databases and EMBASE from database inception to January 12, 2019 for potential candidate studies. Studies included adult critically ill (age &gt; 18 years) patients with increased bleeding risk, and underwent CRRT without anticoagulation were considered for the inclusion. Results Finally, 17 observational studies and 3 randomized controlled trials with 1615 patients were included in our present meta-analysis. There was no significant difference in filter lifespan between the anticoagulation-free and systemic heparin group. The filter lifespan was significantly prolonged in the citrate (WMD -23.01, 95%CI [-28.62, -17.39], P &lt; 0.001; I2 = 0%, P = 0.53) and nafamostat (WMD -8.4, 95%CI [-9.9, -6.9], P &lt; 0.001; I2 = 33.7%, P = 0.21) groups, compared with anticoagulation-free group. The averaged filter lifespan of the anticoagulation-free CRRT ranged from 10.2 to 52.5 hours. Conclusion The filter lifespan in anticoagulation-free patients with increased bleeding risk was comparable to that in patients without increased bleeding risk underwent systemic heparin anticoagulation CRRT. Nafamostat was not recommended for CRRT anticoagulation due to its drawbacks. Currently, the optimal choice of anticoagulation strategy for critically ill patients without citrate contraindications at high risk of bleeding should be regional citrate anticoagulation. Further studies should focus on the special cut-off value of activated partial thromboplastin time (APTT), international normalized ratio (INR) and platelet (PLT) count, at which the anticoagulation-free CRRT would be beneficial.

scholarly journals Epidemiology, clinical characteristics and treatment of critically ill patients with COVID-19): a protocol for a living systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e042008
Author(s):  
Lazar Milovanovic ◽  
Erin Hessey ◽  
Meghan Sebastianski ◽  
Diana Keto-Lambert ◽  
Ben Vandermeer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Search Strategy ◽  
Meta Analysis ◽  
Case Series ◽  
Case Fatality ◽  
Cochrane Library ◽  
Icu Admission ◽  
Epidemiological Characteristics

IntroductionIn December 2019, the first cases of COVID-19 associated with SARS-CoV-2 viral infection were described in Wuhan, Hubei Province, China. Since then, it has spread rapidly affecting 188 countries and was declared a pandemic by the WHO on 11 March 2020. Preliminary reports suggest up to 30% of patients require intensive care unit (ICU) admission and case fatality rate estimate is 2.3%–7.2%. The primary reason for ICU admission is hypoxaemic respiratory failure, while factors associated with ICU admission include increased age, presence of comorbidities and cytokine storm. Case series and retrospective trials initially assessed proposed treatments with randomised controlled trials now reporting early outcomes. We conduct a systematic review and meta-analysis to identify epidemiological factors, treatments and complications that predict mortality among critically ill patients with COVID-19.Methods and analysisOur comprehensive search strategy was developed in consultation with a research librarian. We will search electronic databases: Ovid Medline, Ovid Embase, Ovid Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Wiley Cochrane Library. The search strategy combines concepts from COVID-19, validated COVID-19 search filters and geographical locations of large outbreaks. Citation screening, selection, quality assessment and data abstraction will be performed in duplicate. Clinically homogenous epidemiological characteristics, interventions and complications will be pooled in statistical meta-analysis. Within the framework of a living systematic review, the search and data analysis will be updated every 6 months.Ethics and disseminationOur systematic review will synthesise literature on risk factors and interventions associated with mortality in critically ill patients with COVID-19. Results will be presented at national and international conferences and submitted for peer-reviewed publication. The pooled analysis can provide guidance to inform clinical guidelines for care of critically ill patients with COVID-19. Iterative updates will be made public through open access. Research ethics approval is not required.PROSPERO registration numberCRD42020176672.

scholarly journals Risk of Clinically Relevant Venous Thromboembolism in Critically Ill Patients With COVID-19: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Johannes Gratz ◽  
Marion Wiegele ◽  
Mathias Maleczek ◽  
Harald Herkner ◽  
Herbert Schöchl ◽  
...  
Keyword(s):  
Systematic Review ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
English Language ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Individual Risk ◽  
Bleeding Events

Background: Early during the course of the ongoing COVID-19 pandemic, reports suggested alarmingly high incidences for thromboembolic events in critically ill patients with COVID-19. However, the clinical relevance of these events was not reported in several studies. Additionally, more recent research showed contradictory results and suggested substantially lower rates of venous thromboembolism. Thus, the aim of the present study was to summarize evidence on the incidence of clinically relevant venous thromboembolism (VTE)—defined as VTE excluding isolated subsegmental pulmonary embolism (PE) and distal deep vein thrombosis (DVT)—in adult critically ill patients with COVID-19.Methods: We performed a systematic review of studies reporting the incidence of clinically relevant PE and/or DVT in critically ill patients with COVID-19. Scientific reports published in the English language between January and October 2020 were included. We conducted a random-effects model meta-analysis to calculate incidence estimates of clinically relevant VTE and bleeding events. We also performed exploratory meta-regression and subgroup analyses of different diagnostic approaches and additional factors that possibly influenced the incidence of these outcomes.Results: Fifty-four articles (5,400 patients) fulfilled the predefined inclusion criteria, of which 41 had a high risk of bias. The majority of included patients were male, &gt; 60 years, and overweight. Twenty-one studies reported the use of prophylactic doses of heparin. Pooled incidences for clinically relevant PE were estimated at 8% (95% CI, 4–11%), for proximal DVT at 14% (95% CI, 9–20%), and—after exclusion of studies with a high risk of bias—for the composite outcome of VTE at 18% (95% CI, 13–24%). Clinically relevant bleeding occurred at a rate of 6% (95% CI, 2–9%).Conclusions: We summarized currently available data on the rate of clinically relevant VTE in critically ill patients with COVID-19. Pooled incidence estimates were lower than those reported by previous review articles. In the absence of evidence-based anticoagulation guidelines for critically ill patients with COVID-19, the results of our study provide clinically important information for an individual risk-benefit assessment in this context.Registration: The study protocol was prospectively registered in PROSPERO on June 22, 2020 (CRD42020193353; https://www.crd.york.ac.uk/prospero).

scholarly journals Safety of High-Dose Vitamin C in Critically Ill Patients: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Dhan Bahadur Shrestha ◽  
Pravash Budhathoki ◽  
Yub Raj Sedhai ◽  
Sujit Kumar Mandal ◽  
Shreeja Shikhrakar ◽  
...  
Keyword(s):  
Vitamin C ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Case Series ◽  
High Dose ◽  
Slight Reduction ◽  
Pooled Data

Abstract Objective:High-Dose Intravenous Vitamin C (HDIVC) is currently a controversial therapy for sepsis and ARDS. The published evidence regarding its efficacy in critically ill patients has shown conflicting results, and in fact, case reports have raised concerns for nephrotoxicity. The objective of this meta-analysis is to critically appraise the latest evidence regarding the safety of HDIVC in critically ill patients.Data Sources: Structured literature search on PubMed, PubMed Central, Scopus, Embase, and Google Scholar.Study Selection: Cross-sectional studies, case-control studies, cohort studies, randomized controlled trials, and case series with 20 or more critically ill patients who have received intravenous ascorbic acid (vitamin C), published till February 25, 2021. We identified 53 studies in our qualitative analysis and 48 studies in our quantitative analysis among a standardized search of 18,312 studies.Data Synthesis:We pooled data and calculated Odds Ratios (OR) and Mean Differences (MD) with their 95% confidence intervals to assess explanatory variables. Based on a random effect model from 33 studies, pooled hospital mortality outcomes showed a 19% reduction in odds for overall hospital mortality among the HDIVC group (OR, 0.81; 95% CI, 0.66-0.98). Mortality at 28/30-days, ICU mortality, length of hospital stay (LOS), new-onset AKI, and Renal Replacement Therapy (RRT) for AKI did not differ significantly across treatment and control groups. Pooled data from 30 studies disclosed 0.76 fewer ICU days in the HDIVC group than the placebo/ standard of care (SOC) group, 95% CI, -1.34 to -0.19. This significance persisted when we included RCTs only in the analysis (MD, -0.70; 95% CI, -1.39 to -0.02).Conclusions:Our results suggest that HDIVC treatment is renally safe and did not increase adverse kidney events, or mortality. It was associated with a slight reduction in ICU length of stay in critically ill patients.

scholarly journals Single Versus Multiple Doses of Tocilizumab in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19): A Two-center, Retrospective Cohort Study

2021 ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Ohoud Al Juhani ◽  
Khalid Bin Salah ◽  
Ghazwa Koryem ◽  
Khalid Eljaaly ◽  
...  
Keyword(s):  
Single Dose ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Secondary Infection ◽  
Demographic Data ◽  
Vital Signs ◽  
Multiple Doses ◽  
Significant Difference

Abstract Background: In COVID-19 patients, increased IL-6 levels have been associated with poor disease prognosis. The use of tocilizumab shown to be effective in treating COVID-19 with varying success. This study aims to evaluate the effectiveness and safety of using a single dose of tocilizumab compared with multiple doses in critically ill COVID-19 patients.Methods:This study is a two-center, retrospective cohort, in which patients who received tocilizumab and were admitted to the ICU at two tertiary hospitals from March 1st, 2020, until January 31st, 2021were included. Patients were divided into two groups based on the number of doses of tocilizumab they received. Furthermore, we gathered additional data from the patients, such as but not limited to demographic data, vital signs, and laboratory markers. Multivariable logistic and generalized linear regression were used. We considered a P value of < 0.05 statistically significant. Results: Two hundred sixty-one patients were included in this study; 72.4% received a single dose of tocilizumab, while the rest (27.6%) had received multiple doses. Most of the patients were male, with an average age of 59.2. After adjusting for possible confounders, the 30-day mortality (HR 0.92; 95% CI, 0.48-1.75 p = 0.79) and in-hospital mortality (HR 0.69; 95% CI, 0.36-1.31 p = 0.25) were not significantly different between the two groups. On the flip side, patients who received multiple doses of tocilizumab have higher odds of secondary infection compared with a single dose (OR 3.06; 95% CI, 1.18-7.89 p = 0.02).Conclusion: Multiple doses of tocilizumab were not associated with a statistically significant difference in ICU and hospital mortality in critically ill patients infected with COVID-19. In contrast, it was associated with higher odds of secondary infections compared to a single dose.

scholarly journals Effect of vitamin C in critically ill patients with sepsis and septic shock: A meta-analysis

2021 ◽  
Vol 104 (1) ◽  
pp. 003685042199817
Author(s):  
Fang Feng ◽  
Huyong Yang ◽  
Weiwei Yang ◽  
Min Li ◽  
Xueni Chang ◽  
...  
Keyword(s):  
Septic Shock ◽  
Length Of Stay ◽  
Vitamin C ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Icu Length Of Stay ◽  
Sepsis And Septic Shock

The objective of this study was to investigate the efficacy of vitamin C in patients experiencing sepsis and septic shock. The PubMed, Embase and Cochrane Library databases were searched for randomized controlled trials (RCTs) about vitamin C treatments for critically ill patients suffering from sepsis and septic shock from inception until December 31, 2019. The primary outcome was mortality, and the secondary outcomes were the ICU length of stay and the dose of vasopressors. A meta-analysis of nine RCTs with a total of 584 patients (301 in the intervention group and 283 in the control group) was conducted. There were significant differences between the vitamin C group and the control group in 28-day mortality (fixed effects OR = 0.60 95% CI [0.42, 0.85], p = 0.004) and in the dose of vasopressors (SMD = −0.88 95% CI [−1.48, −0.29], p = 0.003); however, the ICU length of stay was the same between the two groups (SMD  = −0.33 95% CI [−0.87, 0.20] p = 0.23). This meta-analysis demonstrated that the use of vitamin C (compared with placebo) led to a reduction in ICU mortality and a reduction in the dose of vasopressors in patients with septic shock. However, the ICU length of stay was not significantly different between the two groups. Therefore, multicentre and high-quality RCTs are needed to further clarify the safety and effectiveness of vitamin C among patients with sepsis and septic shock.

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