Objectives: To evaluate the impact of HES solutions on adverse renal outcomes and mortality in critically ill patients requiring acute volume resuscitation. Design: Systematic review and ...meta-analysis of randomized controlled trials. Data Sources: We searched electronic databases from 1950 to 2007 (MEDLINE, EMBASE, the Cochrane Central Registry of Controlled Trials, and the SCOPUS database). Conference proceedings and grey literature sources were also searched from 2002-2007. Review Methods: We included all randomised controlled trials of patients requiring acute volume resuscitation who received HES compared to an alternative resuscitation fluid. No restrictions were considered regarding language or publication type. Data were independently extracted in duplicate. Results:Of 2381 citations reviewed, we included 22 trials (n=1866) in the analysis. Patients receiving HES were more likely to receive renal replacement therapy odds ratio OR 1.91 (95% confidence interval CI 1.22-2.99, I^210.5%). This was also true for patients with severe sepsis or septic shock OR 1.82 (95% CI 1.27-2.62, I^20%). In high quality trials, multicentre trials, and in reports indicating adequate allocation concealment, there was a trend toward increased risk of death associated with HES. Other adverse events were not systematically evaluated and were poorly reported. Limitations: Considerable clinical and methodologic heterogeneity exists among these trials. Conclusions: The use of HES for volume resuscitation in critically ill patients is associated with increased use of renal replacement therapy and may result in increased mortality. We caution against the routine use of HES for volume resuscitation in critically ill patients.
Hydroxyethyl starch (HES) is a type of colloid fluid that is commonly used for volume resuscitation of patients admitted to the intensive care unit. Data regarding the renal consequences of HES are ...conflicting.
To evaluate the effect of HES solutions on renal outcomes and mortality among critically ill patients requiring acute volume resuscitation.
We searched electronic databases (MEDLINE, EMBASE, the Cochrane Central Registry of Controlled Trials and the SCOPUS database) from 1950 to 2008. Conference proceedings and grey literature sources were searched from 2002 to 2007.
We included only randomized controlled trials of acute volume resuscitation of critically ill patients comparing HES fluid with an alternative resuscitation fluid.
Two reviewers independently assessed trial eligibility, extracted data and evaluated trial quality. Random-effects models were used for all summary measures of effect.
Twenty-two trials (n = 1865 patients) were included. Patients who received HES were more likely to have received renal replacement therapy (odds ratio OR 1.90, 95% confidence interval CI 1.22-2.96, I(2) 9.5%, n = 749). There was no difference in overall mortality (OR 1.07, 95% CI 0.85-1.34, n = 1657). However, in trials that included patients with severe sepsis and septic shock, in high-quality and multicentre trials, and in trials with adequate allocation concealment, there was a trend toward increased risk of death in association with HES.
Data regarding adverse events, including renal outcomes, were not reported in the majority of published randomized trials. Considerable clinical and methodologic heterogeneity existed among trials.
The use of HES for acute volume resuscitation of critically ill patients, and in particular those with severe sepsis and septic shock, appeared to be associated with increased use of renal replacement therapy. Further randomized controlled trials evaluating clinically important end points are required to examine the efficacy and safety of HES fluids for critically ill patients.
66. Knudston JL, Dort JM, Helmer SD, et al. Surgeonperformed ultrasound for pneumothorax in the trauma suite. J Trauma 2004;56:527-30, doi:10.1097/01.TA. 0000114529.99353.22.
Au Canada, le XXe siècle inaugure une époque faste en matière de culture du livre et de l’imprimé. Après la Première Guerre mondiale, l’émergence de maisons d’édition indépendantes, d’associations ...d’auteurs, la création de prix littéraires et scientifiques et de subventions à la production, notamment au Québec, sont autant de signes de la vitalité du livre dans la transmission et la promotion d’une culture nationale, désormais projetée dans la durée et conçue comme un héritage essentiel. C’est ainsi que l’on peut voir se développer une culture du livre distincte de l’imprimerie et de la presse, où les éditeurs deviennent progressivement des architectes de la culture canadienne. Ce troisième volume de l’Histoire du livre et de l’imprimé au Canada couvre la période de 1918 à 1980, durant laquelle des transformations cruciales ont eu lieu. Ainsi, les deux grands groupes linguistiques du pays s’enrichissent de structures éditoriales distinctes, et grâce aux périodiques, les populations autochtones et les communautés ethniques et religieuses s’approprient les outils de la communication écrite pour exprimer leurs valeurs, affirmer leur appartenance sociale et créer des liens de solidarité. La Deuxième Guerre mondiale crée une demande nationale accrue pour le livre canadien qui se déploie alors sur la scène internationale. Au même moment, le cinéma, la radio et la télévision, phénomènes nouveaux, favorisent la pénétration d’une production de masse en provenance des États-Unis. L’affirmation d’une identité canadienne s’accentue encore dans les années 1960 au moment où les littératures canadienne et québécoise connaissent une période d’effervescence sans précédent. Enfin, après plus d’un siècle de luttes et de revendications, d’actions individuelles et collectives, les gouvernements mettent en place des structures de soutien à la création littéraire et au livre qui en assureront l’essor au cours des années 1980.
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