General Critical Care

Time to Treatment With Intravenous Thrombolysis Before Thrombectomy and Functional Outcomes in Acute Ischemic Stroke

https://jamanetwork.com/journals/jama/fullarticle/2815005

The study in question investigates the efficacy and time sensitivity of combining intravenous thrombolysis (IVT) with thrombectomy versus thrombectomy alone in treating acute ischemic stroke. Here's a breakdown according to the PICO format:

• Population: The study focused on 2,313 participants presenting with anterior circulation large-vessel occlusion at thrombectomy-capable stroke centers across 15 countries. These participants were part of a larger pool from 6 randomized clinical trials. The median age was 71 years, with 44.3% female representation.

• Intervention: The intervention group received IVT followed by thrombectomy.

• Comparison: The comparison group underwent thrombectomy alone.

Electroencephalography (EEG) reveals suppressed background with triphasic waves demonstrating diffuse cerebral disease.

Efficacy of permissive underfeeding for critically ill patients: an updated systematic review and trial sequential meta-analysis

This systematic review and meta-analysis examined permissive underfeeding in ICU patients (less or equal to 20 kcal/kg), involving 23 randomized controlled trials with 11,444 patients. It found no significant differences in overall mortality, hospital mortality, hospital stay length, or overall infection incidence. However, permissive underfeeding significantly reduced ICU mortality (risk ratio [RR] = 0.90) and gastrointestinal adverse events (RR = 0.79), and shortened mechanical ventilation duration by 1.85 days. The study suggests potential benefits of permissive underfeeding in ICU mortality and ventilation duration but calls for more large-scale trials due to sample size and patient heterogeneity.

https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-024-00717-3