These findings need to be confirmed in prospective studies and randomised controlled trials designed to further clarify the pathogenesis of non-alcoholic fatty liver disease and to establish evidence-based dietary recommendations for its prevention and treatment.

Background Septic shock is a distributive shock with decreased systemic vascular resistance and mean arterial pressure (MAP). Septic shock contributes to the most common causes of death in the intensive care unit (ICU). Current guidelines recommend the use of norepinephrine as the first-line vasopressor, while adrenergic agonists and vasopressin analogs are also commonly used by physicians. To date, very few studies have synthetically compared the effects of multiple types of vasoactive medications. The aim of this study is to systemically evaluate the efficacy of vasoactive agents both individually and in combination to treat septic shock. Methods The PubMed, MEDLINE, Embase, Web of Science and Cochrane Central Register for Controlled Trials (CENTRAL) were searched up to May 12, 2022, to identify relevant randomized controlled trials. A network meta-analysis was performed to evaluate the effect of different types of vasopressors. The primary outcome was 28-day all-cause mortality. The secondary outcome was the ICU length of stay. Adverse events are defined as any undesirable outcomes, including myocardial infarction, cardiac arrhythmia, peripheral ischemia or stroke and cerebrovascular events. Findings Thirty-three RCTs comprising 4966 patients and assessing 8 types of vasoactive treatments were included in the network meta-analysis. The surface under the cumulative ranking curve (SUCRA) provided a ranking of vasoactive medications in terms of 28-day all-cause mortality from most effective to least effective: norepinephrine plus dobutamine, epinephrine, vasopressin, terlipressin, norepinephrine, norepinephrine plus vasopressin, dopamine and dobutamine. Dopamine was associated with a significantly shorter ICU stay than norepinephrine, terlipressin and vasopressin, while other vasoactive medications showed no definite difference in ICU length of stay. Regarding adverse events, norepinephrine was associated with the highest incidences of myocardial infarction and peripheral ischemia. Dopamine was associated with the highest incidence of cardiac arrhythmia. Epinephrine and terlipressin were associated with the highest incidences of myocardial infarction and peripheral ischemia. Interpretation The results of this network meta-analysis suggest that norepinephrine plus dobutamine is associated with a lower risk of 28-day mortality in septic shock patients than other vasoactive medications, and the use of dopamine is associated with a higher risk of 28-day mortality due to septic shock than norepinephrine, terlipressin and vasopressin.

Background The ideal time to wean off of a ventilator has been predicted using the spontaneous breathing trial (SBT). Which trial ought to be chosen with preference is still debatable. Among critically sick patients receiving mechanical ventilation (MV) our goal was to evaluate typical SBT modalities such as pressure support ventilation (PSV), continuous positive airway pressure (CPAP), and T-piece. Methods We searched the PubMed, Cochrane, Embase, Web of Science database for RCTs from inception to the 30th of Nov. 2022. We included RCTs involving adult patients (> 18 years) who underwent at least two different SBT methods. Primary outcome was extubation. Secondary outcomes were reintubation, mechanical ventilation duration, intensive care unit (ICU) mortality, and hospital mortality, intensive care unit (ICU) length of stay and hospital length of stay. Statistical analysis was conducted by using RevMan 5.4 and trial sequence analysis (TSA). Results were expressed as risk ratio (RR) or mean difference (MD) with accompanying 95% confidence interval (CI). Results Twenty-one RCTs comprising 4636 patients are included. The results of this meta-analysis showed that there was a significant difference in the successful extubation rate between the T-piece or CPAP group and PSV group (risk ratio [RR] = 0.93; 95% CI, 0.90–0.96; P < 0.00001; Chi2 = 7.86; I2 = 0%). In addition, there was statistically difference in the hospital mortality between 2 groups (risk ratio [RR] = 1.23; 95% CI, 1.01–1.49; P = 0.04; ChI2 = 3.07; I2 = 0%). Compared with the PS group, the T-piece or CPAP group showed no significant difference in other secondary outcomes. Further subgroup analysis found that the duration of mechanical ventilation appeared to be shorter in the PSV group than in the T-piece group in patients with difficult weaning. Conclusions The prognostic power of T-piece, CPAP, and PSV as SBTs for effective extubation in critically ill patients is seen as being equivalent. PSV has the potential to increase the success rate of patient extubation when compared to T-piece or CPAP. In addition, the PSV group appeared to have an advantage over the other group in lowering hospital mortality and cutting the time those patients with difficult weaning.