Background:Much controversy persists regarding the role of statins therapy in patients with sepsis. This systematic review and meta-analysis of randomized trials aimed to evaluate the clinical efficacy of statin therapy on mortality from sepsis.Methods:We comprehensively searched PubMed, Embase, and Cochrane controlled trials register for relevant clinical studies. Randomized controlled trials reporting the effect of statin therapy on mortality in septic patients were included. Pooled risk estimates were calculated with a fixed-effects model. Heterogeneity was determined by Cochran chi-square test and the I2 statistic.Results:Nine trials with a total of 2333 patients were included. Seven randomized trials were eligible for the in-hospital mortality analysis. There were 257 deaths among 1078 individuals in the statin treatment group and 268 deaths among 1081 individuals in the control group. There was no statistically significant difference (RR, 0.96; 95% CI, 0.83–1.11). Five randomized trials reported data on 28 day-hospital mortality. There were 123 deaths among 613 individuals in the statin treatment group and 141 deaths among 633 individuals in the control group. There was no statistically significant difference (RR, 0.90; 95% CI, 0.73–1.11).Conclusion:This systematic review and meta-analysis of randomized trials indicates that statin therapy has no effect on mortality outcomes in patients with sepsis compared with placebo.

Introduction: Enteral feed is an important component of nutritional therapy in critically ill patients and underfeeding has been associated with adverse outcomes. The article developed an enteral feeding protocol and planed a before-and-after comparative trial to explore whether implementation of enteral feeding protocol was able to improve clinical outcomes. Methods and analysis:The study will be conducted in intensive care units (ICUs) of ten tertiary care academic centers. Critically ill patients expected to stay in ICU for over 3 days and require enteral nutrition (EN) were potentially eligible. This is a before-and-after study comprising three phases: The first phase is the period without enteral feeding protocol; the second phase involves four-week training program, and the last phase is to perform the protocol in participating centers. We plan to enroll a total of 350 patients to provide an 80% power and 0.05 error rate to detect a 15% reduction of mortality. The primary outcome is 28-day mortality.Ethics and dissemination: Ethical approval to conduct the research has been obtained from all participating centers. Additionally, the results will be published in peer-reviewed journal.Trial registration: The study was registered at International Standard Registered Clinical/soCial sTudy Number (ISRCTN) registry (ISRCTN10583582).

Background and objectiveEnteral nutrition (EN) feeding protocol was proposed to have positive impact on critically ill patients. However, current studies showed conflicting results. The present study aimed to investigate whether enteral feeding protocol was able to improve clinical outcomes in critically ill patients.MethodsA before (stage 1) and after (stage 2) interventional study was performed in 10 tertiary care hospitals. All patients expected to stay in the intensive care unit (ICU) for over three days were potentially eligible. Clinical outcomes such as 28-day mortality, ICU length of stay, duration of mechanical ventilation (MV), and nosocomial infection were compared between the two stages.Main resultsA total of 410 patients were enrolled during the study period, including 236 in stage 1 and 174 in stage 2. EN feeding protocol was able to increase the proportion of EN in day 2 (41.8±22.3 vs. 50.0±28.3%; p = 0.006) and day 6 (70.3±25.2 vs. 77.6±25.8%; p = 0.006). EN percentages tended to be higher in stage 1 than that in stage 2 on other days, but statistical significance was not reached. There was no difference in 28-day mortality between stage 1 and 2 (0.14 vs. 0.14; p = 0.984). Implementation of EN feeding protocol marginally reduced ICU length of stay (19.44±18.48 vs. 16.29±16.19 days; p = 0.077). There was no difference in the duration of MV between stage a and stage 2 (14.24±14.49 vs. 14.51±17.55 days; p = 0.877).ConclusionsThe study found that the EN feeding protocol was able to increase the proportion of EN feeding, but failed to reduce 28-day mortality, incidence of nosocomial infection or duration of MV.

EffEct of rhubarb on Extravascular lung watEr in patiEnts with acutE rEspiratory distrEss syndromE reV assoC Med Bras 2017; 63 (5) Objective: The aim of this study was to evaluate the effect of rhubarb on extravascular lung water (EVLW) in patients with acute respiratory distress syndrome (ARDS). Method: A total of 80 patients with ARDS were randomly divided into a treatment group (40 cases) and control group (40 cases). Patients in the treatment group received rhubarb (30.0 g/d) and patients in the control group received conventional therapy for seven consecutive days. Extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were determined using pulse contour cardiac output (PiCCO) technology, and the oxygenation index was measured by blood gas analysis at baseline and on days 3, 5 and 7 after treatment. Results: The oxygenation index was higher and the levels of EVLWI and PVPI were lower after treatment in the two groups; however, these indexes showed significant differences on the 5 th and 7 th days after rhubarb treatment compared with the results in the control group (p<0.05). Conclusion: Rhubarb can decrease EVLWI and PVPI, and improve oxygenation in patients with ARDS.