Showing papers by "Simon Hannam published in 2013"

Cooling for Newborns with Hypoxic Ischemic Encephalopathy

Abstract: adverse effects of cooling and ‘early’ indicators of neurodevelopmental outcome. Data Collection and Analysis: Four review authors independently selected, assessed the quality of and extracted data from the included studies. Study authors were contacted for further information. Meta-analyses were performed using risk ratios (RR) and risk differences (RD) for dichotomous data, and weighted mean difference for continuous data with 95% confidence intervals (CI). Main Results: We included 11 randomized controlled trials in this updated review, comprising 1,505 term and late preterm infants with moderate/severe encephalopathy and evidence of intrapartum asphyxia. Therapeutic hypothermia resulted in a statistically significant and clinically important reduction in the combined outcome of mortality or major neurodevelopmental disability to 18 months of age (typical RR 0.75 (95% CI 0.68–0.83); typical RD –0.15, 95% CI –0.20 to –0.10); number needed to treat for an additional beneficial outcome (NNTB) 7 (95% CI 5–10) (8 studies, 1,344 infants). Cooling also resulted in statistically significant reductions in mortality (typical RR 0.75 (95% CI 0.64–0.88), typical RD –0.09 (95% CI –0.13 to –0.04); NNTB 11 (95% CI 8–25) (11 studies, 1,468 infants) and in neurodevelopmental disability in survivors (typical RR 0.77 (95% CI 0.63–0.94), typical RD –0.13 (95% CI –0.19 to –0.07); NNTB 8 (95% CI 5–14) (8 studies, 917 infants). Some adverse effects of hypothermia included an increase sinus bradycardia and a significant increase in thrombocytopenia. Cochrane Abstract

Randomised Trial of Volume-Targeted Ventilation versus Pressure-Limited Ventilation in Acute Respiratory Failure in Prematurely Born Infants

Abstract: Background: During volume-targeted ventilation (VTV), a constant volume is delivered with each ventilator inflation. Objectives: To determine whether VTV compared to pressure-limited ventilation (PLV) reduced the time to reach weaning criteria in prematurely born infants with acute respiratory distress, and if any difference was explained by better respiratory muscle strength and/or a lower work of breathing (WOB). Methods: Infants of Results: Forty infants, median gestational age 27 (range 23-33) weeks, were recruited. The time taken to achieve weaning criteria was similar in the two groups [median 14 h (VTV) vs. 23 h (PLV)]. There were no significant differences between the groups with regard to respiratory muscle strength, WOB or other outcomes, except that fewer of the VTV compared to the PLV group had episodes of hypocarbia (8 vs. 19; p Conclusion: In prematurely born infants with acute respiratory failure, use of VTV did not reduce the time to reach weaning criteria, but was associated with a reduction in episodes of hypocarbia.

Rationale of statin therapy in septic patients

Abstract: Statins are well-established and effective drugs in the treatment of hyperlipidemias. However the effects of statins extend beyond lipid-lowering. The pleiotropic effects of statins have been shown to modify inflammatory cell signaling of the immune response to infection. Statins have emerged as potential immunomodulatory and antioxidant agents that might impact on sepsis outcomes. It was postulated that statins may be candidates for the treatment of sepsis. Recent animal and human data suggest that statin therapy might be beneficial in patients before the onset of sepsis or in its initial period, but should be used with care when patients are diagnosed with severe sepsis or septic shock. Some analyses also provide evidence for statins as an adjuvant therapy in sepsis. Because of the divergent results of studies, the potential benefit needs to be validated in randomized, controlled trials. In this review, we describe current evidence on the use of statins in the prevention and treatment of sepsis.