Objectives: Several clinical trials have evaluated the efficacy and safety of baricitinib in COVID-19 patients. Recently, there have been reports on critical patients, which are different from previous research results. The meta-analysis was performed to investigate the effects of baricitinib in COVID-19, by pooling data from all clinically randomized controlled trials (RCTs) available to increase power to testify. Methods: Studies were searched in PubMed, Embase, and Cochrane Library databases on January 31, 2023. We performed a meta-analysis to estimate the efficacy and safety of baricitinib for the treatment of hospitalized adults with COVID-19. This study is registered with INPLASY, number 202310086. Results: A total of 3010 patients were included in our analyses. All included studies were randomized controlled trials or prospective study. There was no difference in 14-day mortality between the two groups [OR 0.23 (95% CI 0.03–1.84), I² = 72%, P = 0.17]. In subgroup analyses we found that baricitinib did not seem to improve significantly in 24-day mortality critically ill patients [OR 0.60 (95% CI 0.35–1.02), I² = 0%, P = 0.06]. Fortunately, baricitinib have led to faster recovery and shorter hospital stays for COVID-19 patients. There were no difference in infections and infestations, major adverse cardiovascular events, deep vein thrombosis and pulmonary embolism. Conclusions: Baricitinib did not increase the incidence of adverse reactions. At the same time, we can find that it reduces the mortality of COVID-19 patients, not including the critically ill.

We conducted a meta-analysis to investigate the effect of dexmedetomidine on postoperative delirium in elderly orthopedic surgery patients. A meta-analysis was conducted to identify randomized controlled trials of dexmedetomidine in elderly patients undergoing orthopedic surgery. The data was published on October 25, 2024. PubMed, Embase, and Cochrane Library databases were searched. Outcome measures included incidence of delirium, length of hospital stay, visual analogue scale, and postoperative complications. Estimates are expressed as relative risk (RR) or mean difference (MD) with a 95% confidence interval (CI). The publications were reviewed according to the guidelines of the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This study was registered with INPLASY (number INPLASY2024110004). A total of 3159 patients were included in 9 randomized controlled trials. The results showed that dexmedetomidine exhibited a preventive effect on delirium compared with the control group in elderly patients after orthopedic surgery (RR: 0.55, 95% CI: 0.45–0.66, P < 0.01, I2 = 0%). Subgroup analysis suggested that dexmedetomidine was significantly different from saline(RR: 0.56; 95% CI: 0.44–0.73, P<0.01, I²=31%) and propofol(RR: 0.52; 95% CI: 0.39–0.70, P 0.05). Certainty of evidence for postoperative delirium was moderate. Dexmedetomidine has been shown to have a protective effect on postoperative delirium in elderly patients following orthopedic surgery.

Melatonin has been demonstrated to exert a preventive effect on delirium. This meta-analysis sought to investigate the preventive effects of melatonin and melatonin receptor agonists (ramelteon) on delirium in hospitalized elderly patients. This systematic review and meta-analysis delineates the risk of delirium events in older hospitalized patients with melatonin/ramelteon compared with placebo, incorporating randomized controlled trials published up to 8 July 2024. The databases searched were PubMed, Embase and the Cochrane Library. The primary outcome measures were the incidence of delirium, while the secondary outcome measures were the length of hospital stay and mortality. The results are presented as odds ratios (OR) or mean differences (MD) with a 95% confidence interval. The review of publications was conducted in accordance with the guidelines set forth in the Cochrane Handbook and the Preferred Reporting Project for Systematic Review and Meta-Analysis (PRISMA). This study has been registered with INPLASY (number INPLASY202470044). A total of 2086 patients were included in 13 randomized controlled trials. The primary outcome of this meta-analysis demonstrated a statistically difference in the incidence of delirium between the melatonin and placebo groups in hospitalized elderly patients (OR = 0.59, 95% CI: 0.40–0.87, P < 0.01, I2 = 60%), particularly in those who had undergone surgery (OR = 0.60, 95%CI: 0.40–0.89, P = 0.01, I2 = 53%). No statistically differences were observed in terms of length of stay (MD=-0.07, 95%CI:-1.09-0.94, P = 0.89, I2 = 72%) and mortality (OR = 0.79, 95%CI:0.58–1.06, P = 0.12, I2 = 0%). Melatonin has been demonstrated to exert a protective effect on delirium in elderly patients who are hospitalized, particularly in the context of perioperative care.

Several clinical trials have evaluated the efficacy and safety of baricitinib in COVID-19 patients. Recently, there have been reports on critical patients, which are different from previous research results. Studies were searched in PubMed, Embase, and Cochrane Library databases on January 31, 2023. We performed a meta-analysis to estimate the efficacy and safety of baricitinib for the treatment of hospitalised adults with COVID-19. This study is registered with INPLASY , number 202310086. A total of 3010 patients were included in our analyses. All included studies were randomized controlled trials or prospective study. There was no difference in 14-day mortality between the two groups (OR 0.23 [95% CI 0.03–1.84], I²=72%, P=0.17). In subgroup analyses we found that baricitinib did not seem to improve significantly in 24-day mortality critically ill patients (OR 0.60 [95% CI 0.35–1.02], I²=0%, P=0.06). Fortunately, baricitinib have led to faster recovery and shorter hospital stays for COVID-19 patients. There were no difference in infections and infestations, major adverse cardiovascular events, deep vein thrombosis and pulmonary embolism. Baricitinib is safe. At the same time, we can find that it reduces the mortality of COVID-19 patients, but the prognosis of the critically ill patients is not significantly improved.

Background Temperature management has been shown to be important in different diseases, and our study analyzes the research trends and future directions of temperature management in critically ill patients. Methods Literatures in our study were searched from the Web of Science core collection database (WoSCC), timeline was confined from the earliest time of the database to the latest time of literature search (October 22, 2023). R-studio and Citespace were used to perform the visualization analysis. Results A total of 529 publications from the WoSCC were analyzed. According to our research, there has been a rapid increase in publications since 2013. The largest number of articles produced by corresponding authors in the United States is as high as 161. Resuscitation had the highest number of publications among journals worldwide, with 23 publications representing 4.59% of all publications. Most of the keywords were related to cardiac arrest, critical care, hypothermia, targeted temperature management and therapeutic hypothermia. Latest burst words are neuron specific enolase, prognostication, septic shock and ambient temperature. This suggests that there may be more groundbreaking reports in these directions. Conclusions Temperature management is crucial in the clinical treatment of critically ill patients. Future studies should analyze more aspects of specific implementation in different diseases that can be controlled by temperature management target temperature, treatment timing, induction mode, induction speed, duration, rewarming mode and speed.

Background: Traditional volume management for acute decompensated heart failure emphasizes strict fluid restriction. However, this may be harmful in patients with relative hypovolemia (e.g., poor intake or sepsis). We report two cases managed with a physiology-guided, individualized maintenance fluid strategy (avoiding routine restriction) and present them as hypothesis-generating observations. Case presentation: Case 1: A 69-year-old man with dilated cardiomyopathy presented with acute exacerbation, hypotension, prerenal azotemia (urea/creatinine >20:1), and anorexia. We used maintenance fluids (approximately 35 mL/kg/day as an initial empirical target, adjusted clinically) while continuing guideline-directed medical therapy (GDMT). Symptoms improved; NT-proBNP fell from 20,470 to 2,669 pg/mL. Case 2: An 83-year-old woman with sepsis from an infected pressure ulcer developed acute heart failure. We used a similar maintenance fluid strategy (not aggressive resuscitation) plus antibiotics and gradual GDMT. Infection resolved, NT-proBNP fell from 14,995 to 365 pg/mL. Conclusion: In selected patients with ADHF and possible hypovolemic factors, a physiology-guided maintenance strategy may be considered as an alternative to strict restriction. This strategy may help interrupt the hypothesized vicious cycle of hypoperfusion and renal injury, and is compatible with the optimization of GDMT. However, causality cannot be inferred because multiple interventions were given simultaneously. These observations are hypothesis-generating and require prospective validation. Individualized management is essential.