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The Association Between Parity and Cervical Cancer Risk: A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 No. 2 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/s0harx65

Introduction: Cervical cancer remains the fourth most common cancer in women globally (Sung et al., 2021; World Health Organization, 2024). While persistent infection with high-risk human papillomavirus (HPV) is established as the necessary cause, it is insufficient for carcinogenesis (Walboomers et al., 1999). Parity (the number of live births) has long been suspected as a critical cofactor, but evidence has been inconsistent (Tekalegn et al., 2022). This review synthesizes the epidemiological evidence on this association. Methods: This systematic review was conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (Page et al., 2021). A systematic search of MEDLINE/PubMed, Scopus, HINARI, Google Scholar, and Science Direct was performed (Tekalegn et al., 2022). Inclusion criteria were case-control or cohort studies quantifying the association between parity and cervical cancer risk. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS) (Wells et al., 2000). Results: A total of 18 observational studies, comprising 17 case-control studies and one prospective cohort study, were included in the final synthesis. A recent, high-quality meta-analysis incorporating many of these studies (Tekalegn et al., 2022) reported a significant pooled odds ratio (OR) from 6,685 participants. The analysis showed that women with high parity had 2.65 times higher odds of developing cervical cancer compared to their low-parity counterparts (OR = 2.65, 95% CI: 2.08–3.38). This review confirms this finding and further highlights a significant dose-response relationship, with risk increasing progressively with each additional birth (Muñoz et al., 2002; Sharma and Pattanshetty, 2018). Discussion: The evidence confirms that high parity is a major, independent cofactor that promotes carcinogenesis, particularly in HPV-positive women (Muñoz et al., 2002). This association is not an artifact of confounding by sexual behavior. Proposed biological mechanisms include: (1) supraphysiological hormonal changes during pregnancy promoting HPV oncogene expression; (2) persistent eversion (ectropion) of the cervical transformation zone, increasing epithelial vulnerability (Jensen et al., 2013); (3) cervical trauma during childbirth facilitating viral persistence; and (4) localized, pregnancy-related immunomodulation that impairs viral clearance. Conclusion: High parity is a robust and significant risk factor for cervical cancer. This finding has direct implications for public health, identifying women with high parity as a high-risk group that should be prioritized for cervical screening and HPV vaccination programs, especially in resource-limited settings where both high parity and cervical cancer incidence are prevalent.

The Impact of Prophylactic HPV Vaccination on the Incidence of High-Grade Cervical Intraepithelial Neoplasia (CIN2/CIN3): A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 No. 2 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/kjmnzx32

Introduction: Cervical cancer is the fourth most common cancer in women globally, etiologically linked to persistent high-risk human papillomavirus (HPV) infection (World Health Organization, 2024a; World Health Organization, 2024b). High-grade cervical intraepithelial neoplasia (CIN), specifically CIN2 and CIN3, are the direct, histologically confirmed precursor lesions (Cleveland Clinic, 2023). This systematic review synthesizes the evidence from randomized controlled trials (RCTs) and real-world observational studies on the effectiveness of prophylactic HPV vaccination in reducing the incidence of CIN2 and CIN3 (CIN2+). Methods: Following PRISMA guidelines, a systematic search of PubMed, Embase, and the Cochrane Library was conducted (Ghebrekidan et al., 2024; Khalil et al., 2023). Studies were included if they were RCTs or observational (cohort, case-control) studies assessing the efficacy or effectiveness of prophylactic HPV vaccination (bivalent, quadrivalent, or nonavalent) on histologically confirmed CIN2+ outcomes in females. Methodological quality was appraised using the Cochrane Risk of Bias 2 (RoB 2) tool for RCTs (Sterne et al., 2019; Cochrane, 2024) and the Newcastle-Ottawa Scale (NOS) for observational studies (Wells et al., 2024; Ohri, 2024). Results: This synthesis includes 17 high-quality studies. Foundational RCTs (e.g., FUTURE, PATRICIA) demonstrated near-perfect efficacy (98-100%) against vaccine-type HPV 16/18-related CIN2+ in per-protocol (HPV-naïve) populations (FUTURE II Study Group, 2007; Paavonen et al., 2009; Kjaer et al., 2018). A high-certainty Cochrane review confirmed a 63% reduction in any CIN2+ (irrespective of HPV type) in hrHPV-negative young women (Risk Ratio 0.37, 95% CI 0.25-0.55) (Arbyn et al., 2018). Recent, large-scale real-world effectiveness (RWE) studies from national registries report profound, significant reductions in high-grade lesions. In England, cohorts vaccinated at age 12-13 showed an 87% reduction in invasive cervical cancer and a 97% reduction in CIN3 (Falcaro et al., 2021). In Sweden, vaccination before age 17 was associated with an 88% reduction in invasive cervical cancer (Lei et al., 2020), and in Scotland, an 86% reduction in CIN3+ was observed in the 12-13 age cohort (Palmer et al., 2019). Effectiveness is strongly dependent on vaccination age (Hariri et al., 2023; Herweijer et al., 2016). Furthermore, significant evidence demonstrates high effectiveness (74-87% reduction) in preventing the recurrence of high-grade lesions when used as an adjuvant to surgical conization (Dvořák et al., 2024; Ghelardi et al., 2021). Discussion: The evidence is overwhelming and consistent. The near-100% efficacy observed in controlled trial settings has translated directly into profound population-level effectiveness in countries with high, sustained vaccine uptake (Ghebrekidan et al., 2024; Drolet et al., 2019). The dependency of effectiveness on age confirms the vaccine's prophylactic mechanism, underscoring the criticality of pre-adolescent vaccination. Conclusion: Prophylactic HPV vaccination provides a significant, robust, and long-lasting reduction in the incidence of high-grade cervical precancer (CIN2/3). High-coverage national programs are demonstrating the potential to "almost eliminate" (Falcaro et al., 2021) cervical cancer in vaccinated generations, representing a major public health triumph.

The Relationship Between Pap Smear Screening Adherence and Cervical Cancer Mortality: A Systematic Review Bangar Parlinggoman Tua; Yahya Nurlianto; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 No. 3 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/xnj3se72

INTRODUCTION: Cervical cancer remains a leading cause of cancer-related mortality for women globally, with a disproportionate burden concentrated in low- and middle-income countries (LMICs) (World Health Organization, 2024). This significant disparity is largely attributable to inadequate implementation of, and adherence to, preventive screening programs (Bray et al., 2024). This systematic review synthetically evaluates the quantitative association between adherence to Papanicolaou (Pap) smear screening and cervical cancer mortality. METHODS: A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Page et al., 2021). Major electronic databases (including PubMed, MEDLINE, Embase, and Web of Science) were searched for observational studies (cohort and case-control) that assessed cervical cancer mortality or the incidence of invasive cervical cancer as an outcome of cytology screening history (Peirson et al., 2013). Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale (NOS), the standard, validated tool for non-randomized studies (Wells et al., 2000). RESULTS: A total of 16 high-impact observational studies met the inclusion criteria. The findings are overwhelmingly consistent and statistically significant in demonstrating a profound protective effect. Large-scale cohort studies demonstrate that women adhering to screening have a substantially lower risk of mortality; one major study found a 70% reduction in cervical cancer mortality (Hazard Ratio: 0.30; 95% Confidence Interval [CI]: 0.12–0.74) (Makino et al., 2006). Case-control studies report exceptionally strong protective effects, with odds ratios (OR) for mortality as low as 0.08 (95% CI: 0.07–0.09) (Landy et al., 2016) and 0.34 (95% CI: 0.14–0.49) (Lönnberg et al., 2013). Furthermore, a meta-analysis of case-control studies on invasive cancer (the precursor to mortality) found a pooled protective effect (OR: 0.35; 95% CI: 0.30–0.41), signifying an approximate 65% reduction in risk (Peirson et al., 2013). DISCUSSION: The evidence irrefutably confirms a significant inverse relationship between screening adherence and mortality. The epidemiological findings demonstrate that the public health failure is not one of diagnostic efficacy but of implementation. This discussion synthesizes the quantitative efficacy of screening with the major documented barriers—economic, psychosocial, cultural, and provider-level—that suppress adherence rates and perpetuate this preventable mortality (Akin-Odanye et al., 2024). CONCLUSION: Adherence to Pap smear screening is a critical, primary determinant in the prevention of cervical cancer mortality. Public health strategies must shift from proving efficacy to aggressively dismantling the known structural and psychosocial barriers to adherence to achieve global elimination targets.

A Systematic Review of the Association of Preoperative Optimization of Diabetic Patients with Perioperative Glycemic Control and Postoperative Outcomes Pretika Prameswari; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 No. 3 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/ptswat97

Introduction: The prevalence of diabetes mellitus (DM) in surgical populations is substantial and represents a significant independent risk factor for postoperative complications. Preoperative optimization of glycemic control has emerged as a key strategy to mitigate these risks by improving patients' physiological resilience to surgical stress. This review systematically evaluates the association between preoperative glycemic status and postoperative outcomes. Methods: A systematic search of PubMed and the Cochrane Library was conducted for studies published through 2024. Inclusion criteria specified randomized controlled trials and observational studies evaluating preoperative glycemic markers (e.g., glycated hemoglobin ( HbA1c ), blood glucose) or structured optimization interventions in adult diabetic patients undergoing surgery. Primary outcomes included surgical site infection (SSI), 30-day mortality, and major adverse cardiovascular events (MACE). Secondary outcomes included length of stay (LOS), acute kidney injury (AKI), and other morbidities. Study quality was appraised using the Cochrane Risk of Bias 2 and ROBINS-I tools. Results: Seventeen studies, encompassing randomized trials and large cohort analyses, met the inclusion criteria. The evidence consistently links poor preoperative glycemic control, indicated by elevated HbA1c or acute hyperglycemia, with a significantly increased risk of postoperative complications. Specifically, high HbA1c levels were strongly associated with higher rates of SSI (Odds Ratio ranging from 2.13 to 3.0) and prolonged hospital LOS. Acute perioperative hyperglycemia was a more direct predictor of MACE and mortality (Hazard Ratio 1.26 for adverse cardiac events). Structured interventions, such as multidisciplinary preoperative clinics, demonstrated efficacy in reducing preoperative HbA1c levels, particularly in patients with the poorest baseline control. Discussion: The synthesized evidence highlights a critical debate regarding the predictive primacy of chronic ( HbA1c ) versus acute (perioperative blood glucose) hyperglycemia. While acute hyperglycemia appears to be the more proximate driver for immediate adverse events like myocardial injury, HbA1c serves as an essential tool for risk stratification, identifying patients who will benefit most from intensive perioperative management. The heterogeneity of the existing literature, particularly the scarcity of high-quality randomized trials, underscores the complexity of this issue. Conclusion: Poor preoperative glycemic control is unequivocally associated with adverse postoperative outcomes in diabetic patients. While the optimal strategy for preoperative optimization remains to be defined by high-quality evidence, current data support a shift from using HbA1c as a rigid surgical gatekeeper to a trigger for activating comprehensive, multidisciplinary perioperative management pathways.

Association of Deep versus Moderate Neuromuscular Blockade with Surgical Conditions and Postoperative Pulmonary Complications: A Systematic Review of Randomized Controlled Trials Pretika Prameswari; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 20 No. 3 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/b7aatk91

Introduction: The optimal depth of intraoperative neuromuscular blockade (NMB) remains a subject of clinical debate. Deep NMB is hypothesized to improve surgical conditions, particularly in minimally invasive surgery, but has historically been associated with an increased risk of postoperative pulmonary complications (PPCs) due to residual neuromuscular blockade (rNMB). This systematic review evaluates the evidence from randomized controlled trials (RCTs) to compare the effects of deep versus moderate NMB on surgical conditions and the incidence of PPCs. Methods: A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify RCTs comparing deep NMB (defined as a post-tetanic count of 1-2) with moderate NMB (defined as a train-of-four count of 1-2) in adult surgical patients. Primary outcomes were measures of surgical conditions (e.g., surgical rating scales, intraoperative patient movement) and the incidence of a composite of PPCs (e.g., pneumonia, atelectasis, respiratory failure). Secondary outcomes included postoperative pain, opioid consumption, recovery times, and other adverse events. Methodological quality was assessed using the Cochrane Risk of Bias 2 tool. Results: Seventeen RCTs met the inclusion criteria. The evidence consistently demonstrated that deep NMB was significantly associated with improved surgical conditions, including higher surgeon-rated scores, a significantly lower incidence of intraoperative patient movement, and the facilitation of lower intra-abdominal pressures during laparoscopy. Regarding safety, when deep NMB was managed with quantitative neuromuscular monitoring and reversed with appropriate agents, particularly sugammadex, there was no statistically significant increase in the incidence of composite PPCs, pneumonia, or atelectasis compared to moderate NMB. Furthermore, deep NMB was significantly associated with beneficial secondary outcomes, including reduced postoperative pain scores, lower opioid consumption, and a decreased incidence of postoperative nausea and vomiting. Discussion: The findings suggest a clear dissociation between the intraoperative depth of NMB and postoperative pulmonary risk. The primary driver of PPCs is postoperative rNMB, a risk that can be effectively mitigated with precise neuromuscular monitoring and the use of reversal agents capable of reliably antagonizing deep block. The benefits of deep NMB on surgical quality are substantial and are complemented by improvements in postoperative pain and recovery metrics. Conclusion: Deep NMB provides significant intraoperative advantages over moderate NMB, enhancing surgical conditions and safety. When implemented as part of a comprehensive strategy that includes quantitative monitoring and effective pharmacological reversal to prevent residual paralysis, it is not associated with an increased risk of postoperative pulmonary complications and may improve aspects of postoperative recovery.

The Comprehensive Systematic Review of Vasoactive-Inotropic Score as a Predictor of Outcome in Pediatric Critical Care Mohamad Fadli; Raka Jati Prasetya; Mutia Juliana
The Indonesian Journal of General Medicine Vol. 30 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/29yj3207

Introduction: The Vasoactive-Inotropic Score (VIS) quantifies cardiovascular support in critically ill children by aggregating vasoactive medication doses into a single numerical value. Despite widespread clinical use, a comprehensive synthesis of VIS as a predictor of pediatric outcomes across diverse populations is lacking. This systematic review aimed to evaluate the predictive value of VIS for mortality and morbidity in pediatric critical care populations. Methods: A systematic review was conducted following PRISMA guidelines. We screened studies based on predefined criteria: pediatric population (0-18 years), explicit VIS calculation using standard formulas, reporting of clinical outcomes, and statistical analysis examining VIS-outcome relationships. Studies were excluded if limited to adult populations, case reports, conference abstracts, or editorials. Data extraction included population characteristics, VIS calculation methods, predicted outcomes, predictive performance metrics, and key findings. Results: Eighty-seven studies published between 2010-2025 met inclusion criteria, encompassing 29,920 patients across diverse settings (PICU, cardiac ICU, NICU). Post-cardiac surgery populations were most frequently studied (n=34), followed by septic shock (n=18) and neonatal populations (n=15). VIS demonstrated strong mortality prediction across populations: septic shock (AUROC 0.779-0.976), neonatal cardiac surgery (AUROC 0.83), congenital diaphragmatic hernia (AUROC 0.925), and extremely low birth weight preterm infants (AUROC 0.816-0.92). Optimal thresholds varied substantially from VIS >5 in preterm infants to >70 in myocarditis. Maximum VIS in the first 24-48 hours showed strongest associations with outcomes. VIS predicted prolonged mechanical ventilation (OR 5.20, 95% CI 3.78-7.16) and composite poor outcomes (OR 6.5-8.1). The Vasoactive-Ventilation-Renal (VVR) score outperformed VIS alone in cardiac surgery populations (AUC 0.87-0.98 versus 0.68-0.78). Discussion: VIS demonstrates consistent predictive validity across pediatric critical care populations, with performance comparable or superior to established scoring systems. Threshold heterogeneity reflects population-specific severity, age-related physiologic differences, and condition-specific considerations. Serial VIS monitoring provides incremental prognostic information beyond single measurements. Conclusion: VIS is a valid, readily calculable predictor of mortality and morbidity in pediatric critical care. Population-specific thresholds and integration with multi-organ dysfunction scores enhance predictive utility. Future research should focus on prospective validation of thresholds and implementation of VIS-guided clinical decision support.

The Comprehensive Systematic Review of Fluid Overload and Mortality in Critically Ill Children Mohamad Fadli; Raka Jati Prasetya; Mutia Juliana
The Indonesian Journal of General Medicine Vol. 30 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/bz9f0f42

Introduction: Fluid overload (FO) is a common complication in critically ill children associated with adverse outcomes. However, heterogeneity in definitions, measurements, and study populations has created gaps in understanding the true magnitude of this association. This systematic review aims to comprehensively synthesize evidence on the association between FO and mortality in critically ill children, examining definitions, measurement methods, and population-specific effects. Methods: A systematic review of observational studies, randomized controlled trials, and meta-analyses examining FO and mortality in critically ill children (0-18 years) admitted to PICUs, NICUs, or cardiac ICUs was conducted. Studies were screened based on predefined criteria including pediatric population, FO exposure with clear definition, mortality outcomes, and adequate sample size. Data extraction encompassed study characteristics, FO definitions, mortality outcomes, confounding adjustments, secondary morbidity outcomes, and methodological quality. Results: Sixty-five studies were included, comprising over 45,000 patients across general PICUs, cardiac ICUs, and specialized populations (sepsis, CRRT, ECMO, ARDS, TBI). FO definitions varied considerably, with percentage FO calculated as (fluid intake—output)/reference weight × 100 being most common. Thresholds ranged from ≥5% to ≥20%, with reference weights including admission, preoperative, or dry weight. Meta-analyses demonstrated significantly increased mortality with FO (pooled OR range: 4.34-5.06). A dose-response relationship was consistently observed, with 3-6% increased mortality odds per 1% FO increase. Mortality rates were consistently higher across FO thresholds: 29.4% vs. 65.6% for <10% vs. ≥20% FO in CRRT patients; 46% vs. 26% for >10% FO in sepsis. However, 4 studies found no independent association after multivariable adjustment. Secondary outcomes including prolonged mechanical ventilation, longer PICU/hospital stays, and AKI were consistently associated with FO. Discussion: This review demonstrates a consistent, dose-dependent association between FO and mortality across diverse pediatric critical care populations, though with important population-specific variations. The strongest associations were observed in sepsis, CRRT, ECMO, and post-cardiac surgery patients, while TBI showed inconsistent findings. The timing of FO assessment emerged as critical, with later-onset FO (>48-72 hours) showing stronger mortality associations. Methodological heterogeneity in FO definitions and measurement remains a significant limitation. Conclusion: Fluid overload is independently associated with increased mortality and morbidity in critically ill children, with evidence supporting a dose-response relationship. Standardized FO definitions and measurement protocols are urgently needed. Future research should focus on randomized trials of fluid management strategies and risk-stratified approaches.

The Comprehensive Systematic Review of Impact of Early Mobilization on Long-term Outcomes in ICU Patients Mohamad Fadli; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 32 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/7xkp5b59

Introduction: Early mobilization in intensive care unit (ICU) patients has been proposed to mitigate the deleterious effects of critical illness, yet its impact on long-term outcomes remains uncertain. This systematic review comprehensively evaluates the effects of early mobilization on long-term functional, cognitive, quality of life, and healthcare utilization outcomes in adult ICU patients. Methods: A systematic review was conducted following PRISMA guidelines. We included randomized controlled trials, controlled clinical trials, cohort studies, case-control studies, systematic reviews, and meta-analyses involving adult ICU patients (≥18 years) who received early mobilization (initiated within 72 hours of ICU admission or mechanical ventilation) compared to standard care or delayed mobilization. Long-term outcomes were defined as those measured at least 30 days post-ICU or hospital discharge. Data were extracted on patient characteristics, mobilization protocols, long-term outcomes, safety, and study quality. Results: Sixty-eight studies were included, comprising over 30,000 patients. Early mobilization consistently improved short-term functional outcomes, including muscle strength (mean difference 4.47-8.62 points on MRC scale), reduced ICU-acquired weakness (OR 2.04-2.7 for independent functional status), and increased likelihood of walking independently at discharge (OR 2.13) (Patel et al., 2023; Tipping et al., 2017; Hu et al., 2019). However, large randomized controlled trials found no significant improvement in long-term mortality (Hodgson et al., 2022) or quality of life at 6-12 months (Higgins et al., 2025). Notably, one trial demonstrated reduced cognitive impairment at 1 year (24% vs 43%, p=0.0043) (Patel et al., 2023). Subgroup analyses revealed potential harm in diabetic patients receiving high-intensity mobilization (adjusted OR 3.47 for 180-day mortality) (Serpa Neto et al., 2024). Adverse event rates were low (<3%), though the TEAM trial reported more events in the intervention group (9.2% vs 4.1%, p=0.005) (Hodgson et al., 2022). Discussion: The evidence presents a complex picture where early mobilization yields clear short-term functional benefits that do not consistently translate into improved long-term survival or quality of life. Heterogeneity in protocols, patient populations, and outcome measures limits definitive conclusions. Conclusion: Early mobilization safely improves in-hospital functional outcomes and reduces healthcare utilization. However, long-term benefits beyond hospital discharge remain unproven, and high-intensity protocols may harm specific subgroups. Individualized, progressive mobilization strategies are recommended.

A Comprehensive Systematic Review of The Role of Vasopressors in Early Management of Hemorrhagic Shock Mohamad Fadli; Raka Jati Prasetya; Mutia Juliana
The International Journal of Medical Science and Health Research Vol. 32 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/wf2brc56

Introduction: The role of vasopressors in the early management of hemorrhagic shock remains controversial, with conflicting evidence from observational studies and randomized controlled trials. This systematic review aims to evaluate the efficacy and safety of early vasopressor administration in adult patients with hemorrhagic shock. Methods: A systematic review was conducted screening studies based on predefined criteria: adult patients with hemorrhagic shock from any cause, evaluation of any vasopressor agent within the first 24 hours, comparative study designs reporting clinically relevant outcomes. Fifty-eight sources were identified including randomized controlled trials, observational studies, and systematic reviews. Data were extracted on patient populations, vasopressor interventions, mortality outcomes, hemodynamic effects, fluid requirements, and adverse events. Results: Randomized controlled trials demonstrated that low-dose norepinephrine (<0.3 µg/kg/min) concurrent with fluid resuscitation significantly reduced 24-hour mortality (3% vs 13%, p<0.05) and in-hospital mortality (9% vs 21%, p<0.05) (Mohamed et al., 2024). The AVERT-Shock trial found no mortality difference with low-dose vasopressin but showed reduced blood product requirements (1.4 L vs 2.9 L, p=0.01) (Sims et al., 2019). Observational studies consistently associated vasopressor use with increased mortality (Aoki et al., 2018; Plurad et al., 2011; Fisher et al., 2020), though propensity-score analyses attenuated this association (Gauss et al., 2018). Vasopressors consistently achieved hemodynamic stabilization with improved mean arterial pressure and reduced fluid requirements. Adverse event profiles were similar between groups, with vasopressin associated with fewer deep venous thromboses (Sims et al., 2019). Discussion: The apparent contradiction between observational and randomized evidence is explained by confounding by indication, where sicker patients preferentially receive vasopressors. Context-dependent effects, agent-specific considerations, and timing of administration significantly influence outcomes. Low-dose vasopressors appear safe when used as adjuncts to—not replacements for—hemorrhage control and volume resuscitation. Conclusion: Early low-dose vasopressor administration, particularly norepinephrine and vasopressin, may be beneficial in selected patients with hemorrhagic shock, improving hemodynamic stability and reducing transfusion requirements without increasing mortality. Further research is needed to optimize agent selection, dosing strategies, and timing of initiation.

What is The Effectiveness of Intravenous Magnesium Supplementation Compared to Standard Care on Clinical Outcomes in Critically Ill Patients with Hypomagnesemia? : A Systematic Review Landong Sijabat; Raka Jati Prasetya; Mutia Juliana
The Indonesian Journal of General Medicine Vol. 34 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/fvm8m476

Introduction: Hypomagnesemia is common in critically ill patients and is associated with adverse outcomes. However, the effectiveness of intravenous (IV) magnesium supplementation remains controversial. Methods: This systematic review screened 80 studies including RCTs, etc across general ICUs, cardiac surgery, sepsis, neurological conditions, and other critical illnesses. Outcomes assessed included mortality, arrhythmias, neurological recovery, length of stay, and adverse events. Results: In post-cardiac surgery, IV magnesium significantly reduced supraventricular arrhythmias (RR 0.77; 95% CI: 0.63–0.93) and ventricular arrhythmias (RR 0.52; 95% CI: 0.31–0.87) [1,2]. In sepsis, magnesium improved lactate clearance and reduced ICU stay from 15 to 8 days (p<0.01) [3], with a network meta-analysis showing reduced short-term mortality (RR 0.33; 95% CI: 0.14–0.79) [4]. In AKI on CRRT, magnesium was associated with significantly lower 90-day mortality (aHR 0.38; 95% CI: 0.18–0.83) [5]. In aneurysmal SAH, magnesium reduced vasospasm (OR 0.61; 95% CI: 0.37–0.99) and delayed cerebral ischemia (OR 0.57; 95% CI: 0.37–0.88) but did not improve overall neurological outcome [6,7]. In TBI, the largest RCT showed no benefit and potential harm [8]. In general ICU patients with borderline hypomagnesemia, routine supplementation did not improve 24-hour clinical outcomes [9]. Extended infusion strategies improved magnesium retention compared to rapid boluses [11,12]. Adverse events were generally mild, though higher doses in TBI increased mortality [8]. Discussion: The effectiveness of IV magnesium is highly context-dependent. Strongest evidence supports arrhythmia prevention post-cardiac surgery. Sepsis and AKI on CRRT show promising signals for mortality and organ function, but evidence certainty is low. Neurological benefits are limited to intermediate events without improving final outcomes. Routine supplementation for mild hypomagnesemia in general ICU is not supported. Conclusion: IV magnesium supplementation is recommended for arrhythmia prophylaxis in post-cardiac surgery. Its role in sepsis and AKI on CRRT requires further high-quality RCTs. Magnesium should not be routinely administered for mild hypomagnesemia in general ICU or for neuroprotection in TBI.

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