Assessment of Early Tracheostomy in Trauma Patients: A Systematic Review and Meta-Analysis

2006 ◽  
Vol 72 (3) ◽  
pp. 276-281 ◽  
Author(s):  
C. Michael Dunham ◽  
Kenneth J. Ransom
Keyword(s):  
Brain Injury ◽  
Fixed Effects ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Trauma Patients ◽  
Severe Brain Injury ◽  
Early Tracheostomy ◽  
Randomized Controlled ◽  
Meta Analyses ◽  
Patient Studies

The objective of this review was to assess outcomes in trauma patients undergoing early tracheostomy (ET). Abstract databases for the Eastern and American Associations for the Surgery of Trauma and Medline were searched to find trauma patient studies comparing ET and late tracheostomy (LT) or ET and no ET. Fixed-effects meta-analyses were performed on the randomized controlled trial (RCT) studies. Of five retrospective and four RCT studies, none demonstrated survival benefit or harm with ET (P > 0.05). In five RCT studies of ET and no ET, ET pneumonia rates were similar to the no ET group (relative risk 1.00 [95% confidence intervals 0.88–1.15], P = 0.97). In five RCT studies of ET and no ET, ET ventilator/intensive care unit (ICU) days were similar to the no ET group (P = 0.27). In the two severe brain injury studies, ET ventilator/ICU days were lower than the no ET group (P = 0.06). In the three nonbrain injury studies, ET ventilator/ICU days were similar to the no ET group (P = 0.79). Five studies described similar laryngotracheal pathology rates with ET and no ET or LT (P > 0.05). In conclusion, ET has no influence on mortality, pneumonia, or laryngotracheal pathology rates in trauma patients. Patients with severe brain injury may be more rapidly liberated from mechanical ventilation with ET. However, additional research is needed.

scholarly journals Resuscitation fluid types in sepsis, surgical, and trauma patients: A Systematic review and sequential network meta-analyses

2020 ◽  
Author(s):  
Chien-Hua Tseng ◽  
Tzu-Tao Chen ◽  
Mei-Yi Wu ◽  
Ming-Cheng Chan ◽  
Ming-Chieh Shih ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Molecular Weight ◽  
Acute Kidney Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Trauma Patients ◽  
Meta Analyses ◽  
Balanced Crystalloids ◽  
Balanced Crystalloid

Abstract Background: Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with various adverse effects. Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be infer from sepsis to other patient group is uncertain, and adverse effect profile is not comprehensive. This study aims to compare the survival benefits and adverse effects of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. Methods: Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. CINeMA (Confidence in Network Meta-Analysis) web application was used to rate confidence in synthetic evidence. Results: Fifty-eight trials (n=26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer acute kidney injury, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids significantly reduced mortality more than saline (OR, 0.84; 95% CI 0.74 to 0.95) and L-HES (OR, 0.81; 95% CI 0.69 to 0.95) and reduced acute kidney injury more than L-HES (OR, 0.80; 95% CI 0.65 to 0.99). However, they required the greatest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was significantly superior to iso-oncotic albumin (OR, 0.55; 95% CI 0.35 to 0.87). Conclusions: Our network meta-analysis found that balanced crystalloids and albumin decreased mortality more than L-HES and saline did in sepsis patients; however, saline or L-HES, is better than iso-oncotic albumin or balanced crystalloids in traumatic brain injury patients.

scholarly journals Resuscitation fluid types in sepsis, surgical, and trauma patients: a systematic review and sequential network meta-analyses

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Chien-Hua Tseng ◽  
Tzu-Tao Chen ◽  
Mei-Yi Wu ◽  
Ming-Cheng Chan ◽  
Ming-Chieh Shih ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Molecular Weight ◽  
Acute Kidney Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Trauma Patients ◽  
Meta Analyses ◽  
Balanced Crystalloids ◽  
Balanced Crystalloid

Abstract Background Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with various adverse effects. Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be inferred from sepsis to other patient group is uncertain, and adverse effect profile is not comprehensive. This study aims to compare the survival benefits and adverse effects of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. Methods Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. Confidence in Network Meta-Analysis (CINeMA) web application was used to rate confidence in synthetic evidence. Results Fifty-eight trials (n = 26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer acute kidney injury, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids significantly reduced mortality more than saline (OR 0.84; 95% CI 0.74–0.95) and L-HES (OR 0.81; 95% CI 0.69–0.95) and reduced acute kidney injury more than L-HES (OR 0.80; 95% CI 0.65–0.99). However, they required the greatest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was significantly superior to iso-oncotic albumin (OR 0.55; 95% CI 0.35–0.87). Conclusions Our network meta-analysis found that balanced crystalloids and albumin decreased mortality more than L-HES and saline in sepsis patients; however, saline or L-HES was better than iso-oncotic albumin or balanced crystalloids in traumatic brain injury patients. Trial registration PROSPERO website, registration number: CRD42018115641).

scholarly journals Resuscitation fluid types in sepsis, surgical, and trauma patients: A Systematic review and sequential network meta-analyses

2020 ◽  
Author(s):  
Chien-Hua Tseng ◽  
Tzu-Tao Chen ◽  
Mei-Yi Wu ◽  
Ming-Cheng Chan ◽  
Ming-Chieh Shih ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Molecular Weight ◽  
Acute Kidney Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Trauma Patients ◽  
Meta Analyses ◽  
Balanced Crystalloids ◽  
Balanced Crystalloid

Abstract Background: Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with various adverse effects. Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be infer from sepsis to other patient group is uncertain, and adverse effect profile is not comprehensive. This study aims to compare the survival benefits and adverse effects of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. Methods: Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. CINeMA (Confidence in Network Meta-Analysis) web application was used to rate confidence in synthetic evidence. Results: Fifty-eight trials (n=26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer acute kidney injury, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids significantly reduced mortality more than saline (OR, 0.84; 95% CI 0.74 to 0.95) and L-HES (OR, 0.81; 95% CI 0.69 to 0.95) and reduced acute kidney injury more than L-HES (OR, 0.80; 95% CI 0.65 to 0.99). However, they required the greatest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was significantly superior to iso-oncotic albumin (OR, 0.55; 95% CI 0.35 to 0.87).Conclusions: Our network meta-analysis found that balanced crystalloids and albumin decreased mortality more than L-HES and saline in sepsis patients; however, saline or L-HES, was better than iso-oncotic albumin or balanced crystalloids in traumatic brain injury patients.

scholarly journals Assessment of Hydroxychloroquine and Chloroquine Safety Profiles – A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Lu Ren ◽  
Wilson Xu ◽  
James L Overton ◽  
Shandong Yu ◽  
Nipavan Chiamvimonvat ◽  
...  
Keyword(s):  
Fixed Effects ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Regression Analyses ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Central Register ◽  
Precautionary Measures ◽  
Meta Analyses

AbstractBackgroundRecently, chloroquine (CQ) and its derivative hydroxychloroquine (HCQ) have emerged as potential antiviral and immunomodulatory options for the treatment of 2019 coronavirus disease (COVID-19). To examine the safety profiles of these medications, we systematically evaluated the adverse events (AEs) of these medications from published randomized controlled trials (RCTs).MethodsWe systematically searched PubMed, MEDLINE, Cochrane, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and the ClinicalTrials.gov for all the RCTs comparing CQ or HCQ with placebo or other active agents, published before March 31, 2020. The random-effects or fixed-effects models were used to pool the risk estimates relative ratio (RR) with 95% confidence interval (CI) for the outcomes.ResultsThe literature search yielded 23 and 17 studies for CQ and HCQ, respectively, that satisfied our inclusion criteria. Of these studies, we performed meta-analysis on the ones that were placebo-controlled, which included 6 studies for CQ and 14 studies for HCQ. We did not limit our analysis to published reports involving viral treatment alone; data also included the usage of either CQ or HCQ for the treatment of other diseases. The trials for the CQ consisted of a total of 2,137 participants (n=1,077 CQ, n=1,060 placebo), while the trials for HCQ involved 1,096 participants (n=558 HCQ and n=538 placebo). The overall mild or total AEs were statistically higher comparing CQ or HCQ to placebo. The AEs were further categorized into four groups and analyses revealed that neurologic, gastrointestinal, dermatologic, and ophthalmic AEs were higher in participants taking CQ compared to placebo. Although this was not evident in HCQ treated groups, further analyses suggested that there were more AEs attributed to other organ system that were not included in the categorized meta-analyses. Additionally, meta-regression analyses revealed that total AEs was affected by dosage for the CQ group.ConclusionsTaken together, we found that participants taking either CQ or HCQ have more AEs than participants taking placebo. Precautionary measures should be taken when using these drugs to treat COVID-19.

scholarly journals A model for meta-analysis of correlated binary outcomes: The case of split-body interventions

2017 ◽  
Vol 28 (7) ◽  
pp. 1998-2014 ◽  
Author(s):  
Orestis Efthimiou ◽  
Dimitris Mavridis ◽  
Adriani Nikolakopoulou ◽  
Gerta Rücker ◽  
Sven Trelle ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Binary Outcomes ◽  
Binomial Model ◽  
Analysis Model ◽  
Randomized Controlled ◽  
Bivariate Binomial Distribution ◽  
Meta Analyses ◽  
Correlated Binary Outcomes

In several areas of clinical research, it is common for trials to assign different sites of the participants’ bodies to different interventions. For example, a randomized controlled trial comparing surgical techniques for correcting myopia may randomize each eye of a participant to a different operation. Under such bilateral (‘split-body’) interventions, the observations from each participant are correlated. It is challenging to account for these correlations at the meta-analysis level, especially when the outcome is rare. Here, we present a meta-analysis model based on the bivariate binomial distribution. Our model can synthesize studies on patients who received one intervention at one body site, patients who received two interventions at different sites or a mixture of these two groups. The model can analyse studies with zero events in one or both treatment arms and can handle the case of incomplete data reporting. We use simulations to assess the performance of our model and to compare it with the bivariate beta-binomial model. In the case of bilateral interventions, our model performed well and outperformed the bivariate beta-binomial model in all scenarios explored. We illustrate our methods using two previously published meta-analyses from the fields of orthopaedics and ophthalmology. We conclude that our model constitutes a useful new tool for the meta-analysis of binary outcomes in the presence of split-body interventions.

Shuanghuanglian Injection for Viral Pneumonia: A Protocol for Meta-analysis

2021 ◽  
Author(s):  
YANG YUAN ◽  
Quan Zheng ◽  
Mingjun Hu ◽  
Zhilin Si ◽  
Shuncheng Xie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fixed Effects ◽  
Financial Burden ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Viral Pneumonia ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Outcome Indicators ◽  
Randomized Controlled

Abstract Background:Viral pneumonia is inflammation (irritation and swelling) of the lungs due to infection with a virus. Rapidly progressing viral pneumonia is associated with considerable mortality, representing a severe threat and imparting a substantial financial burden worldwide.Specific treatments for the viral pneumonia were not yet determined. Recently, Shuanghuanglian injection of Traditional Chinese Medicine was used to treat viral pneumonia. However,there is no systematic reviews have evaluated its efficacy and safety for viral pneumonia.Methods:We search four English databases ( Pubmed, Web of Science, Embase, and the Cochrane library) and four Chinese databases (China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Database) for all randomized controlled trial of Shuanghuanglian injection for the treatment of viral pneumonia until 11st of December , 2020. Two reviewers individually extracted data from the included randomized controlled trials (RCTs). Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test, Methodological quality assessment and risk of bias will be assessed using the Cochrane bias risk tool. Meta-analysis will be performed using RevMan5.3.5 software provided by the Cochrane Collaboration.Results: Viral pneumonia has become a disease with substantial mortality. A systematic review assessing the beneficial and harmful effects of Shuanghuanglian injection for viral pneumonia is needed. This study will compare the different outcome indicators of various studies directly and indirectly.This analysis will provide a high-quality synthesis of effectiveness and safety of Shuanghuanglian injection treatment for viral pneumonia.The main outcome indicators include: Outcomes will include mortality, cure rate, efficacy or adverse events confirmed by imaging diagnosis. Systematic review registration: INPLASY2020120047.

scholarly journals Resuscitation Fluid Types in Sepsis, Surgical, and Trauma Patients: A Systematic Review and Sequential Network Meta-analyses

2020 ◽  
Author(s):  
Chien-Hua Tseng ◽  
Tzu-Tao Chen ◽  
Mei-Yi Wu ◽  
Ming-Cheng Chan ◽  
Ming-Chieh Shih ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Molecular Weight ◽  
Brain Injury ◽  
Web Application ◽  
Meta Analysis ◽  
Surgical Trauma ◽  
Trauma Patients ◽  
Meta Analyses ◽  
Balanced Crystalloids ◽  
Balanced Crystalloid

Abstract Background: Crystalloids and different component colloids, used for volume resuscitation, are sometimes associated with serious adverse events (AEs). Clinical trial findings for such fluid types in different patients’ conditions are conflicting. Whether the mortality benefit of balanced crystalloid than saline can be infer from sepsis to other patient group is uncertain, and other AEs is not comprehensive. This study aims to compare the survival benefits and AEs of seven fluid types with network meta-analysis in sepsis, surgical, trauma, and traumatic brain injury patients. Methods: Searched databases (PubMed, EMBASE, and Cochrane CENTRAL) and reference lists of relevant articles occurred from inception until January 2020. Studies on critically ill adults requiring fluid resuscitation were included. Intervention studies reported on balanced crystalloid, saline, iso-oncotic albumin, hyperoncotic albumin, low molecular weight hydroxyethyl starch (L-HES), high molecular weight HES, and gelatin. Network meta-analyses were conducted using random-effects model to calculate odds ratio (OR) and mean difference. Risk of Bias tool 2.0 was used to assess bias. CINeMA (Confidence in Network Meta-Analysis) web application was used to rate confidence in synthetic evidence. Results: Fifty-eight trials (n=26,351 patients) were identified. Seven fluid types were evaluated. Among patients with sepsis and surgery, balanced crystalloids and albumin achieved better survival, fewer renal AEs, and smaller blood transfusion volumes than saline and L-HES. In those with sepsis, balanced crystalloids reduced mortality more than saline (OR, 0.84; 95% CI 0.74 to 0.95) and L-HES (OR, 0.81; 95% CI 0.69 to 0.95) and reduced renal AEs more than L-HES (OR, 0.80; 95% CI 0.65 to 0.99). However, they required the largest resuscitation volume among all fluid types, especially in trauma patients. In patients with traumatic brain injury, saline and L-HES achieved lower mortality than albumin and balanced crystalloids; especially saline was superior to iso-oncotic albumin (OR, 0.55; 95% CI 0.35 to 0.87).Conclusions: For sepsis and surgical patients, we recommend balanced crystalloids and albumin, rather than L-HES and saline. For traumatic brain injury patients, we recommend saline or L-HES, rather than iso-oncotic albumin or balanced crystalloids. These findings could guide physicians’ fluid selection.Trial registry: PROSPERO website, registration number: CRD42018115641).

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