Investigation of myocardial protection during pediatric CPB: Practical experience in 100 Chinese hospitals

Perfusion ◽  
2020 ◽  
pp. 026765912098310
Author(s):  
Peiyao Zhang ◽  
Jinping Liu ◽  
Yuanyuan Tong ◽  
Shengwen Guo ◽  
Liting Bai ◽  
...  
Keyword(s):  
Myocardial Protection ◽  
Congenital Heart ◽  
Pediatric Patients ◽  
Practical Experience ◽  
Controlled Trials ◽  
Crystalloid Solution ◽  
Randomized Controlled ◽  
Protection Strategies ◽  
Tangible Evidence ◽  
Systemic Hypothermia

Many measures have been proposed for myocardial protection in pediatric congenital heart surgeries, but little data is available for China. This study investigates myocardial protection strategies in pediatric cardiopulmonary bypass (CPB) throughout China. Online questionnaires were delivered to 100 hospitals in 27 provinces. The number of yearly on-pump pediatric cardiovascular surgeries in these hospitals varied greatly. About 91.0% of respondents believe that each surgery should have at least two perfusionists, while only 64.0% of hospitals actually met this requirement. For pediatric patients, crystalloid cardioplegia was more prevalent than blood-based cardioplegia. Histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid solution were dominant among crystalloid cardioplegia. Del Nido cardioplegia and St. Thomas blood-based cardioplegia ranked the top two in the popularity of blood-based cardioplegia. Dosages varied among different kinds of cardioplegia. In the choice of different cardioplegia, perfusionists mainly focused on myocardial protective effect and cost. Hypothermia of cardioplegia solution was maintained by ice buckets in 3/4 of the hospitals in this survey. In conclusion, the essence of myocardial protection management during pediatric CPB was cardiac arrest induced by cardioplegia under systemic hypothermia. However, there is no uniform standard for the type of cardioplegia, or dosages. Therefore, well-designed multicenter randomized controlled trials are warranted to provide tangible evidence for myocardial protection of cardioplegia in pediatric CPB.

scholarly journals The Effect of Virtual Reality on Preoperative Anxiety: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 9 (10) ◽  
pp. 3151
Author(s):  
Chang-Hoon Koo ◽  
Jin-Woo Park ◽  
Jung-Hee Ryu ◽  
Sung-Hee Han
Keyword(s):  
Virtual Reality ◽  
Randomized Controlled Trials ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Preoperative Anxiety ◽  
Control Group ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference

Virtual reality (VR), a technology that provides a stimulated sensory experience, has recently been implemented in various fields of medicine. Several studies have investigated the efficacy of VR on preoperative anxiety. The purpose of this meta-analysis was to validate whether VR could relieve preoperative anxiety in patients undergoing surgery. Electronic databases were searched to identify all randomized controlled trials (RCTs) investigating the effect of VR on preoperative anxiety. The primary outcome was defined as the preoperative anxiety scores. We estimated the effect size using the standard mean difference (SMD) with a 95% confidence interval (CI) using a random effect model. Ultimately, 10 RCTs, with a total of 813 patients, were included in the final analysis. Preoperative anxiety was significantly lower in the VR group than in the control group (SMD −0.64, 95% CI −1.08 to −0.20, p = 0.004). In a subgroup analysis, the preoperative anxiety scores were lower in the VR group than in the control group in pediatric patients (SMD −0.71, 95% CI −1.14 to −0.27, p = 0.002), whereas a significant difference was not observed between the two groups in adult patients (p = 0.226). The results of this meta-analysis indicated that VR could decrease preoperative anxiety, especially in pediatric patients.

scholarly journals Carbon Dioxide vs. Air Insufflation for Pediatric Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 9 ◽  
Author(s):  
Chunwang Ji ◽  
Xue Liu ◽  
Peng Huang
Keyword(s):  
Carbon Dioxide ◽  
Randomized Controlled Trials ◽  
Pediatric Patients ◽  
Significant Risk ◽  
Pulmonary Complications ◽  
Current Evidence ◽  
Controlled Trials ◽  
Endoscopic Procedures ◽  
Randomized Controlled ◽  
Air Insufflation

Background: Carbon dioxide (CO2) insufflation during gastrointestinal (GI) endoscopic procedures has gained popularity in adults. However, its utility in pediatric patients is not known. The current review aimed to compare the efficacy of CO2 vs. air insufflation for GI endoscopic procedures in pediatric patients.Methods: The electronic databases of PubMed, Embase, Scopus, and CENTRAL were searched from the inception of databases to 15th August 2020.Results: All randomized controlled trials (RCTs) comparing CO2 vs. air insufflation for GI endoscopic procedures in pediatric patients were eligible for inclusion. Five RCTs were identified. Pooled analysis of data from 226 patients in the CO2 group and 224 patients in the air group revealed that patients receiving CO2 insufflation were at a lower odds of experiencing postoperative pain as compared to those undergoing the procedure with air (OR: 0.40; 95% CI: 0.19, 0.87; I2 = 62%; p = 0.02). Descriptive analysis indicated no difference in the two groups for abdominal distention after the procedure. Two trials reported elevated CO2 in the study group but without any pulmonary complications. Bloating was reported by two studies and both reported significantly less bloating in the CO2 group.Conclusion: Our study indicates that the incidence of pain may be reduced with the use of CO2 insufflation in pediatric GI endoscopies without a significant risk of adverse events. However, current evidence is from a limited number of trials and not strong to recommend a routine of CO2 in pediatric gastroenterology practice. Further high-quality RCTs are required to supplement current evidence.

Prophylactic Colony-Stimulating Factors in Pediatric Patients Receiving Myelosuppressive Chemotherapy: A Meta-Analysis of Randomized Controlled Trials.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2211-2211
Author(s):  
Brenda Wittman ◽  
John T. Horan ◽  
Gary H. Lyman
Keyword(s):  
Randomized Controlled Trials ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Antibiotic Use ◽  
Severe Neutropenia ◽  
Controlled Trials ◽  
High Grade ◽  
Myelosuppressive Chemotherapy ◽  
Gm Csf ◽  
Randomized Controlled

Abstract Background: The colony-stimulating factors (CSFs) are widely utilized to prevent neutropenic complications in both adults and children, but randomized controlled trials in the pediatric setting have varied considerably in size, methodology and patient population. A systematic review and meta-analysis was conducted to more definitively assess the impact of prophylactic CSFs on the risk of febrile neutropenia (FN) in pediatric oncology patients. The rates of documented infection (DI) and duration of severe neutropenia (ANC <500), hospitalization and antibiotic use were also evaluated. Methods: MEDLINE and EMBASE were searched and identified references were hand-searched through July 2004 for randomized controlled trials (RCTs) of prophylactic G-CSF or GM-CSF in pediatric oncology patients. Both parallel and crossover studies were included. Of the 625 articles identified, 16 studies were included. Ten studies evaluated children with acute leukemia or high-grade lymphoma, and 6 evaluated those with solid tumors. Study objectives, quality, and outcomes were extracted by 2 independent reviewers. Weighted summary estimates of relative risks (RR) for FN and DI were calculated by the method of Mantel-Haenszel using a fixed effects model. Mean differences in durations (days) were estimated by the method of Cohen using a random effects model due to significant heterogeneity. An economic analysis based on cost minimization was calculated from the results of this analysis and a recent cost study. Results: Among the 12 reporting RCTs, FN occurred in 68% of 400 controls and 59% of 404 CSF patients. Estimated RR was 0.88 [.81–.97; P=.01] favoring the CSFs for leukemia and high grade lymphoma studies and 0.71 [.51–.97; P=.03] for solid tumor studies. RR estimates were 0.85 [.78–.94; P<.001) for G-CSF and 0.83 [.47–1.49; P=.54] for GM-CSF. In 9 reporting studies, DI occurred in 25% of controls and 20% of CSF patients for an estimated RR of 0.80 [.61–1.06; P=.12]. The mean decrease in duration of neutrophils <500 in 13 reporting studies was 3.5 days [2.2–4.7; P<0.0001). Mean decreases favoring CSF use were also observed for hospital stay of 1.7 days [0.9–2.5] in 13 reporting RCTs (P<.01) and antibiotic use of 2.0 days [0.4–3.6; P=.02] in 10 RCTs. Baseline estimates based on the economic model provide incremental cost savings with CSF of $3,824 per subject and a cost saving FN risk threshold of 24%. Conclusions: This analysis reveals that prophylactic CSFs significantly decrease the incidence of FN and the durations of severe neutropenia, hospitalization, and antibiotic use in pediatric patients receiving myelosuppressive chemotherapy. Differences in rates of documented infection were not statistically signficant. The economic analysis supports guidelines for CSF prophylaxis above a risk of 20%.

Efficacy and Safety of Sublingual Immunotherapy for Allergic Rhinitis in Pediatric Patients: A Meta-Analysis of Randomized Controlled Trials

2017 ◽  
Vol 31 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Bohai Feng ◽  
Jueting Wu ◽  
Bobei Chen ◽  
Haijie Xiang ◽  
Ruru Chen ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Randomized Controlled Trials ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Symptom Relief ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Symptom Scores

Background Allergic rhinitis (AR) has become a global health problem that constantly affects a large part of the general population, especially children. Objective Sublingual allergen immunotherapy (SLIT) has been used extensively for pediatric AR, although its efficacy and safety are often questioned. In this meta-analysis of randomized controlled trials (RCT), we evaluated the use of SLIT for pediatric AR. Methods A number of medical literature data bases were searched through January 2016 to identify RCTs that examined the use of SLIT for pediatric AR and that assessed clinical outcomes related to efficacy. Descriptive and quantitative information was abstracted. Standardized mean differences (SMD) were calculated by using fixed- and random-effects models. Subgroup analyses were performed. Heterogeneity was assessed by using the I2 metric. A network meta-analysis was used to estimate SMDs between two SLIT protocols for pediatric seasonal AR. All data were extracted from publications or received from the authors. Results Twenty-six studies were eligible for inclusion in the meta-analysis of rhinitis or rhinoconjunctivitis symptom scores, and 19 studies were eligible for the meta-analysis of medication scores. Descriptive and quantitative data were extracted. SLIT differed significantly from placebo in terms of symptom scores (SMD -0.55 [95% confidence interval {CI}, -0.86 to -0.25]; p = 0.0003, I2 = 90%) and medication scores (SMD -0.67 [95% CI, -0.96 to -0.38J; p < 0.00001, I2 = 83%). Oral pruritus was the adverse effect, which occurred most commonly in children who were receiving SLIT. Network meta-analysis revealed no significant difference between the pre-coseasonal and continuous SLIT protocols for seasonal AR in symptom scores (SMD -6.55 [95% CI, -25.38 to 12.29]; p = 0.496) and medication scores (SMD -8.83 [95% CI, -22.10 to 4.43]; p = 0.192). Conclusions Our meta-analysis results indicated that SLIT provided significant symptom relief and reduced the need for medication in pediatric patients Moreover, the safety of SLIT needs to be confirmed in RCTs with larger samples.

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