COVID-19 Related Cardiovascular Comorbidities and Complications in Critically Ill Patients: A Systematic Review and Meta-analysis

Objective: This systematic-review and meta-analysis aimed to assess the prevalence of cardiovascular comorbidities and complications in ICU-admitted coronavirus disease 2019 (COVID-19) patients. Data sources: PubMed and Web of Science databases were referenced until November 25, 2020. Data extraction: We extracted retrospective and prospective observational studies on critically ill COVID-19 patients admitted to an intensive care unit. Only studies reporting on cardiovascular comorbidities and complications during ICU therapy were included. Data synthesis: We calculated the pooled prevalence by a random-effects model and determined heterogeneity by Higgins’ I2 test. Results: Of the 6346 studies retrieved, 29 were included in this review. The most common cardiovascular comorbidity was arterial hypertension (50%; 95% confidence interval [CI], 0.42-058; I2 = 94.8%, low quality of evidence). Among cardiovascular complications in the ICU, shock (of any course) was most common, being present in 39% of the patients (95% CI, 0.20-0.59; I2 = 95.6%; 6 studies). Seventy-four percent of patients in the ICU required vasopressors to maintain target blood pressure (95% CI, 0.58-0.88; I2 = 93.6%; 8 studies), and 30% of patients developed cardiac injury in the ICU (95% CI, 0.19-0.42; I2 = 91%; 14 studies). Severe heterogeneity existed among the studies. Conclusions: Cardiovascular complications are common in patients admitted to the intensive care unit for COVID-19. However, the existing evidence is highly heterogeneous in terms of study design and outcome measurements. Thus, prospective, observational studies are needed to determine the impact of cardiovascular complications on patient outcome in critically ill COVID-19 patients.

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Protocol for a systematic review and meta-analysis of respiratory rehabilitation following intensive care unit discharge for COVID-19 survivors

BMJ Open ◽

10.1136/bmjopen-2020-041184 ◽

2020 ◽

Vol 10 (12) ◽

pp. e041184

Author(s):

Dan Wang ◽

Jin Li ◽

Feilong Zhu ◽

Qianqin Hong ◽

Ming Zhang ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Meta Analysis ◽

Biomedical Literature ◽

Controlled Trials ◽

Cochrane Central Register ◽

The Impact ◽

Respiratory Rehabilitation

IntroductionBoth physical and mental disorders may be exacerbated in patients with COVID-19 due to the experience of receiving intensive care; undergoing prolonged mechanical ventilation, sedation, proning and paralysis. Pulmonary rehabilitation is aimed to improve dyspnoea, relieve anxiety and depression, reduce the incidence of related complications, as well as prevent and improve dysfunction. However, the impact of respiratory rehabilitation on discharged patients with COVID-19 is currently unclear, especially on patients who have been mechanically ventilated over 24 hours. Therefore, we aim to investigate the efficacy of respiratory rehabilitation programmes, initiated after discharge from the intensive care unit, on the physical and mental health and health-related quality of life in critical patients with COVID-19.Methods and analysisWe have registered the protocol on PROSPERO and in the process of drafting it, we strictly followed the checklist of Preferred Reporting Items for Systematic Review and Meta-Analysis Potocols. We will search the PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, WanFang, VIP information databases and Chinese Biomedical Literature Database. Additionally, ongoing trials in the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and ISRCTN registry will be searched as well. Studies in English or Chinese and from any country will be accepted regardless of study design. Two review authors will independently extract data and assess the quality of included studies. Continuous data are described as standard mean differences (SMDs) with 95% CIs. Dichotomous data from randomised controlled trials are described as risk ratio(RR) with 95% CIs; otherwise, it is described as odds ratio(OR) with 95% CIs. I2 and the Cochrane’s Q statistic will be used to conduct heterogeneity assessment. The quality of evidence of main outcomes will be evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation(GRADE) criteria. When included studies are sufficient, we will conduct subgroup analysis and sensitivity analysis; the publication bias will be statistically analysed using a funnel plot analysis and Egger’s test.Ethics and disseminationOur review, planning to include published studies, does not need the request to the ethical committee. The final results of this review will be published in a peer-reviewed journal after completion.Patient and public involvementNo patient involved.PROSPERO registration numberCRD42020186791.

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Safety and efficacy of erythropoiesis-stimulating agents in critically ill patients admitted to the intensive care unit: a systematic review and meta-analysis

Intensive Care Medicine ◽

10.1007/s00134-019-05686-y ◽

2019 ◽

Vol 45 (9) ◽

pp. 1190-1199 ◽

Cited By ~ 6

Author(s):

Edward Litton ◽

Peter Latham ◽

Julia Inman ◽

Jingjing Luo ◽

Peter Allan

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Safety And Efficacy ◽

Erythropoiesis Stimulating Agents

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The Incidence of Pulmonary Thromboembolism in Critically Ill Patients With COVID-19: A Systematic Review, Meta-Analysis and Meta-Regression of Observational Studies

10.21203/rs.3.rs-74260/v1 ◽

2020 ◽

Author(s):

Jun Jie Ng ◽

Zhen Chang Liang ◽

Andrew MTL Choong

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Observational Studies ◽

Pulmonary Thromboembolism ◽

Meta Analysis ◽

Weighted Average ◽

Meta Regression ◽

Prophylactic Anticoagulation

Abstract Purpose Coronavirus disease 2019 (COVID-19) infection is known to be associated with a hypercoagulable and prothrombotic state, especially in critically ill patients. Several observational studies have reported the incidence of thromboembolic events such as pulmonary thromboembolism (PTE). We performed a meta-analysis to estimate the weighted average incidence of PTE in critically ill COVID-19 patients who are admitted to the intensive care unit.Methods We searched MEDLINE via PubMed, Embase and Web of Science for relevant studies from 31 December 2019 till 15 Aug 2020 onwards using the search terms “coronavirus”, “COVID-19”, “SARS-CoV-2”, “2019-nCoV”, “thrombus”, “thrombo*”, “embolus” and “emboli*”. We included prospective and retrospective observational studies that reported the incidence of PTE in critically ill COVID-19 patients who required treatment in the intensive care unit. We identified 14 studies after two phases of screening and extracted data related to study characteristics, patient demographics and the incidence of PTE. Risk of bias was assessed by using the ROBINS-I tool. Statistical analysis was performed with R 3.6.3.Results We included 14 studies with a total of 1182 patients in this study. Almost 100% of patients in this meta-analysis received at least prophylactic anticoagulation. The weighted average incidence of PTE was 11.09% (95% CI 7.72% to 15.69%, I2 = 78%, Cochran’s Q test P < 0.01). We performed univariate and multivariate meta-regression which identified the proportion of males as a significant source of heterogeneity (P = 0.03, 95% CI 0.00 to -0.09)Conclusion This is the only study that had specifically reported the weighted average incidence of PTE in critically ill COVID-19 patients using meta-analytic techniques. The weighted average incidence of PTE remains high even after prophylactic anticoagulation. This study is limited by incomplete data from included studies. More studies are needed to determine the optimal anticoagulation strategy in critically ill COVID-19 patients.

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Systematic review and meta-analysis of interventions for operating room to intensive care unit handoffs

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-012474 ◽

2021 ◽

pp. bmjqs-2020-012474

Author(s):

Joanna Abraham ◽

Alicia Meng ◽

Sanjna Tripathy ◽

Michael S Avidan ◽

Thomas Kannampallil

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Operating Room ◽

Meta Analysis ◽

Intervention Group ◽

Future Research ◽

Original Research ◽

Cochrane Central Register ◽

The Impact

ObjectiveTo conduct a systematic review and meta-analysis to ascertain the impact of operating room (OR) to intensive care unit (ICU) handoff interventions on process-based and clinical outcomes.MethodWe included all English language, prospective evaluation studies of OR to ICU handoff interventions published as original research articles in peer-reviewed journals. The search was conducted on 11 November 2019 on MEDLINE, CINAHL, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials databases, with no prespecified criteria for the type of comparison or outcome. A meta-analysis of similar outcomes was conducted using a random effects model. Quality was assessed using a modified Downs and Black (D&B) checklist.Results32 studies were included for review. 31 studies were conducted at a single site and 28 studies used an observational study design with a control. Most studies (n=28) evaluated bundled interventions which comprised information transfer/communication checklists and protocols. Meta-analysis showed that the handoff intervention group had statistically significant improvements in time to analgesia dosing (mean difference (MD)=−42.51 min, 95% CI −60.39 to −24.64), fewer information omissions (MD=−2.22, 95% CI −3.68 to –0.77), fewer technical errors (MD=−2.38, 95% CI −4.10 to –0.66) and greater information sharing scores (MD=30.03%, 95% CI 19.67% to 40.40%). Only 15 of the 32 studies scored above 9 points on the modified D&B checklist, indicating a lack of high-quality studies.DiscussionBundled interventions were commonly used to support OR to ICU handoff standardisation. Although the meta-analysis showed significant improvements for a number of clinical and process outcomes, the statistical and clinical heterogeneity must be accounted for when interpreting these findings. Implications for OR to ICU handoff practice and future research are discussed.

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Clinical and Economic Outcomes of Telemedicine Programs in the Intensive Care Unit: A Systematic Review and Meta-Analysis

Journal of Intensive Care Medicine ◽

10.1177/0885066617726942 ◽

2017 ◽

Vol 33 (7) ◽

pp. 383-393 ◽

Cited By ~ 33

Author(s):

Jing Chen ◽

Dalong Sun ◽

Weiming Yang ◽

Mingli Liu ◽

Shufan Zhang ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Meta Analysis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Icu Length Of Stay ◽

The Impact

Objective: To evaluate the impact of telemedicine programs in intensive care unit (Tele-ICU) on ICU or hospital mortality or ICU or hospital length of stay and to summarize available data on implementation cost of Tele-ICU. Methods: Controlled trails or observational studies assessing outcomes of interest were identified by searching 7 electronic databases from inception to July 2016 and related journals and conference literatures between 2000 and 2016. Two reviewers independently screened searched records, extracted data, and assessed the quality of included studies. Random-effect models were applied to meta-analyses and sensitivity analysis. Results: Nineteen of 1035 records fulfilled the inclusion criteria. The pooled effects demonstrated that Tele-ICU programs were associated with reductions in ICU mortality (15 studies; risk ratio [RR], 0.83; 95% confidence interval [CI], 0.72 to 0.96; P = .01), hospital mortality (13 studies; RR, 0.74; 95% CIs, 0.58 to 0.96; P = .02), and ICU length of stay (9 studies; mean difference [MD], −0.63; 95% CI, −0.28 to 0.17; P = .007). However, there is no significant association between the reduction in hospital length of stay and Tele-ICU programs. Summary data concerning costs suggested approximately US$50 000 to US$100 000 per Tele-ICU bed was required to implement Tele-ICU programs for the first year. Hospital costs of US$2600 reduction to US$5600 increase per patient were estimated using Tele-ICU programs. Conclusions: This systematic review and meta-analysis provided limited evidence that Tele-ICU approaches may reduce the ICU and hospital mortality, shorten the ICU length of stay, but have no significant effect in hospital length of stay. Implementation of Tele-ICU programs substantially costs and its long-term cost-effectiveness is still unclear.

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Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0223185 ◽

2019 ◽

Vol 14 (10) ◽

pp. e0223185 ◽

Cited By ~ 26

Author(s):

Lan Zhang ◽

Weishu Hu ◽

Zhiyou Cai ◽

Jihong Liu ◽

Jianmei Wu ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Early Mobilization

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High-flow nasal cannula therapy as apneic oxygenation during endotracheal intubation in critically ill patients in the intensive care unit: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-020-60636-9 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Hong-Jie Jhou ◽

Po-Huang Chen ◽

Chin Lin ◽

Li-Yu Yang ◽

Cho-Hao Lee ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Endotracheal Intubation ◽

Critically Ill Patients ◽

Meta Analysis ◽

High Flow ◽

High Flow Nasal Cannula ◽

Apneic Oxygenation

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Sarcopenia as a predictor of mortality among the critically ill in an intensive care unit: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-021-02276-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiao-Ming Zhang ◽

Denghong Chen ◽

Xiao-Hua Xie ◽

Jun-E Zhang ◽

Yingchun Zeng ◽

...

Keyword(s):

Systematic Review ◽

Skeletal Muscle ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Muscle Area ◽

Risk Of Mortality ◽

Increased Risk

Abstract Background The evidence of sarcopenia based on CT-scan as an important prognostic factor for critically ill patients has not seen consistent results. To determine the impact of sarcopenia on mortality in critically ill patients, we performed a systematic review and meta-analysis to quantify the association between sarcopenia and mortality. Methods We searched studies from the literature of PubMed, EMBASE, and Cochrane Library from database inception to June 15, 2020. All observational studies exploring the relationship between sarcopenia based on CT-scan and mortality in critically ill patients were included. The search and data analysis were independently conducted by two investigators. A meta-analysis was performed using STATA Version 14.0 software using a fixed-effects model. Results Fourteen studies with a total of 3,249 participants were included in our meta-analysis. The pooled prevalence of sarcopenia among critically ill patients was 41 % (95 % CI:33-49 %). Critically ill patients with sarcopenia in the intensive care unit have an increased risk of mortality compared to critically ill patients without sarcopenia (OR = 2.28, 95 %CI: 1.83–2.83; P < 0.001; I2 = 22.1 %). In addition, a subgroup analysis found that sarcopenia was associated with high risk of mortality when defining sarcopenia by total psoas muscle area (TPA, OR = 3.12,95 %CI:1.71–5.70), skeletal muscle index (SMI, OR = 2.16,95 %CI:1.60–2.90), skeletal muscle area (SMA, OR = 2.29, 95 %CI:1.37–3.83), and masseter muscle(OR = 2.08, 95 %CI:1.15–3.77). Furthermore, critically ill patients with sarcopenia have an increased risk of mortality regardless of mortality types such as in-hospital mortality (OR = 1.99, 95 %CI:1.45–2.73), 30-day mortality(OR = 2.08, 95 %CI:1.36–3.19), and 1-year mortality (OR = 3.23, 95 %CI:2.08 -5.00). Conclusions Sarcopenia increases the risk of mortality in critical illness. Identifying the risk factors of sarcopenia should be routine in clinical assessments and offering corresponding interventions may help medical staff achieve good patient outcomes in ICU departments.

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