scholarly journals Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Hideto Yasuda ◽  
Hiromu Okano ◽  
Takuya Mayumi ◽  
Chihiro Narita ◽  
Yu Onodera ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Relative Risk ◽  
Confidence Interval ◽  
Acute Respiratory Failure ◽  
Meta Analysis ◽  
Positive Pressure ◽  
Cochrane Central Register ◽  
Short Term ◽  
Short Term Mortality ◽  
Registration Number

Abstract Background High-flow nasal cannula oxygenation (HFNC) and noninvasive positive-pressure ventilation (NPPV) possibly decrease tracheal reintubation rates better than conventional oxygen therapy (COT); however, few large-scale studies have compared HFNC and NPPV. We conducted a network meta-analysis (NMA) to compare the effectiveness of three post-extubation respiratory support devices (HFNC, NPPV, and COT) in reducing the mortality and reintubation risk. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. COT, NPPV, and HFNC use were assessed in patients who were aged ≥ 16 years, underwent invasive mechanical ventilation for > 12 h for acute respiratory failure, and were scheduled for extubation after spontaneous breathing trials. The GRADE Working Group Approach was performed using a frequentist-based approach with multivariate random-effect meta-analysis. Short-term mortality and reintubation and post-extubation respiratory failure rates were compared. Results After evaluating 4631 records, 15 studies and 2600 patients were included. The main cause of acute hypoxic respiratory failure was pneumonia. Although NPPV/HFNC use did not significantly lower the mortality risk (relative risk [95% confidence interval] 0.75 [0.53–1.06] and 0.92 [0.67–1.27]; low and moderate certainty, respectively), HFNC use significantly lowered the reintubation risk (0.54 [0.32–0.89]; high certainty) compared to COT use. The associations of mortality with NPPV and HFNC use with respect to either outcome did not differ significantly (short-term mortality and reintubation, relative risk [95% confidence interval] 0.81 [0.61–1.08] and 1.02 [0.53–1.97]; moderate and very low certainty, respectively). Conclusion NPPV or HFNC use may not reduce the risk of short-term mortality; however, they may reduce the risk of endotracheal reintubation. Trial registration number and date of registration PROSPERO (registration number: CRD42020139112, 01/21/2020).

scholarly journals Post-extubation Oxygenation Strategies and Mortality and Reintubation Rates in Acute Respiratory Failure: A Systematic Review and Network Meta-Analysis

2021 ◽  
Author(s):  
Hideto Yasuda ◽  
Hiromu Okano ◽  
Takuya Mayumi ◽  
Chihiro Narita ◽  
Yu Onodera ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Relative Risk ◽  
Confidence Interval ◽  
Acute Respiratory Failure ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Positive Pressure ◽  
Short Term ◽  
Short Term Mortality ◽  
Registration Number

Abstract Background: High-flow nasal cannula oxygenation (HFNC) and noninvasive positive-pressure ventilation (NPPV) possibly decrease tracheal reintubation rates better than conventional oxygen therapy (COT); however, few large-scale studies have compared HFNC and NPPV. We conducted a network meta-analysis (NMA) to compare the effectiveness of three post-extubation respiratory support devices (HFNC, NPPV, COT) in reducing the mortality and reintubation risk.Methods: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. COT, NPPV, and HFNC use were assessed in patients aged ≥16 years who underwent invasive mechanical ventilation for >12 hours for acute respiratory failure and were scheduled for extubation after spontaneous breathing trials. The GRADE Working Group Approach was performed using a frequentist-based approach with multivariate random-effects meta-analysis. Short-term mortality and reintubation and post-extubation respiratory failure rates were compared. Results: After evaluating 4,631 records, 15 studies and 2,600 patients were included. The main cause of acute hypoxic respiratory failure was pneumonia. Although NPPV/HFNC use did not significantly lower the mortality risk (relative risk [95% confidence interval], 0.75 [0.53–1.06] and 0.92 [0.67–1.27]; low and moderate certainty, respectively), HFNC use significantly lowered the reintubation risk (0.54 [0.32–0.89]; high certainty) compared with COT use. The associations of mortality with NPPV and HFNC in either outcome did not differ significantly (short-term mortality and reintubation, relative risk [95% confidence interval], 0.81 [0.61–1.08] and 1.02 [0.53–1.97]; moderate and very low certainty, respectively).Conclusion: NPPV or HFNC use may reduce endotracheal reintubation risk, but not short-term mortality risk.Trial registration number and date of registrationPROSPERO (registration number: CRD42020139112, 01/21/2020).

Effect of Premorbid Beta-Blockers on Mortality in Patients With Sepsis: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 088506662110529
Author(s):  
Daisuke Hasegawa ◽  
Ryota Sato ◽  
Narut Prasitlumkum ◽  
Kazuki Nishida
Keyword(s):  
Systematic Review ◽  
Beta Blockers ◽  
Data Extraction ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Short Term ◽  
Cross Sectional ◽  
Short Term Mortality ◽  
The Impact

Objective The aim of this study was to conduct a systematic review and meta-analysis to investigate the impact of premorbid beta-blockers on mortality in patients with sepsis. Data Sources We searched EMBASE, the Cochrane Central Register of Controlled Trials, and MEDLINE for eligible studies. The protocol was registered at the PROSPERO (CRD42021256813). Study Selection Two authors independently evaluated the following inclusion criteria: (1) randomized controlled trials, cohort studies, cross-sectional studies; (2) patients with sepsis aged ≥18 years, and (3) premorbid beta-blocker use. Data Extraction Two authors extracted the patients’ characteristics and outcomes independently. All analyses were performed using the random-effects models. The primary outcome was short-term mortality, defined as mortality within 30 days, in-hospital or intensive care unit mortality. Data Synthesis Ten studies (n = 24 748 patients) were included. The pooled odds ratio (OR) of short-term mortality associated with the premorbid use of beta-blockers was 0.85 (95% confidence interval [CI], 0.69-1.04; P = .12; I2 = 50%). Five studies reported an adjusted OR of short-term mortality. The pooled adjusted OR of short-term mortality associated with the premorbid use of beta-blockers was 0.73 (95% CI, 0.65-0.83; P < .001; I2 = 0%). Conclusion Premorbid beta-blockers were associated with a lower short-term mortality in patients with sepsis.

scholarly journals Impella versus intra-aortic balloon pump in cardiogenic shock: a meta-analysis assessing 30-days mortality

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Shariff ◽  
R Doshi ◽  
I Pedreira Vaz ◽  
D Adalja ◽  
A Krishnan ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cardiogenic Shock ◽  
Risk Ratio ◽  
Observational Studies ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Shock Trial ◽  
Short Term ◽  
Intra Aortic Balloon Pump ◽  
Short Term Mortality

Abstract Introduction Cardiogenic shock is linked with eminent morbidity and mortality despite advances in treatment modality. Adjuvant treatment modalities to provide mechanical haemodynamic support in the form of intra-aortic balloon pump (IABP) or Impella are being used among patients with cardiogenic shock. The Impella prunes left ventricular preload, whereas, IABP persuades after load reduction and both contribute to improved cardiac output. A few underpowered randomised control trials (RCTs) and observational studies compared short term mortality benefit of Impella juxtaposed to IABP among patients with cardiogenic shock. Purpose A meta-analysis of RCTs and observational studies researching the short-term mortality in cardiogenic shock comparing Impella to IABP was executed. Methods The databases PubMed, EMBASE and Cochrane were searched systematically to identify relevant RCTs and observational studies contrasting Impella to IABP and reporting 30-days mortality as outcomes. The search terms used were “Impella”, “IAPB”, “intra-aortic balloon pump” and all word variations were utilised. The search was conducted from the debut of the databases up to January 2020. Two reviewers independently and in tandem performed data screening and extraction from identified articles. Inverse variance method with Paule-Mandel estimator for tau2 and Hartung-Knapp adjustment was used to calculate Risk Ratio with 95% confidence interval. Heterogeneity was assessed using I2 statistics. Furthermore, we calculated the 95% predictive interval for the pooled estimate. All statistical analysis for this meta-analysis was carried out using R statistical software version 3.6.2 using the package meta ( ). Additionally, Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria were used to assess the certainty of evidence. Results Five studies constituting 728 patients were included in the final analysis. Two were RCTs (ISAR-SHOCK trial and IMPRESS in Severe Shock trial), one study was a propensity score matched observational study and two were unmatched observational studies. There was no difference in the risk of 30-days mortality in patients treated with Impella as compared to IABP [Risk Ratio: 0.97, 95% confidence interval: 0.66–1.41, I2: 32%]. To account for the heterogeneity, we calculated 95% predictive interval: 0.46–2.02. Thus, very low certainty of evidence concluded no difference in the risk of 30-days mortality among cardiogenic shock patients treated with Impella in opposition to IABP. Conclusion This meta-analysis comparing Impella juxtaposed with IABP demonstrated no difference in the risk of 30-days mortality among patients with cardiogenic shock. 30-days Mortality Funding Acknowledgement Type of funding source: None

Do Breast Implants Influence Breastfeeding? A Meta-Analysis of Comparative Studies

2018 ◽  
Vol 34 (3) ◽  
pp. 424-432 ◽  
Author(s):  
Fengrui Cheng ◽  
Shuiping Dai ◽  
Chiyi Wang ◽  
Shaoxue Zeng ◽  
Junjie Chen ◽  
...  
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Exclusive Breastfeeding ◽  
Comparative Studies ◽  
Meta Analysis ◽  
Breast Implants ◽  
Cochrane Central Register ◽  
Periareolar Incision ◽  
Breastfeeding Rate ◽  
Aesthetic Breast

Background: Aesthetic breast implant augmentation surgery is the most popular plastic surgery worldwide. Many women choose to receive breast implants during their reproductive ages, although the long-term effects are still controversial. Research aim: We conducted a meta-analysis to assess the influence of aesthetic breast augmentation on breastfeeding. We also compared the exclusive breastfeeding rates of periareolar versus inframammary incision. Methods: A systematic search for comparative studies about breast implants and breastfeeding was performed in PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ScienceDirect, Scopus, and Web of Science through May 2018. Meta-analysis was conducted with a random-effects model (or fixed effects, if heterogeneity was absent). Results: Four cohorts and one cross-sectional study were included. There was a significant reduction in the exclusive breastfeeding rate for women with breast implants compared with women without implants, pooled relative risk = 0.63, 95% confidence interval [0.46, 0.86], as well as the breastfeeding rate, pooled relative risk = 0.88, 95% confidence interval [0.81, 0.95]. There was no evidence that periareolar incision was associated with a reduction in the exclusive breastfeeding rate, pooled relative risk = 0.84, 95% confidence interval [0.45, 1.58]. Conclusion: Participants with breast implants are less likely to establish breastfeeding, especially exclusive breastfeeding. Periareolar incision does not appear to reduce the exclusive breastfeeding rate.

scholarly journals Association of noninvasive respiratory support with mortality and intubation rates in acute respiratory failure: a systematic review and network meta-analysis

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Hideto Yasuda ◽  
Hiromu Okano ◽  
Takuya Mayumi ◽  
Masaki Nakane ◽  
Nobuaki Shime
Keyword(s):  
Respiratory Failure ◽  
Tracheal Intubation ◽  
Meta Analysis ◽  
Respiratory Support ◽  
Controlled Trials ◽  
Intubation Rate ◽  
Short Term ◽  
Short Term Mortality ◽  
Hypoxic Respiratory Failure ◽  
Support Devices

Abstract Background Noninvasive respiratory support devices may reduce the tracheal intubation rate compared with conventional oxygen therapy (COT). To date, few studies have compared high-flow nasal cannula (HFNC) use with noninvasive positive-pressure ventilation (NPPV). We conducted a network meta-analysis to compare the effectiveness of three respiratory support devices in patients with acute respiratory failure. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults aged ≥ 16 years with acute hypoxic respiratory failure and randomized-controlled trials that compared two different oxygenation devices (COT, NPPV, or HFNC) before tracheal intubation were included. A frequentist-based approach with a multivariate random-effects meta-analysis was used. The network meta-analysis was performed using the GRADE Working Group approach. The outcomes were short-term mortality and intubation rate. Results Among 5507 records, 27 studies (4618 patients) were included. The main cause of acute hypoxic respiratory failure was pneumonia. Compared with COT, NPPV and HFNC use tended to reduce mortality (relative risk, 0.88 and 0.93, respectively; 95% confidence intervals, 0.76–1.01 and 0.80–1.08, respectively; both low certainty) and lower the risk of endotracheal intubation (0.81 and 0.78; 0.72–0.91 and 0.68–0.89, respectively; both low certainty); however, short-term mortality or intubation rates did not differ (0.94 and 1.04, respectively; 0.78–1.15 and 0.88–1.22, respectively; both low certainty) between NPPV and HFNC use. Conclusion NPPV and HFNC use are associated with a decreased risk of endotracheal intubation; however, there are no significant differences in short-term mortality. Trial registration PROSPERO (registration number: CRD42020139105, 01/21/2020)

scholarly journals The roles of noninvasive mechanical ventilation with helmet in patients with acute respiratory failure: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250063
Author(s):  
Shukun Hong ◽  
Hongye Wang ◽  
Yonggang Tian ◽  
Lujun Qiao
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Meta Analysis ◽  
Face Mask ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Intubation Rate ◽  
Noninvasive Mechanical Ventilation

Objective To compare the safety and effectiveness between helmet and face mask noninvasive mechanical ventilation (NIMV) in patients with acute respiratory failure (ARF). Methods English databases included PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science. Chinese databases involved Wanfang Data, China Knowledge Resource Integrated Database and Chinese Biological Medicine Database. Randomized controlled trials (RCTs) comparing helmet and face mask NIMV for patients with ARF were searched. Meta-analysis was performed using Review manager 5.1.0. Results Twelve trials with a total of 569 patients were eligible. Our meta-analysis showed that, comparing with face mask, helmet could significantly decrease the incidences of intolerance [risk ratio (RR) 0.19; 95% confidence interval (CI) 0.09−0.39], facial skin ulcer (RR 0.19; 95% CI 0.08−0.43) and aerophagia (RR 0.15; 95% CI 0.06−0.37), reduce respiratory rate [mean difference (MD) -3.10; 95% CI -4.85 to -1.34], intubation rate (RR 0.39; 95% CI 0.26−0.59) and hospital mortality (RR 0.62; 95% CI 0.39−0.99) in patients with ARF, and improve oxygenation index in patients with hypoxemic ARF (MD 55.23; 95% CI 31.37−79.09). However, subgroupanalysis for hypercapnic ARF revealed that PaCO2 was significantly reduced in face mask group compared with helmet group (MD 5.34; 95% CI 3.41−7.27). Conclusion NIMV with helmet can improve the patient’s tolerance, reduce adverse events, increase oxygenation effect, and decrease intubation rate and hospital mortality comparing to face mask. However, the low number of patients from included studies may preclude strong conclusions. Large RCTs are still needed to provide more robust evidence.

scholarly journals A Novel Prediction Prognosis Model of sepsis with acute respiratory failure: A cohort study from the MIMIC-IV database

2021 ◽  
Author(s):  
Lina Zhao ◽  
Jing Yang ◽  
Yunying Wang ◽  
Zheng Ge. Zeng ◽  
Tao Liu ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Medical Information ◽  
Cox Regression ◽  
Abdominal Cavity ◽  
Simplified Acute Physiology Score ◽  
Hospital Death ◽  
Short Term ◽  
Short Term Mortality ◽  
Prognosis Model

Abstract Objectives: Acute respiratory failure is significantly related to increased short-term mortality in sepsis patients. We aimed to develop a novel prognosis model for predicting the risk for hospital mortality in sepsis patients with acute respiratory failure.Methods: We researched the Medical Information Mart for Intensive Care (MIMIC)-IV database, and developed a matched cohort of adult sepsis with acute respiratory failure. After applying multivariate Cox regression, a nomogram was developed based on identified risk factors of the mortality in the cohort. Besides, the discrimination of the nomogram in predicting individual hospital death was evaluated by the area under o the characteristic operating curve (ROC).Results: A total of 663 sepsis patients with acute respiratory failure were included in this study. Systolic blood pressure, white blood cell count, neutrophils, mechanical ventilation, PaO2 < 60mmHg, abdominal cavity infection, Klebsiella pneumoniae, Acinetobacter baumannii, and immunosuppressive disease were the independent risk predictors of the mortality in sepsis patients with acute respiratory failure. The area under curve of the nomogram in the ROC was 0.880 (95% CI: 0.851-0.908) that provided significantly higher discrimination compared with simplified acute physiology score II [0.656 (95% CI: 0.612-0.701)].Conclusion: The model has good performance in predicting the mortality risk of sepsis patients with acute respiratory failure, and it can be clinically useful to evaluate the short-term prognosis in critically ill patients with sepsis and acute respiratory failure.

scholarly journals Acute respiratory failure and inflammatory response after out-of-hospital cardiac arrest: results of the Post-Cardiac Arrest Syndrome (PCAS) pilot study

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S110-S121
Author(s):  
Katarzyna Czerwińska-Jelonkiewicz ◽  
Johannes Grand ◽  
Guido Tavazzi ◽  
Jordi Sans-Rosello ◽  
Alice Wood ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Respiratory Failure ◽  
Inflammatory Response ◽  
Acute Respiratory Failure ◽  
White Blood Cells ◽  
Short Term ◽  
Reactive Protein ◽  
Short Term Mortality ◽  
Post Cardiac Arrest Syndrome ◽  
Hospital Cardiac Arrest

Background: Although the lungs are potentially highly susceptible to post-cardiac arrest syndrome injury, the issue of acute respiratory failure after out-of-hospital cardiac arrest has not been investigated. The objectives of this analysis were to determine the prevalence of acute respiratory failure after out-of-hospital cardiac arrest, its association with post-cardiac arrest syndrome inflammatory response and to clarify its importance for early mortality. Methods: The Post-Cardiac Arrest Syndrome (PCAS) pilot study was a prospective, observational, six-centre project (Poland 2, Denmark 1, Spain 1, Italy 1, UK 1), studying patients resuscitated after out-of-hospital cardiac arrest of cardiac origin. Primary outcomes were: (a) the profile of organ failure within the first 72 hours after out-of-hospital cardiac arrest; (b) in-hospital and short-term mortality, up to 30 days of follow-up. Respiratory failure was defined using a modified version of the Berlin acute respiratory distress syndrome definition. Inflammatory response was defined using leukocytes (white blood cells), platelet count and C-reactive protein concentration. All parameters were assessed every 24 hours, from admission until 72 hours of stay. Results: Overall, 148 patients (age 62.9±15.27 years; 27.7% women) were included. Acute respiratory failure was noted in between 50 (33.8%) and 75 (50.7%) patients over the first 72 hours. In-hospital and short-term mortality was 68 (46.9%) and 72 (48.6%), respectively. Inflammation was significantly associated with the risk of acute respiratory failure, with the highest cumulative odds ratio of 748 at 72 hours (C-reactive protein 1.035 (1.001–1.070); 0.043, white blood cells 1.086 (1.039–1.136); 0.001, platelets 1.004 (1.001–1.007); <0.005). Early acute respiratory failure was related to in-hospital mortality (3.172, 95% confidence interval 1.496–6.725; 0.002) and to short-term mortality (3.335 (1.815–6.129); 0.0001). Conclusions: An inflammatory response is significantly associated with acute respiratory failure early after out-of-hospital cardiac arrest. Acute respiratory failure is associated with a worse early prognosis after out-of-hospital cardiac arrest.

scholarly journals The Impact of Right Ventricular Dysfunction on the Mortality in Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis.

2021 ◽  
Author(s):  
Ryota Sato ◽  
Siddharth Dugar ◽  
Wisit Cheungpasitporn ◽  
Mary Schleicher ◽  
Patrick Collier ◽  
...  
Keyword(s):  
Systematic Review ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Meta Analysis ◽  
Right Ventricular Dysfunction ◽  
P Value ◽  
Cochrane Central Register ◽  
Short Term ◽  
Short Term Mortality ◽  
The Impact

Abstract Background: Previous studies have found various incidences of right ventricular dysfunction (RVD) and its association with clinical outcome. In this systematic review and meta-analysis, we aimed to investigate the impact of the presence of RVD on mortality in patients with ARDS.Method: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies investigating the association between RVD and mortality. Two authors independently evaluated whether studies meet eligibility criteria and extracted the selected patients’ and studies’ characteristics and outcomes. The primary outcome was the association between mortality and the presence of RVD in patients with ARDS. Results: We included 9 studies (N = 1,861 patients) in this meta-analysis. RVD was present in 21.0% (391/1,861). In the pooled meta-analysis, the presence of RVD in patients with ARDS was associated with significantly higher overall mortality (OR: 1.45, 95%CI: 1.13-1.86, p-value = 0.003, I2 = 0%), as well as short-term mortality (OR: 1.48, 95%CI: 1.14-1.93, p-value = 0.003, I2 = 0%).Conclusion: In this systematic review and meta-analysis including 1,861 patients with ARDS, the presence of RVD was significantly associated with increased overall and short-term mortality.Trial registration: The protocol was registered at PROSPERO (CRD42020206521).

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