scholarly journals Neurally adjusted ventilatory assist as a weaning mode for adults with invasive mechanical ventilation: a systematic review and meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Xueyan Yuan ◽  
Xinxing Lu ◽  
Yali Chao ◽  
Jennifer Beck ◽  
Christer Sinderby ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Practice ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Cochrane Library ◽  
Neurally Adjusted Ventilatory Assist ◽  
Partial Support ◽  
Ventilatory Assist

Abstract Background Prolonged ventilatory support is associated with poor clinical outcomes. Partial support modes, especially pressure support ventilation, are frequently used in clinical practice but are associated with patient–ventilation asynchrony and deliver fixed levels of assist. Neurally adjusted ventilatory assist (NAVA), a mode of partial ventilatory assist that reduces patient–ventilator asynchrony, may be an alternative for weaning. However, the effects of NAVA on weaning outcomes in clinical practice are unclear. Methods We searched PubMed, Embase, Medline, and Cochrane Library from 2007 to December 2020. Randomized controlled trials and crossover trials that compared NAVA and other modes were identified in this study. The primary outcome was weaning success which was defined as the absence of ventilatory support for more than 48 h. Summary estimates of effect using odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with accompanying 95% confidence interval (CI) were expressed. Results Seven studies (n = 693 patients) were included. Regarding the primary outcome, patients weaned with NAVA had a higher success rate compared with other partial support modes (OR = 1.93; 95% CI 1.12 to 3.32; P = 0.02). For the secondary outcomes, NAVA may reduce duration of mechanical ventilation (MD = − 2.63; 95% CI − 4.22 to − 1.03; P = 0.001) and hospital mortality (OR = 0.58; 95% CI 0.40 to 0.84; P = 0.004) and prolongs ventilator-free days (MD = 3.48; 95% CI 0.97 to 6.00; P = 0.007) when compared with other modes. Conclusions Our study suggests that the NAVA mode may improve the rate of weaning success compared with other partial support modes for difficult to wean patients.

scholarly journals Neurally adjusted ventilatory assist as a weaning mode for adults with invasive mechanical ventilation: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Xueyan Yuan ◽  
Xinxing Lu ◽  
Yali Chao ◽  
Jennifer Beck ◽  
Christer Sinderby ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Practice ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Cochrane Library ◽  
Neurally Adjusted Ventilatory Assist ◽  
Partial Support ◽  
Ventilatory Assist

Abstract Background Prolonged ventilatory support is associated with poor clinical outcomes. Partial support modes, especially pressure support ventilation, are frequently used in clinical practice but are associated with patient-ventilation asynchrony and deliver fixed levels of assist. Neurally adjusted ventilatory assist (NAVA), a mode of partial ventilatory assist that reduces patient-ventilator asynchrony (PVA), may be an alternative for weaning. However, the effects of NAVA on weaning outcomes in clinical practice are unclear. Methods We searched PubMed, Embase, Medline, and Cochrane Library from 2007 to December, 2020. Randomized controlled trials (RCTs) and crossover trials that compared NAVA and other modes were identified in this study. The primary outcome was weaning success. Summary estimates of effect using odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with accompanying 95% confidence interval (CI) were expressed. Results Seven studies (n = 683 patients) were included. Regarding the primary outcome, patients weaned with NAVA had a higher success rate compared with other partial support modes (OR = 1.80; 95% CI, 1.08 to 3.01; P = 0.02). For the secondary outcomes, NAVA may reduce duration of mechanical ventilation (MD = -3.88; 95% CI, -7.49 to -0.27; P = 0.04) and hospital mortality (OR = 0.58; 95% CI, 0.40 to 0.84; P = 0.004), and prolongs ventilator-free days (MD = 3.48; 95% CI, 0.97 to 6.00; P = 0.007) when compared with other modes. Conclusions Our study suggests that the NAVA mode was significantly associated with higher rates of weaning success compared with other partial support modes.

scholarly journals COVID-19 ICU and mechanical ventilation patient characteristics and outcomes - A systematic review and meta-analysis

2020 ◽  
Author(s):  
Raymond Chang ◽  
Khaled Mossad Elhusseiny ◽  
Yu-Chang Yeh ◽  
Wei-zen Sun
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Kidney Injury ◽  
Admission Rate ◽  
Resource Planning ◽  
Patient Characteristics ◽  
Icu Mortality

Background Insight into COVID-19 intensive care unit (ICU) patient characteristics, rates and risks of invasive mechanical ventilation (IMV) and associated outcomes as well as any regional discrepancies is critical in this pandemic for individual case management and overall resource planning. Methods and Findings Electronic searches were performed for reports through May 1 2020 and reports on COVID-19 ICU admissions and outcomes were included using predefined search terms. Relevant data was subsequently extracted and pooled using fixed or random effects meta-analysis depending on heterogeneity. Study quality was assessed by the NIH tool and heterogeneity was assessed by I2 and Q tests. Baseline patient characteristics, ICU and IMV outcomes were pooled and meta-analyzed. Pooled odds ratios (pOR) were calculated for clinical features against ICU, IMV mortality. Subgroup analysis was carried out based on patient regions. A total of twenty-eight studies comprising 12,437 COVID-19 ICU admissions from seven countries were meta-analyzed. Pooled ICU admission rate was 21% [95% CI 0.12-0.34] and 69% of cases needed IMV [95% CI 0.61-0.75]. ICU and IMV mortality were 28.3% [95% CI 0.25-0.32], 43% [95% CI 0.29-0.58] and ICU, IMV duration was 7.78 [95% CI 6.99-8.63] and 10.12 [95% CI 7.08-13.16] days respectively. Besides confirming the significance of comorbidities and clinical findings of COVID-19 previously reported, we found the major correlates with ICU mortality were IMV [pOR 16.46, 95% CI 4.37-61.96], acute kidney injury (AKI) [pOR 12.47, 95% CI 1.52-102.7], and acute respiratory distress syndrome (ARDS) [pOR 6.52, 95% CI 2.66-16.01]. Subgroup analyses confirm significant regional discrepancies in outcomes. Conclusions This is the most comprehensive systematic review and meta-analysis of COVID-19 ICU and IMV cases and associated outcomes to date and the only analysis to implicate IMV's associtaion with COVID-19 ICU mortality. The significant association of AKI, ARDS and IMV with mortality has implications for ICU resource planning for AKI and ARDS as well as research into optimal ventilation strategies for patients. Regional differences in outcome implies a need to develop region specific protocols for ventilatory support as well as overall treatment.

scholarly journals Comparison of ventilatory modes to facilitate liberation from mechanical ventilation: protocol for a systematic review and network meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030407 ◽  
Author(s):  
Kimberley A Lewis ◽  
Dipayan Chaudhuri ◽  
Gordon Guyatt ◽  
Karen E A Burns ◽  
Karen Bosma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Random Effect ◽  
Risk Of Bias ◽  
Evaluation Methodology ◽  
Cochrane Library ◽  
Alternative Mode ◽  
Mechanical Ventilation Duration

IntroductionTimely liberation from invasive mechanical ventilation is important to reduce the risk of ventilator-associated complications. Once a patient is deemed ready to tolerate a mode of partial ventilator assist, clinicians can use one of multiple ventilatory modes. Despite multiple trials, controversy regarding the optimal ventilator mode to facilitate liberation remains. Herein, we report the protocol for a systematic review and network meta-analysis comparing modes of ventilation to facilitate the liberation of a patient from invasive mechanical ventilation.Methods and analysisWe will search MEDLINE, EMBASE, PubMed, the Cochrane Library from inception to April 2019 for randomised trials that report on critically ill adults who have undergone invasive mechanical ventilation for at least 24 hours and have received any mode of assisted invasive mechanical ventilation compared with an alternative mode of assisted ventilation. Outcomes of interest will include: mortality, weaning success, weaning duration, duration of mechanical ventilation, duration of stay in the acute care setting and adverse events. Two reviewers will independently screen in two stages, first titles and abstracts, and then full texts, to identify eligible studies. Independently and in duplicate, two investigators will extract all data, and assess risk of bias in all eligible studies using the Modified Cochrane Risk of Bias tool. Reviewers will resolve disagreement by discussion and consultation with a third reviewer as necessary. Using a frequentist framework, we will perform random-effect network meta-analysis, including all ventilator modes in the same model. We will calculate direct and indirect estimates of treatment effect using a node-splitting procedure and report effect estimates using OR and 95% CI. We will assess certainty in effect estimates using Grading of Recommendations Assessment, Development and Evaluation methodology.Ethics and disseminationResearch ethics board approval is not necessary. The results will be disseminated through publication in a peer-reviewed journals.PROSPERO registration numberCRD42019137786

scholarly journals Neurally Adjusted Ventilatory Assist versus Pressure Support Ventilation in Difficult Weaning

2020 ◽  
Vol 132 (6) ◽  
pp. 1482-1493 ◽  
Author(s):  
Ling Liu ◽  
Xiaoting Xu ◽  
Qin Sun ◽  
Yue Yu ◽  
Feiping Xia ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Invasive Mechanical Ventilation ◽  
Neurally Adjusted Ventilatory Assist ◽  
Support Ventilation ◽  
Difficult Weaning ◽  
Diaphragm Electrical Activity ◽  
Ventilatory Assist ◽  
Successful Weaning

Abstract Background Difficult weaning frequently develops in ventilated patients and is associated with poor outcome. In neurally adjusted ventilatory assist, the ventilator is controlled by diaphragm electrical activity, which has been shown to improve patient–ventilator interaction. The objective of this study was to compare neurally adjusted ventilatory assist and pressure support ventilation in patients difficult to wean from mechanical ventilation. Methods In this nonblinded randomized clinical trial, difficult-to-wean patients (n = 99) were randomly assigned to neurally adjusted ventilatory assist or pressure support ventilation mode. The primary outcome was the duration of weaning. Secondary outcomes included the proportion of successful weaning, patient–ventilator asynchrony, ventilator-free days, and mortality. Weaning duration was calculated as 28 days for patients under mechanical ventilation at day 28 or deceased before day 28 without successful weaning. Results Weaning duration in all patients was statistically significant shorter in the neurally adjusted ventilatory assist group (n = 47) compared with the pressure support ventilation group (n = 52; 3.0 [1.2 to 8.0] days vs. 7.4 [2.0 to 28.0], mean difference: −5.5 [95% CI, −9.2 to −1.4], P = 0.039). Post hoc sensitivity analysis also showed that the neurally adjusted ventilatory assist group had shorter weaning duration (hazard ratio, 0.58; 95% CI, 0.34 to 0.98). The proportion of patients with successful weaning from invasive mechanical ventilation was higher in neurally adjusted ventilatory assist (33 of 47 patients, 70%) compared with pressure support ventilation (25 of 52 patients, 48%; respiratory rate for neurally adjusted ventilatory assist: 1.46 [95% CI, 1.04 to 2.05], P = 0.026). The number of ventilator-free days at days 14 and 28 was statistically significantly higher in neurally adjusted ventilatory assist compared with pressure support ventilation. Neurally adjusted ventilatory assist improved patient ventilator interaction. Mortality and length of stay in the intensive care unit and in the hospital were similar among groups. Conclusions In patients difficult to wean, neurally adjusted ventilatory assist decreased the duration of weaning and increased ventilator-free days. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals COVID-19 ICU and mechanical ventilation patient characteristics and outcomes—A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246318
Author(s):  
Raymond Chang ◽  
Khaled Mossad Elhusseiny ◽  
Yu-Chang Yeh ◽  
Wei-Zen Sun
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Kidney Injury ◽  
Admission Rate ◽  
Resource Planning ◽  
Patient Characteristics ◽  
Individual Case

Background Insight into COVID-19 intensive care unit (ICU) patient characteristics, rates and risks of invasive mechanical ventilation (IMV) and associated outcomes as well as any regional discrepancies is critical in this pandemic for individual case management and overall resource planning. Methods and findings Electronic searches were performed for reports through May 1 2020 and reports on COVID-19 ICU admissions and outcomes were included using predefined search terms. Relevant data was subsequently extracted and pooled using fixed or random effects meta-analysis depending on heterogeneity. Study quality was assessed by the NIH tool and heterogeneity was assessed by I2 and Q tests. Baseline patient characteristics, ICU and IMV outcomes were pooled and meta-analyzed. Pooled odds ratios (pOR) were calculated for clinical features against ICU, IMV mortality. Subgroup analysis was carried out based on patient regions. A total of twenty-eight studies comprising 12,437 COVID-19 ICU admissions from seven countries were meta-analyzed. Pooled ICU admission rate was 21% [95% CI 0.12–0.34] and 69% of cases needed IMV [95% CI 0.61–0.75]. ICU and IMV mortality were 28.3% [95% CI 0.25–0.32], 43% [95% CI 0.29–0.58] and ICU, IMV duration was 7.78 [95% CI 6.99–8.63] and 10.12 [95% CI 7.08–13.16] days respectively. Besides confirming the significance of comorbidities and clinical findings of COVID-19 previously reported, we found the major correlates with ICU mortality were IMV [pOR 16.46, 95% CI 4.37–61.96], acute kidney injury (AKI) [pOR 12.47, 95% CI 1.52–102.7], and acute respiratory distress syndrome (ARDS) [pOR 6.52, 95% CI 2.66–16.01]. Subgroup analyses confirm significant regional discrepancies in outcomes. Conclusions This is a comprehensive systematic review and meta-analysis of COVID-19 ICU and IMV cases and associated outcomes. The significant association of AKI, ARDS and IMV with mortality has implications for ICU resource planning for AKI and ARDS as well as suggesting the need for further research into optimal ventilation strategies for COVID-19 patients in the ICU setting. Regional differences in outcome implies a need to develop region specific protocols for ventilatory support as well as overall treatment.

Nasal High-Frequency Oscillatory Ventilation in Preterm Infants with Moderate Respiratory Distress Syndrome: A Multicenter Randomized Clinical Trial

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Xingwang Zhu ◽  
Zhichun Feng ◽  
Chengjun Liu ◽  
Liping Shi ◽  
Yuan Shi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Preterm Infants ◽  
High Frequency ◽  
Primary Outcome ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Risk Difference ◽  
High Frequency Oscillatory Ventilation ◽  
High Frequency Oscillatory

<b><i>Objective:</i></b> To determine whether nasal high-frequency oscillatory ventilation (NHFOV) as a primary mode of respiratory support as compared with nasal continuous airway pressure (NCPAP) will reduce the need for invasive mechanical ventilation in preterm infants (26<sup>0/7</sup>–33<sup>6/7</sup> weeks of gestational age [GA]) with respiratory distress syndrome (RDS). <b><i>Methods:</i></b> This multicenter randomized controlled trial was conducted in 18 tertiary neonatal intensive care units in China. A total of 302 preterm infants born at a GA of 26<sup>0/7</sup>–33<sup>6/7</sup> weeks with a diagnosis of RDS were randomly assigned to either the NCPAP (<i>n</i> = 150) or the NHFOV (<i>n</i> = 152) group. The primary outcome was the need for invasive mechanical ventilation during the first 7 days after birth. <b><i>Results:</i></b> Treatment failure occurred in 15 of 152 infants (9.9%) in the ­NHFOV group and in 26 of 150 infants (17.3%) in the NCPAP group (95% CI of risk difference: −15.2 to 0.4, <i>p =</i> 0.06). In the subgroup analysis, NHFOV resulted in a significantly lower rate of treatment failure than did NCPAP in the strata of 26<sup>+0/7</sup>–29<sup>+6/7</sup>weeks of GA (11.9 vs. 32.4%, 95% CI of risk difference: −39.3 to −1.7, <i>p =</i> 0.03) and birth weight &#x3c;1,500 g (10.4 vs. 29.6%, 95% CI of risk difference: −33.8 to −4.6, <i>p =</i> 0.01). The rate of thick secretions causing an airway obstruction was higher in the NHFOV group than in the NCPAP group (13.8 vs. 5.3%, 95% CI of risk difference: 1.9–15.1, <i>p =</i> 0.01). No significant differences in other secondary outcomes were found between the NHFOV and NCPAP groups. <b><i>Conclusions:</i></b> NHFOV was not superior to NCPAP with regard to the primary outcome when applied as the primary respiratory support for RDS in infants between 26<sup>+0/7</sup> and 33<sup>+6/7</sup> weeks of GA. In the subgroup analysis, NHFOV seemed to improve effectiveness than NCPAP in preterm infants &#x3c;30 weeks of GA.

scholarly journals Intraosseous versus intravenous vascular access during cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a systematic review and meta-analysis of observational studies

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Yu-Lin Hsieh ◽  
Meng-Che Wu ◽  
Jon Wolfshohl ◽  
James d’Etienne ◽  
Chien-Hua Huang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Vascular Access ◽  
Subgroup Analysis ◽  
Observational Studies ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Hospital Cardiac Arrest

Abstract Introduction This study is aimed to investigate the association of intraosseous (IO) versus intravenous (IV) route during cardiopulmonary resuscitation (CPR) with outcomes after out-of-hospital cardiac arrest (OHCA). Methods We systematically searched PubMed, Embase, Cochrane Library and Web of Science from the database inception through April 2020. Our search strings included designed keywords for two concepts, i.e. vascular access and cardiac arrest. There were no limitations implemented in the search strategy. We selected studies comparing IO versus IV access in neurological or survival outcomes after OHCA. Favourable neurological outcome at hospital discharge was pre-specified as the primary outcome. We pooled the effect estimates in random-effects models and quantified the heterogeneity by the I2 statistics. Time to intervention, defined as time interval from call for emergency medical services to establishing vascular access or administering medications, was hypothesized to be a potential outcome moderator and examined in subgroup analysis with meta-regression. Results Nine retrospective observational studies involving 111,746 adult OHCA patients were included. Most studies were rated as high quality according to Newcastle-Ottawa Scale. The pooled results demonstrated no significant association between types of vascular access and the primary outcome (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.27–1.33; I2, 95%). In subgroup analysis, time to intervention was noted to be positively associated with the pooled OR of achieving the primary outcome (OR: 3.95, 95% CI, 1.42–11.02, p: 0.02). That is, when the studies not accounting for the variable of “time to intervention” in the statistical analysis were pooled together, the meta-analytic results between IO access and favourable outcomes would be biased toward inverse association. No obvious publication bias was detected by the funnel plot. Conclusions The meta-analysis revealed no significant association between types of vascular access and neurological outcomes at hospital discharge among OHCA patients. Time to intervention was identified to be an important outcome moderator in this meta-analysis of observation studies. These results call for the need for future clinical trials to investigate the unbiased effect of IO use on OHCA CPR.

scholarly journals Effects of early extubation followed by noninvasive ventilation versus standard extubation on the duration of invasive mechanical ventilation in hypoxemic non-hypercapnic patients: a systematic review and individual patient data meta-analysis of randomized controlled trials

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Rosanna Vaschetto ◽  
Alessandro Pecere ◽  
Gavin D. Perkins ◽  
Dipesh Mistry ◽  
Gianmaria Cammarota ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Randomized Controlled Trials ◽  
Noninvasive Ventilation ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Patient Data ◽  
Controlled Trials ◽  
Early Extubation ◽  
Randomized Controlled

Abstract Background Usefulness of noninvasive ventilation (NIV) in weaning patients with non-hypercapnic hypoxemic acute respiratory failure (hARF) is unclear. The study aims to assess in patients with non-hypercapnic hARF, the efficacy of NIV after early extubation, compared to standard weaning. Methods In this individual patient data meta-analysis, we searched EMBASE, Medline and Cochrane Central Register of Controlled Trials to identify potentially eligible randomized controlled trials published from database inception to October 2020. To be eligible, studies had to include patients treated with NIV after early extubation and compared to conventional weaning in adult non-hypercapnic hARF patients. Anonymized individual patient data from eligible studies were provided by study investigators. Using one-step and two-step meta-analysis models we tested the difference in total days spent on invasive ventilation. Results We screened 1605 records. Six studies were included in quantitative synthesis. Overall, 459 participants (mean [SD] age, 62 [15] years; 269 [59%] males) recovering from hARF were included in the analysis (233 in the intervention group and 226 controls). Participants receiving NIV had a shorter duration of invasive mechanical ventilation compared to control group (mean difference, − 3.43; 95% CI − 5.17 to − 1.69 days, p < 0.001), a shorter duration of total days spent on mechanical ventilation (mean difference, − 2.04; 95% CI − 3.82 to − 0.27 days, p = 0.024), a reduced risk of ventilatory associated pneumonia (odds ratio, 0.24; 95% CI 0.08 to 0.71, p = 0.014), a reduction of time spent in ICU (time ratio, 0.81; 95% CI 0.68 to 0.96, p = 0.015) and in-hospital (time ratio, 0.81; 95% CI 0.69 to 0.95, p = 0.010), with no difference in ICU mortality. Conclusions Although primary studies are limited, using an individual patient data metanalysis approach, NIV after early extubation appears useful in reducing total days spent on invasive mechanical ventilation. Trial registration The protocol was registered to PROSPERO database on 12/06/2019 and available at PROSPERO website inserting the study code i.e., CRD42019133837.

Novel oral anticoagulats for the treatment of left ventricle thrombosis: a systematic review and meta-analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Serenelli ◽  
F Vitali ◽  
R Pavasini ◽  
E Tonet ◽  
G Pompei ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Ventricular Thrombus

Abstract Funding Acknowledgements Type of funding sources: None. Background novel oral anticoagulants (NOACs) are not guideline-recommanded treatment for left ventricular thrombus.  Purpose: the aim of this meta-analysis is to compare NOACs versus vitamin-K atagonsits (VKAs) efficacy in treating left ventricular thrombus (LVT). Methods: we systematically searched MEDLINE, Cochrane Library, Biomed Central, and Web of Science for trials comparing NOACs versus VKAs in the setting of LVT. Five studies, out of the 74 initially selected after first screening, were included in the meta-analysis. For the development of this meta-analysis, the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. The shortlisted studies were retrieved as full articles and appraised independently by two unblinded reviewers. The Mantel-Haensel method with a random effect model was used for the pooled analysis. The primary outcome was the occurrence of stroke and systemic embolism. Secondary outcome was occurrence of left ventricular thrombosis resolution during treatment.  Results: 707 patients were included in the analysis for the primary outcome. Of these, 230 were treated with NOACs and 477 with VKAs. The pooled OR for the primary outcome was 0.71 (95% CI 0.18-2.86, I2 67%), thus showing similar effect in term of ischaemic protection. A total of 698 patients, 228 on NOACs and 470 on VKAs were included in the analysis of the secondary outcome. The pooled OR for the secondary outcome pooled OR 0.97, 95% CI 0.56-1.68, I2 46%. Conclusions and Relevance: NOACs seem to have a similar efficacy profile compare to VKAs and so they should be considered as an alternative treatment for left ventricular thrombosis. Large prospective randomized clinical trials are needed to confirm this exploratory finding. Abstract Figure 1

MECHANICAL VENTILATION FOR INTERSTITIAL LUNG DISEASE BY SYSTEMIC SCLEROSIS WITH CREST SYNDROME. PRESENTATION OF A CLINICAL CASE

2021 ◽  
pp. 80-81
Author(s):  
Katherine Esparza Maquilón ◽  
Antonio Miguel Ornes Rodriguez ◽  
Diana Mercedes Bombón Salazar ◽  
Daniela Macarena Mediavilla Paredes ◽  
Luis Gustavo Mediavilla Sevilla ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Systemic Sclerosis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Crest Syndrome ◽  
Positive Skin ◽  
Lung Protection ◽  
Advanced Stages

INTRODUCTION. Interstitial lung disease (ILD) with acute respiratory failure needs ventilatory support poorly documented. One of the interstitial diseases known is the Systemic sclerosis, its advanced stages develop CREST syndrome. Faverio P, et al. (2016) suggested do not close the door to these patients and open the correct protocol, criticizing the little value that the scientic community concede to invasive mechanical ventilation (IMV). CASE REPORT. 85-year-old male is internalized in critical care unit by pneumonia, the complementary evaluation shows a systemic sclerosis disease with CREST syndrome and it is conrmed by elevation of anti-centromere antibody and positive skin biopsy. Tomography highlights pneumonic consolidation plus interstitial lung involvement and echocardiography reveals pulmonary hypertension. The management is done with IMV, keeping the goal of driving pressure less than 15 as lung protection, recovering respiratory function in 3 weeks. Discussion. The evidence is too insufcient to establish the best decision on IMV to the management of ILD.

Sign in / Sign up

Export Citation Format

Share Document