scholarly journals Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Priyam Batra ◽  
Kapil Dev Soni ◽  
Purva Mathur
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Critically Ill ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Icu Stay ◽  
Length Of Icu Stay

Abstract Introduction Ventilator-associated pneumonia (VAP) is reported as the second most common nosocomial infection among critically ill patients with the incidence ranging from 2 to 16 episodes per 1000 ventilator days. The use of probiotics has been shown to have a promising effect in many RCTs. Our systematic review and meta-analysis were thus planned to determine the effect of probiotic use in critically ill ventilated adult patients on the incidence of VAP, length of hospital stay, length of ICU stay, duration of mechanical ventilation, the incidence of diarrhea, and the incidence of oropharyngeal colonization and in-hospital mortality. Methodology Systematic search of various databases (such as Embase, Cochrane, and Pubmed), published journals, clinical trials, and abstracts of the various major conferences were made to obtain the RCTs which compare probiotics with placebo for VAP prevention. The results were expressed as risk ratios or mean differences. Data synthesis was done using statistical software - Review Manager (RevMan) Version 5.4 (The Cochrane Collaboration, 2020). Results Nine studies met our inclusion criterion and were included in the meta-analysis. The incidence of VAP (risk ratio: 0.70, CI 0.56, 0.88; P = 0.002; I2 = 37%), duration of mechanical ventilation (mean difference −3.75, CI −6.93, −0.58; P 0.02; I2 = 96%), length of ICU stay (mean difference −4.20, CI −6.73, −1.66; P = 0.001; I2 = 84%) and in-hospital mortality (OR 0.73, CI 0.54, 0.98; P = 0.04; I2 = 0%) in the probiotic group was significantly lower than that in the control group. Probiotic administration was not associated with a statistically significant reduction in length of hospital stay (MD −1.94, CI −7.17, 3.28; P = 0.47; I2 = 88%), incidence of oro-pharyngeal colonization (OR 0.59, CI 0.33, 1.04; P = 0.07; I2 = 69%), and incidence of diarrhea (OR 0.59, CI 0.34, 1.03; P = 0.06; I2 = 38%). Discussion Our meta-analysis shows that probiotic administration has a promising role in lowering the incidence of VAP, the duration of mechanical ventilation, length of ICU stay, and in-hospital mortality.

Prognostic Significance of Hyponatremia in Acute Stroke: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 49 (5) ◽  
pp. 531-539
Author(s):  
Shogo Shima ◽  
Yasunari Niimi ◽  
Yosuke Moteki ◽  
Osamu Takahashi ◽  
Shinsuke Sato ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Acute Stroke ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Stroke Patients

<b><i>Objective:</i></b> Hyponatremia is a common electrolyte disorder in patients with stroke, which leads to various fatal complications. We performed a systematic review and meta-analysis to investigate the outcomes of acute stroke patients with hyponatremia. <b><i>Methods:</i></b> We searched MEDLINE, EMBASE, and the Cochrane Library databases for relevant literature in English published up to March 2020. Two review authors independently screened and selected the studies by assessing the eligibility and validity based on the inclusion criteria. Mortality at 90 days was set as the primary end point, and in-hospital mortality and length of hospital stay were set as the secondary end points. We conducted the data synthesis and analyzed the outcomes by calculating the odds ratio (OR) and mean difference. <b><i>Results:</i></b> Of 835 studies, 15 studies met the inclusion criteria (<i>n</i> = 10,745). The prevalence rate of stroke patients with hyponatremia was 7.0–59.2%. They had significantly higher 90-day mortality (OR, 1.73; 95% confidence interval (CI), 1.24–2.42) and longer length of hospital stay (mean difference, 10.68 days; 95% CI, 7.14–14.22) than patients without hyponatremia. Patients with hyponatremia had a higher tendency of in-hospital mortality than those without hyponatremia (OR, 1.61; 95% CI, 0.97–2.69). <b><i>Conclusions:</i></b> The development of hyponatremia in the clinical course of stroke is associated with higher short-term mortality and a longer hospital stay. Although the causal relationship is unclear, hyponatremia could be a significant predictor of poor outcomes after stroke.

Pneumonia Is Associated with Increased Mortality in Hospitalized COPD Patients: A Systematic Review and Meta-Analysis

Respiration ◽  
2021 ◽  
Vol 100 (1) ◽  
pp. 64-76
Author(s):  
Yan Yu ◽  
Wei Liu ◽  
Hong-Li Jiang ◽  
Bing Mao
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Readmission Rate ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mortality And Morbidity ◽  
Icu Stay ◽  
Copd Patients ◽  
The Impact

<b><i>Background:</i></b> Patients with chronic obstructive pulmonary disease (COPD) are at a heightened risk of pneumonia. Whether coexisting community-acquired pneumonia (CAP) can predict increased mortality in hospitalized COPD patients is still controversial. <b><i>Objective:</i></b> This systematic review and meta-analysis aims to assess the association between CAP and mortality and morbidity in COPD patients hospitalized for acute worsening of respiratory symptoms. <b><i>Methods:</i></b> In this review, cohort studies and case-control studies investigating the impact of CAP in hospitalized COPD patients were retrieved from 4 electronic databases from inception until December 2019. Methodological quality of included studies was assessed using Newcastle-Ottawa Quality Assessment Scale. The primary outcome was mortality. The secondary outcomes included length of hospital stay, need for mechanical ventilation, intensive care unit (ICU) admission, length of ICU stay, and readmission rate. The Mantel-Haenszel method and inverse variance method were used to calculate pooled relative risk (RR) and mean difference (MD), respectively. <b><i>Results:</i></b> A total of 18 studies were included. The presence of CAP was associated with higher mortality (RR = 1.85; 95% CI: 1.50–2.30; <i>p</i> &#x3c; 0.00001), longer length of hospital stay (MD = 1.89; 95% CI: 1.19–2.59; <i>p</i> &#x3c; 0.00001), more need for mechanical ventilation (RR = 1.48; 95% CI: 1.32–1.67; <i>p</i> &#x3c; 0.00001), and more ICU admissions (RR = 1.58; 95% CI: 1.24–2.03; <i>p</i> = 0.0002) in hospitalized COPD patients. CAP was not associated with longer ICU stay (MD = 5.2; 95% CI: −2.35 to 12.74; <i>p</i> = 0.18) or higher readmission rate (RR = 1.02; 95% CI: 0.96–1.09; <i>p</i> = 0.47). <b><i>Conclusion:</i></b> Coexisting CAP may be associated with increased mortality and morbidity in hospitalized COPD patients, so radiological confirmation of CAP should be required and more attention should be paid to these patients.

scholarly journals High-dose versus low-dose haemofiltration for the treatment of critically ill patients with acute kidney injury: an updated systematic review and meta-analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e014171 ◽  
Author(s):  
Peng Li ◽  
Li-ping Qu ◽  
Dong Qi ◽  
Bo Shen ◽  
Yi-mei Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Dose ◽  
Meta Analysis ◽  
Kidney Injury ◽  
High Dose

ObjectiveThe purpose of this study was to perform a systematic review and meta-analysis to evaluate the effect of high-dose versus low-dose haemofiltration on the survival of critically ill patients with acute kidney injury (AKI). We hypothesised that high-dose treatments are not associated with a higher risk of mortality.DesignMeta-analysis.SettingRandomised controlled trials and two-arm prospective and retrospective studies were included.ParticipantsCritically ill patients with AKI.InterventionsContinuous renal replacement therapy.Primary and secondary outcome measuresPrimary outcomes: 90-day mortality, intensive care unit (ICU) mortality, hospital mortality; secondary outcomes: length of ICU and hospital stay.ResultEight studies including 2970 patients were included in the analysis. Pooled results showed no significant difference in the 90-mortality rate between patients treated with high-dose or low-dose haemofiltration (pooled OR=0.90, 95% CI 0.73 to 1.11, p=0.32). Findings were similar for ICU (pooled OR=1.12, 95% CI 0.94 to 1.34, p=0.21) and hospital mortality (pooled OR=1.03, 95% CI 0.81 to 1.30, p=0.84). Length of ICU and hospital stay were similar between high-dose and low-dose groups. Pooled results are not overly influenced by any one study, different cut-off points of prescribed dose or different cut-off points of delivered dose. Meta-regression analysis indicated that the results were not affected by the percentage of patients with sepsis or septic shock.ConclusionHigh-dose and low-dose haemofiltration produce similar outcomes with respect to mortality and length of ICU and hospital stay in critically ill patients with AKI.This study was not registered at the time the data were collected and analysed. It has since been registered on 17 February 2017 athttp://www.researchregistry.com/, registration number: reviewregistry211.

scholarly journals Higher PEEP versus Lower PEEP Strategies for Patients in ICU without Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Hongyu Yi ◽  
Xiaoming Li ◽  
Zhi Mao ◽  
Chao Liu ◽  
Xin Hu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
High Peep ◽  
Icu Patients ◽  
Icu Stay ◽  
Significant Difference ◽  
Duration Of Ventilation

Abstract Background: The application of high PEEP remains to be a controversial issue when it comes to ICU patients underwent ventilation. There are studies supporting the usage of high PEEP in patients with ARDS, while for those without ARDS, the conclusion is of great ambiguity. We performed this systematic review and meta-analysis to compare the effects of high and low level of PEEP on ICU patients without ARDS.Methods: We searched public databases (including PubMed, EMBASE, Cochrane Library and Clinicaltrial.gov) to find eligible randomized controlled trials (RCTs). The primary outcomes included in this meta-analysis were in-hospital mortality, 28-day mortality and the duration of ventilation, ICU stay, and hospital stay. We used the Cochrane risk of bias assessment tool to evaluate risk of bias. Trial Sequential Analysis (TSA) was conducted. Results: We included 2307 patients from 24 trials using high and low PEEP. Although no significant difference was found between high and low PEEP applications in in-hospital mortality (risk ratio[RR] 0.98, 95% confidence interval[CI] [0.81, 1.19], P=0.87), 28-day mortality (RR 0.68, 95% CI [0.33, 1.40], P=0.30) and the duration of ventilation (mean difference[MD] -0.30, 95% CI [-0.64, 0.04], P=0.09), ICU stay (MD -0.38, 95% CI [-1.03, 0.27], P=0.25), and hospital stay (MD -0.56, 95% CI [-1.44, 0.32], P=0.22), high PEEP indeed increased the level of PaO2/FIO2 (MD 32.39, 95% CI [13.06, 51.72], P=0.001), and therefore decreased the incidences of ARDS (RR 0.57, 95% CI [0.37, 0.89], P=0.01) and hypoxaemia (RR 0.60, 95% CI [0.41, 0.88], P=0.009). In addition, although total results did not reveal the advantage of high PEEP on other secondary outcomes regarding atelectasis, barotrauma, ventilator associated pneumonia (VAP), hypotension, mean arterial pressure (MAP), SaO2 and lactate, subgroup analysis seemed to obtain different results. The TSA results suggested more RCTs were needed. Conclusion: Ventilation with high PEEP in ICU patients without ARDS may improve the level of oxygenation (PaO2/FIO2) resulting in low incidences of ARDS and hypoxaemia. Nevertheless, other clinical outcomes including in-hospital and 28-day mortality, duration of ventilation, ICU stay and hospital stay, pulmonary complications, hemodynamics and post-operative fluid balance did not show any significant difference.

scholarly journals Clinical usefulness of prethymectomy plasmapheresis in patients with myasthenia gravis: a systematic review and meta-analysis

2019 ◽  
Vol 29 (6) ◽  
pp. 867-875
Author(s):  
Tarcisio A Reis ◽  
Daniele C Cataneo ◽  
Antônio Jose Maria Cataneo
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Myasthenia Gravis ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Severe Disease ◽  
Myasthenic Crisis ◽  
Preoperative Period ◽  
Icu Stay ◽  
Number Of Patients

Abstract OBJECTIVES Our goal was to evaluate, through a systematic review, the efficacy of plasmapheresis in the preoperative preparation of the patient for a thymectomy for the treatment of myasthenia gravis. METHODS MEDLINE, Embase, LILACS, Scopus and CENTRAL databases were searched. The following outcomes were evaluated: myasthenic crisis, mortality, pneumonia, bleeding, use of mechanical ventilation, length of hospital stay and intensive care unit (ICU) stay. RevMan 5.3 software provided by the Cochrane Collaboration was used for the meta-analysis. RESULTS The total number of patients evaluated in the 7 included studies was 360. Plasmapheresis during the preoperative period did not decrease the myasthenic crisis [risk ratio (RR) 0.36, 95% confidence interval (CI) 0.08–1.66; I2 = 44%; 5 studies, 243 patients]. There was also no change in the mortality rate (RR 0.7, 95% CI 0.11–4.62; I2 = 0%; 3 studies, 172 patients) or pneumonia cases (RR 0.28, 95% CI 0.07–1.09; I2 = 27%; 5 studies, 272 patients). Bleeding was greater in patients who underwent plasmapheresis (mean difference 34.34 ml; 95% CI 24.93–43.75; I2 = 0%). We evaluated the following outcomes: need for mechanical ventilation, hospital stay, ICU stay and mechanical ventilation, but these outcomes were not adequate to perform the meta-analysis due to the high heterogeneity among the studies. Subgroup analysis showed that plasmapheresis performed during the preoperative period in patients with severe disease (Osserman III and IV) decreased the myasthenic crisis postoperatively (RR 0.12, 95% CI 0.02–0.65; I2 = 63%). CONCLUSIONS Plasmapheresis may reduce the myasthenic crisis during the postoperative period in patients with severe disease but may produce little or no difference in patients with mild clinical expression of the disease.

scholarly journals Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Eleni Papoutsi ◽  
Vassilis G. Giannakoulis ◽  
Eleni Xourgia ◽  
Christina Routsi ◽  
Anastasia Kotanidou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
All Cause Mortality ◽  
Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

666 EARLY EXTUBATION AFTER ESOPHAGECTOMY IS SAFE. A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Maria Serafim ◽  
Clara Santos ◽  
Marina Orlandini ◽  
Letícia Datrino ◽  
Guilherme Tavares ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Risk Difference ◽  
Pulmonary Complications ◽  
Mean Difference ◽  
Early Extubation ◽  
Icu Length Of Stay ◽  
Anastomotic Fistula

Abstract   Esophagectomy has high morbidity and mortality, mainly due to pulmonary complications. Consequently, ventilatory support is a cornerstone in postoperative management. However, there is still no consensus on the timing for extubation. There is a fear that untimely extubation would lead to a high risk for an urgent reintubation. On the other hand, there is a risk for pulmonary damage in prolonged intubation. Thus, the present study aimed to compare early and late extubation after esophagectomy. Methods A systematic review was carried out on PubMed, Lilacs, Cochrane Library Central, and Embase, comparing early and late extubation after esophagectomy. The primary outcome was reintubation. Secondary outcomes included mortality; complications; pulmonary complications; pneumonia; anastomotic fistula; length of hospital stay; and ICU length of stay. The inclusion criteria were: a) clinical trials and cohort studies; b) adult patients (&gt; 18 years); and c) patients with esophageal cancer undergoing esophagectomy. The results were summarized by risk difference and mean difference. 95% confidence interval and random model were applied. Results Four articles were selected, comprising 490 patients. Early extubation did not increase the risk for reintubation, with a risk difference of 0.01 (95%CI -0.03; 0.04). Also, there was no difference for mortality −0.01 (95%CI -0.04; 0.03); complications −0.09 (95%CI -0.22; 0.05); pulmonary complications −0.05 (95%CI -0.13; 0.03); pneumonia −0.06 (95% CI-0.18; 0.05); anastomotic fistula −0.01 (95% CI -0.09; 0.08). In addition, there was no significant mean difference for: length of hospital stay −0.10 (95%CI -0.38; 0.1); and ICU length of stay 0.00 (95%CI -0.22; 0.22). Conclusion Early extubation after esophagectomy does not increase the risk for reintubation, mortality, complications, and lenght of stay.

Haemostatic devices in parotid surgery: a systematic review

2021 ◽  
pp. 1-7
Author(s):  
L Allen ◽  
C MacKay ◽  
M H Rigby ◽  
J Trites ◽  
S M Taylor
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Facial Nerve ◽  
Hospital Stay ◽  
Outcome Measures ◽  
Meta Analysis ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Operative Blood Loss ◽  
Parotid Surgery

Abstract Objective The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. Method A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. Results A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. Conclusion Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

scholarly journals Outcome Difference in Neurosurgical Patients Based on Timing of Tracheostomy and Ventilator Associated Pneumonia

2018 ◽  
Vol 15 (1) ◽  
pp. 19-22
Author(s):  
Pratyush Shrestha ◽  
Subash Lohani ◽  
Sunita Shrestha ◽  
Upendra P Devkota
Keyword(s):  
Hospital Stay ◽  
Tracheostomy Tube ◽  
Length Of Hospital Stay ◽  
Ventilator Associated Pneumonia ◽  
Early Tracheostomy ◽  
Icu Stay ◽  
Neurosurgical Patients ◽  
Significant Difference ◽  
Length Of Icu Stay

Background and Objective: Tracheostomy in neurosurgical patients has been shown in various studies to lower the length of ICU stay and the length of hospital stay by decreasing the incidence of ventilator associated pneumonia. In this regard, we wanted to evaluate the outcome of neurosurgical ICU patients based on timing of tracheostomy and ventilator associated pneumonia.Methods: This is a retrospective single centre study performed over a period of two and a half years. Early tracheostomy was defi ned as those done three days of intubation or earlier and late as those done then after. Statistical analysis was done using SPSS.Results: There were 56 patients over the study period of which 18 patients underwent early tracheostomy and 38 patients underwent late tracheostomy. There was no statistically significant difference between the two groups with regards to the length of ICU stay, the length of hospital stay or the length of tracheostomy tube in situ. But based on tracheal aspirate culture positivity, length of tracheostomy tube in situ was signifi cantly longer in those with positive bacterial cultures.Early tracheostomy does not improve neurosurgical outcome while documented pneumonia prolongs the length of tracheostomy tube in situ.Nepal Journal of Neuroscience 15:19-22, 2018

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