scholarly journals High flow nasal oxygen for acute type two respiratory failure: a systematic review

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 482
Author(s):  
Asem Abdulaziz Alnajada ◽  
Bronagh Blackwood ◽  
Abdulmajeed Mobrad ◽  
Adeel Akhtar ◽  
Ivan Pavlov ◽  
...  
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Cohort Studies ◽  
Small Sample ◽  
High Flow ◽  
Risk Of Bias ◽  
Low Flow ◽  
Acute Type ◽  
Significant Difference ◽  
Time Point

Background: Acute type two respiratory failure (AT2RF) is characterized by high carbon dioxide levels (PaCO2 >6kPa). Non-invasive ventilation (NIV), the current standard of care, has a high failure rate. High flow nasal therapy (HFNT) has potential additional benefits such as CO2 clearance, the ability to communicate and comfort. The primary aim of this systematic review is to determine whether HFNT in AT2RF improves 1) PaCO2, 2) clinical and patient-centred outcomes and 3) to assess potential harms. Methods: We searched EMBASE, MEDLINE and CENTRAL  (January 1999-January 2021). Randomised controlled trials (RCTs) and cohort studies comparing HFNT with low flow nasal oxygen (LFO) or NIV were included. Two authors independently assessed studies for eligibility, data extraction and risk of bias. We used Cochrane risk of bias tool for RCTs and Ottawa-Newcastle scale for cohort studies. Results: From 727 publications reviewed, four RCTs and one cohort study (n=425) were included. In three trials of HFNT vs NIV, comparing PaCO2 (kPa) at last follow-up time point, there was a significant reduction at four hours (1 RCT; HFNT median 6.7, IQR 5.6 – 7.7 vs NIV median 7.6, IQR 6.3 – 9.3) and no significant difference at  24-hours or five days. Comparing HFNT with LFO, there was no significant difference at 30-minutes. There was no difference in intubation or mortality. Conclusions: This review identified a small number of studies with low to very low certainty of evidence. A reduction of PaCO2 at an early time point of four hours post-intervention was demonstrated in one small RCT. Significant limitations of the included studies were lack of adequately powered outcomes and clinically relevant time-points and small sample size. Accordingly, systematic review cannot recommend the use of HFNT as the initial management strategy for AT2RF and trials adequately powered to detect clinical and patient-relevant outcomes are urgently warranted.

scholarly journals High flow nasal oxygen for acute type two respiratory failure: a systematic review

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 482
Author(s):  
Asem Abdulaziz ◽  
Bronagh Blackwood ◽  
Abdulmajeed Mobrad ◽  
Adeel Akhtar ◽  
Ivan Pavlov ◽  
...  
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Cohort Studies ◽  
Small Sample ◽  
High Flow ◽  
Risk Of Bias ◽  
Low Flow ◽  
Acute Type ◽  
Significant Difference ◽  
Time Point

Background: Acute type two respiratory failure (AT2RF) is characterized by high carbon dioxide levels (PaCO2 >6kPa). Non-invasive ventilation (NIV), the current standard of care, has a high failure rate. High flow nasal therapy (HFNT) has potential additional benefits such as CO2 clearance, the ability to communicate and comfort. The primary aim of this systematic review is to determine whether HFNT in AT2RF improves 1) PaCO2, 2) clinical and patient-centred outcomes and 3) to assess potential harms. Methods: We searched EMBASE, MEDLINE and CENTRAL  (January 1999-January 2021). Randomised controlled trials (RCTs) and cohort studies comparing HFNT with low flow nasal oxygen (LFO) or NIV were included. Two authors independently assessed studies for eligibility, data extraction and risk of bias. We used Cochrane risk of bias tool for RCTs and Ottawa-Newcastle scale for cohort studies. Results: From 727 publications reviewed, four RCTs and one cohort study (n=425) were included. In three trials of HFNT vs NIV, comparing PaCO2 (kPa) at last follow-up time point, there was a significant reduction at four hours (1 RCT; HFNT median 6.7, IQR 5.6 – 7.7 vs NIV median 7.6, IQR 6.3 – 9.3) and no significant difference at  24-hours or five days. Comparing HFNT with LFO, there was no significant difference at 30-minutes. There was no difference in intubation or mortality. Conclusions: This review identified a small number of studies with low to very low certainty of evidence. A reduction of PaCO2 at an early time point of four hours post-intervention was demonstrated in one small RCT. Significant limitations of the included studies were lack of adequately powered outcomes and clinically relevant time-points and small sample size. Accordingly, systematic review cannot recommend the use of HFNT as the initial management strategy for AT2RF and trials adequately powered to detect clinical and patient-relevant outcomes are urgently warranted.

scholarly journals High-Flow Nasal Cannula in Hypercapnic Respiratory Failure: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Yongkang Huang ◽  
Wei Lei ◽  
Wenyu Zhang ◽  
Jian-an Huang
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Cohort Studies ◽  
Meta Analysis ◽  
High Flow ◽  
Nasal Cannula ◽  
Cochrane Library ◽  
Intubation Rate ◽  
High Flow Nasal Cannula ◽  
Hypercapnic Respiratory Failure

Background. Although the efficacy and safety of high-flow nasal cannula (HFNC) in hypoxemic respiratory failure are widely recognized, it is yet unclear whether HFNC can effectively reduce the intubation rate and mortality in hypercapnic respiratory failure. We performed a systematic review and meta-analysis to assess the safety and efficiency of HFNC in these patients. Methods. A systematic search of PubMed, Embase, and Cochrane Library (CENTRAL) was carried out. Two reviewers independently screened all references according to the inclusion criteria. We used the Cochrane risk-of-bias tool and the Newcastle–Ottawa Quality Assessment Scale to assess the quality of randomized controlled trials (RCTs) and cohort studies, respectively. Data from eligible trials were extracted for the meta-analysis. Results. Eight studies with a total of 621 participants were included (six RCTs and two cohort studies). Our analysis showed that HFNC is noninferior to noninvasive ventilation (NIV) with respect to intubation rate in both RCTs (OR = 0.92, 95% CI: 0.45–1.88) and cohort studies (OR = 0.94, 95% CI: 0.55–1.62). Similarly, the analysis of cohort studies showed no difference in reducing mortality rates (OR = 0.96, 95% CI: 0.42–2.20). Based on RCTs, NIV seemed more effective in reducing mortality (OR = 1.33, 95% CI: 0.68–2.60), but the intertreatment difference was not statistically significant. Furthermore, no significant differences were found between HFNC and NIV relating to change of blood gas analysis or respiratory rate (MD = −0.75, 95% CI: −2.6 to 1.09). Likewise, no significant intergroup differences were found with regard to intensive care unit stay (SMD = −0.07, 95% CI: 0.26 to 0.11). Due to a physiological friendly interface and variation, HFNC showed a significant advantage over NIV in patients’ comfort and complication of therapy. Conclusion. Despite the limitations noted, HFNC may be an effective and safe alternative to prevent endotracheal intubation and mortality when NIV is unsuitable in mild-to-moderate hypercapnia. Further high-quality studies are needed to validate these findings.

scholarly journals Opioid reduction for patients with chronic pain in primary care: systematic review

2022 ◽  
pp. BJGP.2021.0537
Author(s):  
Loes de Kleijn ◽  
Julie Pedersen ◽  
Hanneke Rijkels-Otters ◽  
Alessandro Chiarotto ◽  
Bart Koes
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Chronic Pain ◽  
Cohort Studies ◽  
Small Sample ◽  
Risk Of Bias ◽  
Cochrane Central Register ◽  
Opioid Treatment ◽  
Reduction Strategies

Background: Long-term opioid treatment in patients with chronic pain is often ineffective and possibly harmful. These patients are often managed by general practitioners, who are calling for a clear overview of effective opioid reduction strategies for primary care. Aim: Evaluate effectiveness of opioid reduction strategies applicable in primary care for patients with chronic pain on long-term opioid treatment. Design: Systematic review of controlled trials and cohort studies. Method Literature search conducted in Embase, Medline, Web of Science, Cochrane CENTRAL register of trials, CINAHL, Google Scholar and PsychInfo. Studies evaluating opioid reduction interventions applicable in primary care among adults with long-term opioid treatment for chronic non-cancer pain were included. Risk of bias was assessed using Cochrane risk of bias (RoB) 2.0 tool or Risk-of-Bias in Non-randomized studies of Interventions (ROBINS-I) tool. Narrative synthesis was performed due to clinical heterogeneity in study designs and types of interventions. Results: Five RCTs and five cohort studies were included (total n= 1717, range 35-985) exploring various opioid reduction strategies. Six studies had high RoB, three moderate RoB, and one low RoB. Three cohort studies investigating a GP supervised opioid taper (critical ROBINS-I), an integrative pain treatment (moderate ROBINS-I) and group medical visits (critical ROBINS-I) demonstrated significant between-group opioid reduction. Conclusion: Results carefully point in the direction of a GP supervised tapering and multidisciplinary group therapeutic sessions to reduce long term opioid treatment. However, due to high risk of bias and small sample sizes, no firm conclusions can be made demonstrating need for more high-quality research.

scholarly journals High Flow Nasal Oxygen for Acute Type 2 Respiratory Failure: A Systematic Review and Meta-Analysis Protocol

2020 ◽  
Author(s):  
Asem Alnajada ◽  
Bronagh Blackwood ◽  
Abdulmajeed Almobrad ◽  
Adeel Akhtar ◽  
Murali Shyamsundar
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Meta Analysis ◽  
High Flow ◽  
Current Evidence ◽  
Acute Type ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Abstract BackgroundAcute Type 2 respiratory failure (AT2RF) is defined by hypercapnia (>6kPa) and these patients require ventilatory support in a significant proportion of cases. Non-invasive ventilation (NIV) is effective in preventing escalation to invasive mechanical ventilation (IMV) but has a high failure rate. High flow nasal oxygen (HFNO) is a novel device that integrates humidified air with oxygen at flow rates of up to 60 L/min. Various additional benefits including carbon-di-oxide (CO2) clearance have been attributed to HFNO. This systematic review aims to determine whether the use of HFNO for patients with AT2RF 1) improves arterial CO2 (PaCO2), 2) improves other clinical and patient-centred outcomes and 3) assess any potential harms.MethodSearches for relevant studies will be conducted in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials, with no language restrictions. In addition, we will search Google Scholar and the references of all articles for any pertinent studies not found in our initial search. With the assistance of a professional librarian, we will develop a systematic search strategy using appropriate keywords and MeSH terms. We will identify trials that examined the efficacy of HFNO in adult AT2RF patients. We will include randomised trials and observational studies that compared two or more modalities of oxygen delivery that includes high flow nasal oxygen as one of the modes with the comparator being low flow oxygen and/or non-invasive ventilation. The primary outcome is change in PaCO2 level while other clinical and patient centred outcomes will be collected. Two reviewers will independently assess studies for eligibility, data extraction and quality appraisal. We will conduct a meta-analysis and/or a narrative summary as appropriate.DiscussionHFNO is utilised extensively in clinical practice with widening indications of use. The effects of HFNO includes CO2 clearance and PEEP benefits that may be beneficial to patients with AT2RF. While current publications indicate a beneficial role, no systematic review has attempted to summarise the evidence for this indication. The results of the proposed systematic review will summarise the current evidence to guide practice, guideline development and the design of future trials.Systematic review registrationPROSPERO CRD42019148748. (https://www.crd.york.ac.uk/prospero/)

scholarly journals Efficacy and safety of Ayurveda interventions for Sinusitis: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Azeem Ahmad ◽  
Manohar S. Gundeti ◽  
Parth P. Dave ◽  
Sophia Jameela ◽  
Shruti Khanduri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Numerical Data ◽  
Small Sample ◽  
Risk Of Bias ◽  
Nasal Discharge ◽  
List Type ◽  
Efficacy And Safety ◽  
Significant Difference

ABSTRACTObjectivesTo provide a broad evaluation of the efficacy and safety of Ayurveda interventions (procedural and non-procedural) for the management of sinusitis, and also of the relative efficacy and safety of different Ayurveda therapies for Sinusitis.MethodsFive electronic databases for published research articles, three databases for the unpublished doctoral thesis, clinical trial registries, and hand searches were done till August 2020. All comparative clinical trials recruiting sinusitis patients of any age group, receiving Ayurveda intervention, regardless of forms, dosages, and ingredients, for not less than one week were included. The data extraction and the risk of bias(RoB) assessment were done by two reviewers independently.ResultsA total of 2824 records were identified, of which 09 randomized parallel arms trials met inclusion criteria. No studies were found comparing Ayurveda versus placebo or non-Ayurveda interventions. Combined Ayurveda therapy (CT) was statistically more beneficial compared with either procedural or non-procedural Ayurveda therapy alone in reducing symptoms nasal discharge (standardized MD −0.71, 95% CI −1.16 to −0.26, I2 58%, 210 participants) and headache (standardized MD −0.44, 95% CI −0.86 to −0.02, I2 56%, 218 participants), however, no significant difference was found in reducing symptoms nasal obstruction and loss of smell. No numerical data related to the safety of Ayurveda intervention was found in included trials. Because, included trials(09) were having ‘high’ to ‘unclear’ overall bias, sub-standard methodology, and heterogeneity in results, the overall findings need to be interpreted cautiously.ConclusionsAlthough individual studies appeared to produce positive results, very low certainty of total effect(downgraded twice for RoB, once for inconsistency, indirectness, and imprecision each) hindered to arrive at any conclusion regarding efficacy or safety of Ayurveda interventions for sinusitis. There is a need for well-designed-executed-reported clinical studies on clinically relevant outcomes.PROSPERO registration numberRD42018103995ARTICLE SUMMARYStrength and limitations of this studyThis is the first systematic review to provide the status of available evidence on the efficacy and safety of Ayurveda interventions for sinusitis.The search strategy was comprehensive, all the relevant sources were searched for published as well as unpublished research works.This systematic review has a broad review question, which compromises its eternal validity.The certainty of the overall effect is ‘very low’ due to ‘unclear’ to ‘high’ overall risk of bias, lack of validated outcome measures, inconsistency in results with wide CIs, small sample sizes, incomplete reporting, etc.

scholarly journals Vital Pulp Therapy in Permanent Mature Posterior Teeth with Symptomatic Irreversible Pulpitis: A Systematic Review of Treatment Outcomes

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 573
Author(s):  
João Miguel Santos ◽  
Joana F. Pereira ◽  
Andréa Marques ◽  
Diana B. Sequeira ◽  
Shimon Friedman
Keyword(s):  
Systematic Review ◽  
Root Canal ◽  
Small Sample ◽  
Risk Of Bias ◽  
Root Canal Treatment ◽  
Cochrane Library ◽  
Posterior Teeth ◽  
Pulp Therapy ◽  
Vital Pulp Therapy ◽  
Irreversible Pulpitis

Background and Objectives: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review assessed the outcomes of VPT, including partial and full pulpotomy performed with hydraulic calcium silicate cements (HCSCs) in permanent mature posterior teeth diagnosed with symptomatic irreversible pulpitis. Materials and Methods: The PRISMA guidelines were followed. The search strategy included PubMed®, EMBASE, Cochrane library and grey literature electronic databases. The quality assessment of the identified studies followed the Cochrane Collaboration Risk of Bias, ROBINS-I and Newcastle–Ottawa Scale tools. Results: The search of primary databases identified 142 articles, of which 9 randomized controlled trials and 3 prospective cohort studies were selected for review. The risk-of-bias was assessed as ‘high’ or ‘serious’, ‘fair’, and ‘low’ for three, seven and two articles, respectively. One to five years after VPT using HCSCs, the success rates mostly ranged from 78 to 90%. Based on two articles, the outcomes of the VPT and NSRCT were comparable at one and five years. Despite the necessity for the intra-operative pulp assessment in VPT procedures, the majority of the studies did not fully report on this step or on the time needed to achieve hemostasis. Small sample sizes, of under 23 teeth, were reported in three studies. Conclusions: The reviewed 12 articles reported favorable outcomes of the VPT performed with HCSCs in permanent mature posterior teeth with symptomatic irreversible pulpitis, with radiographic success in the range of 81 to 90%. Two articles suggested comparable outcomes of the VPT and root canal treatment. Universal case selection and outcome criteria needs to be established for VPT when considered as an alternative to NSRCT. This evidence supports the need for further research comparing longer-term outcomes of both of the treatment modalities.

Mortality Benefit From the Passive Leg Raise Maneuver in Guiding Resuscitation of Septic Shock Patients: A Systematic Review and Meta-Analysis of Randomized Trials

2021 ◽  
pp. 088506662110197
Author(s):  
Moosa Azadian ◽  
Suyee Win ◽  
Amir Abdipour ◽  
Carolyn Krystal Kim ◽  
H. Bryant Nguyen
Keyword(s):  
Systematic Review ◽  
Septic Shock ◽  
Fluid Resuscitation ◽  
Standard Care ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Time Interval ◽  
Eligibility Criteria ◽  
Significant Difference ◽  
Passive Leg Raise

Background: Fluid therapy plays a major role in the management of critically ill patients. Yet assessment of intravascular volume in these patients is challenging. Different invasive and non-invasive methods have been used with variable results. The passive leg raise (PLR) maneuver has been recommended by international guidelines as a means to determine appropriate fluid resuscitation. We performed this systematic review and meta-analysis to determine if using this method of volume assessment has an impact on mortality outcome in patients with septic shock. Methods: This study is a systematic review and meta-analysis. We searched available data in the MEDLINE, CINAHL, EMBASE, and CENTRAL databases from inception until October 2020 for prospective, randomized, controlled trials that compared PLR-guided fluid resuscitation to standard care in adult patients with septic shock. Our primary outcome was mortality at the longest duration of follow-up. Results: We screened 1,425 article titles and abstracts. Of the 23 full-text articles reviewed, 5 studies with 462 patients met our eligibility criteria. Odds ratios (ORs) and associated 95% confidence intervals (CIs) for mortality at the longest reported time interval were calculated for each study. Using random effects modeling, the pooled OR (95% CI) for mortality with a PLR-guided resuscitation strategy was 0.82 (0.52 -1.30). The included studies were not blinded and they ranged from having low to high risk of bias using the Cochrane Risk of Bias Tool. Conclusion: Our analysis showed there was no statistically significant difference in mortality among septic shock patients treated with PLR-guided resuscitation vs. those with standard care.

P–394 Intralipid infusion at time of embryo transfer in women with history of recurrent implantation failure: a systematic review and meta-analysis

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M P Rimmer ◽  
N Black ◽  
S Keay ◽  
S Quenby ◽  
B. H.A Wattar
Keyword(s):  
Systematic Review ◽  
Embryo Transfer ◽  
Meta Analysis ◽  
Small Sample ◽  
Risk Of Bias ◽  
Population Characteristics ◽  
Implantation Failure ◽  
Randomised Trials ◽  
Recurrent Implantation Failure ◽  
History Of

Abstract Study question What is the effectiveness of IV Intralipid (IVI) in improving pregnancy rates in women undergoing IVF with history of Recurrent implantation failure (RIF) to improve reproductive outcomes. Summary answer The evidence to support the use of IVI at the time of embryo transfer in women with RIF is limited. More RCTs are needed. What is known already: Optimising the implantation process following embryo transfer remains a clinical challenge with 10% of couples undergoing IVF affected by (RIF). Immunotherapy could help to optimise endometrial receptivity and increase the chances for successful conception in women with history of RIF. Intra-venous Intralipid (IVI), a fat-based emulsion of soybean oil, glycerine, phospholipids, egg, and polyunsaturated fatty acids, has been evaluated in several trials as a potential intervention to downregulate the uNK cells and macrophages as well as inhibit the pro-inflammatory mediators including T1 helper cells. Evidence synthesis is needed to evaluate the effectiveness of this intervention. Study design, size, duration We performed this systematic review using a prospectively registered protocol (CRD42019148517) and reported in accordance with the PRISMA guidelines. Participants/materials, setting, methods: We searched MEDLINE, EMBASE and CENTRAL for any randomised trials evaluating the use of IVI at the time of embryo transfer in women undergoing assisted conception until September 2020. We extracted data in duplicate and assessed risk of bias using the Cochrane Risk of Bias tools. We meta-analysed data using a random effect model and reported on dichotomous outcomes using risk ratio (RR) and 95% confidence interval (CI). Main results and the role of chance We included five randomised trials reporting on 843 women with an overall moderate risk of bias. All trials used 20% IVI solution at the time of embryo transfer compared to normal saline infusion or no intervention (routine care). The IVI group had a higher chance of clinical pregnancy (172 vs 119, RR 1.55, 95%CI 1.16–2.07, I2 44.2%) and live birth (132 vs 73, RR 1.83, 95%CI 1.42–2.35, I2 0%) post treatment compared to no intervention. Limitations, reasons for caution Our findings are limited by the small sample size and the variations in treatment protocols and population characteristics. Wider implications of the findings: Our meta-analysis offers an overview on the value of IVI to help women affected by RIF. Given the limitations and the quality of included trials, adopting the use of IVI a-la-carte to couples undergoing IVF remains immature. IVI should not be offered until larger RCTs demonstrate a persistent benefit. Trial registration number CRD42019148517

scholarly journals Racecadotril for acute diarrhoea in children: systematic review and meta-analyses

2015 ◽  
Vol 101 (3) ◽  
pp. 234-240 ◽  
Author(s):  
Morris Gordon ◽  
Anthony Akobeng
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Methodological Quality ◽  
Data Extraction ◽  
Meta Analysis ◽  
Acute Diarrhoea ◽  
Risk Of Bias ◽  
Duration Of Symptoms ◽  
Duration Of Illness ◽  
Significant Difference

ObjectiveRacecadotril is an antisecretory agent that can prevent fluid/electrolyte depletion from the bowel as a result of acute diarrhoea without affecting intestinal motility. An up-to-date systematic review is indicated to summarise the evidence on racecadotril for the treatment of acute diarrhoea in children.DesignA Cochrane format systematic review of randomised controlled trials (RCTs). Data extraction and assessment of methodological quality were performed independently by two reviewers. Methodological quality was assessed using the Cochrane risk of bias tool.PatientsChildren with acute diarrhoea, as defined by the primary studies.InterventionsRCTs comparing racecadotril with placebo or other interventions.Main outcome measursDuration of illness, stool output/volume and adverse events.ResultsSeven RCTs were included, five comparing racecadotril with placebo or no intervention, one with pectin/kaolin and one with loperamide. Moderate to high risk of bias was present in all studies. There was no significant difference in efficacy or adverse events between racecadotril and loperamide. A meta-analysis of three studies with 642 participants showed significantly shorter duration of symptoms with racecadotril compared with placebo (mean difference −53.48 h, 95% CI −65.64 to −41.33). A meta-analysis of five studies with 949 participants showed no significant difference in adverse events between racecadotril and placebo (risk ratio 0.99, 95% CI 0.73 to 1.34).ConclusionsThere is some evidence that racecadotril is more effective than placebo or no intervention in reducing the duration of illness and stool output in children with acute diarrhoea. However, the overall quality of the evidence is limited due to sparse data, heterogeneity and risk of bias. Racecadotril appears to be safe and well tolerated.

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