scholarly journals Comparative efficacy of different laryngoscopes in obese patients: a systematic review and network meta-analysis

2019 ◽  
Author(s):  
Miao Liu ◽  
Zhaodi Zhang ◽  
Guiyue Wang ◽  
Yuhang Li ◽  
Kaijiang Yu ◽  
...  
Keyword(s):  
Success Rate ◽  
Web Of Science ◽  
Meta Analysis ◽  
Side Channel ◽  
Obese Patients ◽  
Intubation Time ◽  
Comparative Efficacy ◽  
Randomized Controlled ◽  
Glottic View ◽  
Study Results

Abstract Background: Due to changes in the anatomical structure of oral pharynx, increased oxygen consumption and other pathophysiological changes, the airway management of obese patients is complex. Intubation is a critical step, and it is important to choose the optimal laryngoscope. Moreover, the best type of laryngoscopes to use for this population is unclear. The aim of this study is to determine the optimal laryngoscopes for endotracheal intubation in obese patients. Methods: We searched the Cochrane, Medline, EMBASE, EBSCOhost and Web of Science databases for randomized controlled trials comparing video laryngoscopes (VLs) with direct laryngoscopes (DLs) or different brands of VLs in adults with obesity for inclusion in this study. Results: A total of 13 trials with 1264 patients were identified. VLs were associated with an increase in the first-attempt success rate (relative risk (RR) 1.11, 95% confidence interval (CI) 1.06-1.16), shorter intubation time (MD -13.19, 95% CI -25.57 to -0.81) and an improved glottic view (RR 1.24, 95% CI 1.17-1.30). No difference was observed in the incidence of any complications. In the network meta-analysis, all three types of VLs (Macintosh blade VLs, angulated blade VLs and side-channel blade VLs) were associated with an improved glottic view (RR 1.4, 95% CI 1.2-1.7; RR 1.3, 95% CI 1.2-1.5; and RR 1.2, 95% CI 1.1-1.3, respectively). Conclusions: Compared with DLs, VLs generally increased the success rate on the first-attempt, reduced the intubation time and provided a superior glottic view without increasing complications. All three types of video devices improved visualization of the glottis. Trial registration: This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO 2017: CRD42017079927. http://www.crd.york.ac.uk/PROSPERO).

scholarly journals Comparative efficacy of different laryngoscopes in obese patients: a systematic review and network meta-analysis

2019 ◽  
Author(s):  
changsong wang ◽  
Miao Liu ◽  
Zhaodi Zhang ◽  
Guiyue Wang ◽  
Yuhang Li ◽  
...  
Keyword(s):  
Success Rate ◽  
Endotracheal Intubation ◽  
Meta Analysis ◽  
Credible Interval ◽  
Side Channel ◽  
Obese Patients ◽  
Intubation Time ◽  
Randomized Controlled ◽  
Glottic View ◽  
Optimal Type

Abstract Background: The airway management of obese patients is complex, and intubation is a critical step. Therefore, it is important to choose the optimal laryngoscope. Moreover, the best type of laryngoscopes to use for this population is unclear. The aim of this study was to determine the optimal laryngoscopes for endotracheal intubation in obese patients. Methods: We searched the Cochrane, Medline, EMBASE, EBSCOhost and Web of Science databases for randomized controlled trials comparing video laryngoscopes (VLs) with direct laryngoscopes (DLs) or different brands of VLs in adults with obesity for inclusion in this study. First-attempt success rate, intubation time, glottic view and composite complications were identified in this meta-analysis. Results: A total of 13 trials with 1264 patients were identified. VLs were associated with an increase in the first-attempt success rate (relative risk (RR) 1.11, 95% confidence interval (CI) 1.06-1.16), shorter intubation time (mean difference (MD) -13.19, 95% CI -25.57 to -0.81) and an improved glottic view (RR 1.24, 95% CI 1.17-1.30). No difference was observed in the incidence of composite complications. In the network meta-analysis, all three types of VLs (Macintosh blade VLs, angulated blade VLs and side-channel blade VLs) were associated with an improved glottic view (RR 1.4, 95% credible interval (CrI) 1.2-1.7; RR 1.3, 95% CrI 1.2-1.5; and RR 1.2, 95% CrI 1.1-1.3, respectively). Conclusions: Compared with DLs, VLs generally showed advantages in obese patients requiring endotracheal intubation. Despite the composite complications, there is insufficient evidence to definitively identify the optimal type of laryngoscopes in obese patients. Angulated blade VLs reduce the complications related to intubation compared with side-channel blade VLs and conventional Macintosh DLs. Trial registration: This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO 2017: CRD42017079927. http://www.crd.york.ac.uk/PROSPERO).

scholarly journals Pre-Procedural Lumbar Neuraxial Ultrasound—A Systematic Review of Randomized Controlled Trials and Meta-Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 479
Author(s):  
Tatiana Sidiropoulou ◽  
Kalliopi Christodoulaki ◽  
Charalampos Siristatidis
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Randomized Controlled Trials ◽  
Success Rate ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Technical Failure ◽  
Obese Patients ◽  
Randomized Controlled ◽  
Meta Analyses

A pre-procedural ultrasound of the lumbar spine is frequently used to facilitate neuraxial procedures. The aim of this review is to examine the evidence sustaining the utilization of pre-procedural neuraxial ultrasound compared to conventional methods. We perform a systematic review of randomized controlled trials with meta-analyses. We search the electronic databases Medline, Cochrane Central, Science Direct and Scopus up to 1 June 2019. We include trials comparing a pre-procedural lumbar spine ultrasound to a non-ultrasound-assisted method. The primary endpoints are technical failure rate, first-attempt success rate, number of needle redirections and procedure time. We retrieve 32 trials (3439 patients) comparing pre-procedural lumbar ultrasounds to palpations for neuraxial procedures in various clinical settings. Pre-procedural ultrasounds decrease the overall risk of technical failure (Risk Ratio (RR) 0.69 (99% CI, 0.43 to 1.10), p = 0.04) but not in obese and difficult spinal patients (RR 0.53, p = 0.06) and increase the first-attempt success rate (RR 1.5 (99% CI, 1.22 to 1.86), p < 0.0001, NNT = 5). In difficult spines and obese patients, the RR is 1.84 (99% CI, 1.44 to 2.3; p < 0.0001, NNT = 3). The number of needle redirections is lower with pre-procedural ultrasounds (SMD = −0.55 (99% CI, −0.81 to −0.29), p < 0.0001), as is the case in difficult spines and obese patients (SMD = −0.85 (99% CI, −1.08 to −0.61), p < 0.0001). No differences are observed in procedural times. Ιn conclusion, a pre-procedural ultrasound provides significant benefit in terms of technical failure, number of needle redirections and first attempt-success rate. Τhe effect of pre-procedural ultrasound scanning of the lumbar spine is more significant in a subgroup analysis of difficult spines and obese patients.

scholarly journals Efficacy and Safety of Video-Laryngoscopy versus Direct Laryngoscopy for Double-Lumen Endotracheal Intubation: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (23) ◽  
pp. 5524
Author(s):  
Katarzyna Karczewska ◽  
Szymon Bialka ◽  
Jacek Smereka ◽  
Maciej Cyran ◽  
Grazyna Nowak-Starz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Success Rate ◽  
Endotracheal Intubation ◽  
Meta Analysis ◽  
Video Laryngoscopy ◽  
Intubation Attempt ◽  
Intubation Time ◽  
Double Lumen ◽  
Glottic View ◽  
Lehane Grade

The available meta-analyses have inconclusively indicated the advantages of video-laryngoscopy (VL) in different clinical situations; therefore, we conducted a systematic review and meta-analysis to determine efficacy outcomes such as successful first attempt or time to perform endotracheal intubation as well as adverse events of VL vs. direct laryngoscopes (DL) for double-lumen intubation. First intubation attempt success rate was 87.9% for VL and 84.5% for DL (OR = 1.64; 95% CI: 0.95 to 2.86; I2 = 61%; p = 0.08). Overall success rate was 99.8% for VL and 98.8% for DL, respectively (OR = 3.89; 95%CI: 0.95 to 15.93; I2 = 0; p = 0.06). Intubation time for VL was 43.4 ± 30.4 s compared to 54.0 ± 56.3 s for DL (MD = −11.87; 95%CI: −17.06 to −6.68; I2 = 99%; p < 0.001). Glottic view based on Cormack–Lehane grades 1 or 2 equaled 93.1% and 88.1% in the VL and DL groups, respectively (OR = 3.33; 95% CI: 1.18 to 9.41; I2 = 63%; p = 0.02). External laryngeal manipulation was needed in 18.4% cases of VL compared with 42.8% for DL (OR = 0.28; 95% CI: 0.20 to 0.40; I2 = 69%; p < 0.001). For double-lumen intubation, VL offers shorter intubation time, better glottic view based on Cormack–Lehane grade, and a lower need for ELM, but comparable first intubation attempt success rate and overall intubation success rate compared with DL.

scholarly journals Comparative Efficacy of Antifungal Agents Used in the Treatment of Oropharyngeal Candidiasis among HIV-Infected Adults: A Systematic Review and Network Meta-Analysis

2021 ◽  
Vol 7 (8) ◽  
pp. 637
Author(s):  
Shamala Gopal Rajadurai ◽  
Mari Kannan Maharajan ◽  
Sajesh K. Veettil ◽  
Divya Gopinath
Keyword(s):  
Antifungal Agents ◽  
Meta Analysis ◽  
Oropharyngeal Candidiasis ◽  
Mycological Cure ◽  
Comparative Efficacy ◽  
Assessment Development ◽  
Randomized Controlled ◽  
Favorable Safety ◽  
Grade Approach

The objective of this study was to assess the comparative efficacy and safety of different antifungal agents used for the treatment of oropharyngeal candidiasis (OPC) in adult patients with HIV. A systematic search was performed on the four major databases (Medline, Embase, CENTRAL and Scopus) to identify randomized controlled trials (RCTs) that evaluated the efficacy of antifungal agents in HIV patients with OPC. A network meta-analysis was performed from the data extracted from the selected studies. The agents were ranked according using surface under the cumulative ranking (SUCRA). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of evidence. A total of 15 trials were included in the quantitative analysis involving the data from a total of 2883 participants. Fluconazole was ranked as the most effective antifungal agent to achieve clinical cure (SUCRA = 0.87) in OPC followed by posaconazole and itraconazole. Posaconazole was ranked the most efficacious agent in achieving mycological cure (SUCRA = 0.81), followed by fluconazole. While nystatin was ranked the safest, the effect estimates of none of the other systemic antifungal agents were significantly higher than fluconazole. Based on the available evidence, fluconazole can be considered as the most effective drug in the treatment of OPC among HIV-infected adults and has a favorable safety profile, followed by posaconazole.

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