Safety of Albumin and Hydroxyethyl Starch as Priming Fluid for Cardiopulmonary Bypass in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Abstract Introduction: Hydroxyethyl starch (HES) has been widely used for volume expansion, but its safety as priming fluid for cardiopulmonary bypass has been questioned recently. The aim of this meta-analysis is to compare the safety of albumin and hydroxyethyl starch as priming fluid for cardiopulmonary bypass.Methods: Pubmed, Embase database and Cochrane Library were searched for randomized controlled trials (RCTs) involving patients who received HES or albumin as priming fluid for cardiopulmonary bypass in cardiac surgery published up to October 2019. Two reviewers independently extracted the valid data, including the length of ICU stay, ventilator time, the length of hospital stay, crystal volume, fresh frozen plasma, platelet input, blood loss, blood platelet count. hemoglobin value, fibrin, APTT, PT, urea, creatinine and urine volume. Meta-analysis was performed with revman version 5.3. Results: Total 9 RCTs involving 452 patients were included in this meta-analysis. Compared with albumin, HES had similar effects on the length of ICU stay(MD = 0.70；95%CI：-0.14 to 1.55；P = 0.10；I2 = 89%);ventilation time(MD = 2.31 ;95%CI-3.93 to 8.55;P = 0.47,I2 = 60%); the length of hospital stay(MD = -0.31;95% CI:-2.00 to 1.37; P = 0.71 ;I2 = 0%); crystal volume(SMD = 0.26;95% CI:-0.09 to 0.61; P = 0.15;I2 = 0%); fresh frozen plasma(SMD = 0.25；95%CI：-0.08 to 0.59；P = 0.66；I2 =0%); platelet input(SMD =-0.17;95% Cl:-0.59 to 0.26;P =0.45;I2 = 0%);blood loss (SMD =0.31;95% Cl:-0.01 to 0.63;P = 0.06;I2 =29%);platelet count (SMD =-0.21;95% cl :-0.54 to 0.11; P = 0.20;I2 = 29% );hemoglobin value(SMD =0.1;95% CI: -0.15 to 0.36;P = 0.42; I2 = 0% ); fibrin (SMD =0.12;95% CI: -0.19 to 0.44 ; P = 0.45; I2 = 0% );APTT(MD =1.13;95% CI: -2.06 to 4.32 ; P = 0.49; I2 = 0%);PT(MD =0.10;95% CI: -0.21 to 0.40,P = 0.52; I2 = 0%);creatinine(SMD =0.09;95% CI: -0.32 to 0.50 ; P = 0.66; I2 = 51% );urine volume(SMD =0.11;95% CI: -0.26 to 0.48 ; P = 0.55; I2 = 43% ).but did not increase urea (SMD =-0.46;95% CI: -0.81 to -0.11; P = 0.01; I2 = 0%).Conclusions: HES was safe and effective compared to albumin as priming fluid for cardiopulmonary bypass because it did not affect renal function, coagulation function, liquid input, or the length of ICU stay and ventilation time of patients.

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

Journal of Intensive Care ◽

10.1186/s40560-020-00487-8 ◽

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.

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Failure of Prophylaxis with Fresh Frozen Plasma after Cardiopulmonary Bypass

Anesthesiology ◽

10.1097/00000542-198808000-00017 ◽

1988 ◽

Vol 69 (2) ◽

pp. 254-256 ◽

Cited By ~ 12

Author(s):

RAYMOND C. ROY ◽

MICHAEL A. STAFFORD ◽

ALLEN S. HUDSPETH ◽

WAYNE MEREDITH

Keyword(s):

Cardiopulmonary Bypass ◽

Fresh Frozen Plasma ◽

Fresh Frozen ◽

Frozen Plasma

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Effect of hydroxyethyl starch on bleeding after cardiopulmonary bypass: A meta-analysis of randomized trials

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2012.04.009 ◽

2012 ◽

Vol 144 (1) ◽

pp. 223-230.e5 ◽

Cited By ~ 86

Author(s):

Roberta J. Navickis ◽

Gary R. Haynes ◽

Mahlon M. Wilkes

Keyword(s):

Cardiopulmonary Bypass ◽

Hydroxyethyl Starch ◽

Randomized Trials ◽

Meta Analysis

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Clinical evaluation of two adult oxygenator systems in terms of mortality and major adverse events

Perfusion ◽

10.1177/02676591211063830 ◽

2021 ◽

pp. 026765912110638

Author(s):

Hüsnü Kamil Limandal ◽

Mehmet Ali Kayğın ◽

Servet Ergün ◽

Taha Özkara ◽

Mevriye Serpil Diler ◽

...

Keyword(s):

Adverse Events ◽

Hospital Stay ◽

Artery Bypass ◽

Length Of Hospital Stay ◽

Fresh Frozen Plasma ◽

Wound Complications ◽

Significant Difference ◽

Delayed Sternal Closure ◽

Fresh Frozen ◽

Major Adverse Events

Purpose The primary aim of this study was to examine the effects of two oxygenator systems on major adverse events and mortality. Methods A total of 181 consecutive patients undergoing coronary artery bypass grafting in our clinic were retrospectively analyzed. The patients were divided into two groups according to the oxygenator used: Group M, in which a Medtronic Affinity (Medtronic Operational Headquarters, Minneapolis, MN, USA) oxygenator was used, and Group S, in which a Sorin Inspire (Sorin Group Italia, Mirandola, Italy) oxygenator was used. Results Group S consisted of 89 patients, whereas Group M included 92 patients. No statistically significant differences were found between the two groups in terms of age ( p = .112), weight ( p = .465), body surface area ( p = .956), or gender ( p = .484). There was no statistically significant difference in hemorrhage on the first or second postoperative day ( p = .318 and p = .455, respectively). No statistically significant differences were observed in terms of red blood cell ( p = .468), fresh frozen plasma ( p = .116), or platelet concentrate transfusion ( p = .212). Infections, wound complications, and delayed sternal closure were significantly more common in Group M ( p = .006, p = .023, and p = .019, respectively). Extracorporeal membrane oxygenators and intra-aortic balloon pumps were required significantly more frequently in Group S ( p = .025 and p = .013, respectively). Major adverse events occurred in 16 (18%) patients in Group S and 14 (15.2%) patients in Group M ( p = .382). Mortality was observed in six (6.7%) patients in Group S and three (3.3%) patients in Group M ( p = .232). No statistically significant difference was found between the two groups in terms of length of hospital stay ( p = .451). Conclusion The clinical outcomes of the two oxygenator systems, including mortality, major adverse events, hemorrhage, erythrocyte and platelet transfusions, and length of hospital stay, were similar.

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Pro: Priming the Cardiopulmonary Bypass Circuit with Fresh Frozen Plasma Reduces Bleeding in Complex Cardiac Surgery

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2021.05.020 ◽

2021 ◽

Author(s):

Jared Roberts ◽

Daniel Tolpin

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Fresh Frozen Plasma ◽

Fresh Frozen ◽

Frozen Plasma

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

Nepal Journal of Neuroscience ◽

10.3126/njn.v15i1.20022 ◽

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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Prothrombin Complex Concentrates are Superior to Fresh Frozen Plasma for Emergency Reversal of Vitamin K Antagonists: A Meta-Analysis in 2606 Subjects

Drugs ◽

10.1007/s40265-019-01179-w ◽

2019 ◽

Vol 79 (14) ◽

pp. 1557-1565 ◽

Cited By ~ 1

Author(s):

Robert Hill ◽

Thang S. Han ◽

Irina Lubomirova ◽

Nikhil Math ◽

Paul Bentley ◽

...

Keyword(s):

Vitamin K ◽

Meta Analysis ◽

Vitamin K Antagonists ◽

Fresh Frozen Plasma ◽

Prothrombin Complex Concentrates ◽

Fresh Frozen ◽

Frozen Plasma

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Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis

Nutrients ◽

10.3390/nu11040708 ◽

2019 ◽

Vol 11 (4) ◽

pp. 708 ◽

Cited By ~ 53

Author(s):

Harri Hemilä ◽

Elizabeth Chalker

Keyword(s):

Mechanical Ventilation ◽

Length Of Stay ◽

Vitamin C ◽

Meta Analysis ◽

Kidney Injury ◽

Practical Significance ◽

Controlled Trials ◽

Elective Cardiac Surgery ◽

Icu Stay ◽

Length Of Icu Stay

A number of controlled trials have previously found that in some contexts, vitamin C can have beneficial effects on blood pressure, infections, bronchoconstriction, atrial fibrillation, and acute kidney injury. However, the practical significance of these effects is not clear. The purpose of this meta-analysis was to evaluate whether vitamin C has an effect on the practical outcomes: length of stay in the intensive care unit (ICU) and duration of mechanical ventilation. We identified 18 relevant controlled trials with a total of 2004 patients, 13 of which investigated patients undergoing elective cardiac surgery. We carried out the meta-analysis using the inverse variance, fixed effect options, using the ratio of means scale. In 12 trials with 1766 patients, vitamin C reduced the length of ICU stay on average by 7.8% (95% CI: 4.2% to 11.2%; p = 0.00003). In six trials, orally administered vitamin C in doses of 1–3 g/day (weighted mean 2.0 g/day) reduced the length of ICU stay by 8.6% (p = 0.003). In three trials in which patients needed mechanical ventilation for over 24 hours, vitamin C shortened the duration of mechanical ventilation by 18.2% (95% CI 7.7% to 27%; p = 0.001). Given the insignificant cost of vitamin C, even an 8% reduction in ICU stay is worth exploring. The effects of vitamin C on ICU patients should be investigated in more detail.

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