scholarly journals Efficacy of Non-Invasive and Invasive Respiratory Managements in Adult Patients with Acute Hypoxaemic Respiratory Failure: A Systematic Review and Network Meta-Analysis

2021 ◽  
Author(s):  
Masaaki Sakuraya ◽  
Hiromu Okano ◽  
Tomoyuki Masuyama ◽  
Shunsuke Kimata ◽  
Satoshi Hokari
Keyword(s):  
Lower Risk ◽  
De Novo ◽  
Meta Analysis ◽  
Non Invasive ◽  
Risk Of Mortality ◽  
Non Invasive Ventilation ◽  
Respiratory Management ◽  
Short Term Mortality ◽  
Ventilation Modes ◽  
Meta Analyses

Abstract Background: Although non-invasive respiratory managements are preformed to avoid intubation, patients with de novo acute hypoxaemic respiratory failure (AHRF) are high risk for treatment failure. Choosing the most effective primary respiratory management for adults with de novo AHRF is a complex problem. In the previous meta-analyses, the effect of non-invasive ventilation was not sufficiently evaluated according to ventilation modes in patients with AHRF. Furthermore, no meta-analyses comparing non-invasive respiratory managements with invasive mechanical ventilation (IMV) have been reported. We performed a network meta-analysis to compare the efficacy of non-invasive ventilation according to ventilation modes with high-flow nasal oxygen (HFNO), standard oxygen therapy (SOT), and IMV in adult patients with AHRF.Methods: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults with AHRF and randomised controlled trials comparing two different respiratory managements (continuous positive airway pressure [CPAP], pressure support ventilation [PSV], HFNO, SOT, or IMV) were reviewed. A network meta-analysis was performed via a frequentist approach with a multivariate random-effects meta-analysis. The certainty of evidence was assessed based on the Grades of Recommendation, Assessment, Development and Evaluation Working Group approach. The primary outcome was short-term mortality.Results: Using SOT as the reference, CPAP (risk ratio [RR], 0.55; 95% confidence interval [CI], 0.31–0.95; very low certainty) was significantly associated with a lower risk of mortality. Compared with SOT, PSV (RR, 0.81; 95% CI, 0.62–1.06; low certainty) and HFNO (RR, 0.90; 95% CI, 0.65–1.25; very low certainty) were not associated with a significantly lower risk of mortality. Compared with IMV, no non-invasive respiratory management was associated with a significantly lower risk of mortality, although all certainties of evidence were very low. The probability of being best in reducing short-term mortality among all possible interventions was higher for CPAP, followed by PSV and HFNO; IMV and SOT were tied for the worst.Conclusions: Our findings imply that CPAP may be the most effective strategy as the primary non-invasive respiratory management for AHRF to avoid unnecessary pressure support. Trial registration: protocols.io (Protocol integer ID 49375, April 23, 2021). dx.doi.org/10.17504/protocols.io.buf7ntrn.

scholarly journals Efficacy of non-invasive and invasive respiratory management strategies in adult patients with acute hypoxaemic respiratory failure: a systematic review and network meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Masaaki Sakuraya ◽  
Hiromu Okano ◽  
Tomoyuki Masuyama ◽  
Shunsuke Kimata ◽  
Satoshi Hokari
Keyword(s):  
Lower Risk ◽  
De Novo ◽  
Meta Analysis ◽  
Management Strategies ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Risk Of Mortality ◽  
Non Invasive Ventilation ◽  
Respiratory Management ◽  
Ventilation Modes

Abstract Background Although non-invasive respiratory management strategies have been implemented to avoid intubation, patients with de novo acute hypoxaemic respiratory failure (AHRF) are high risk of treatment failure. In the previous meta-analyses, the effect of non-invasive ventilation was not evaluated according to ventilation modes in those patients. Furthermore, no meta-analyses comparing non-invasive respiratory management strategies with invasive mechanical ventilation (IMV) have been reported. We performed a network meta-analysis to compare the efficacy of non-invasive ventilation according to ventilation modes with high-flow nasal oxygen (HFNO), standard oxygen therapy (SOT), and IMV in adult patients with AHRF. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults with AHRF and randomized controlled trials (RCTs) comparing two different respiratory management strategies (continuous positive airway pressure (CPAP), pressure support ventilation (PSV), HFNO, SOT, or IMV) were reviewed. Results We included 25 RCTs (3,302 participants: 27 comparisons). Using SOT as the reference, CPAP (risk ratio [RR] 0.55; 95% confidence interval [CI] 0.31–0.95; very low certainty) was associated significantly with a lower risk of mortality. Compared with SOT, PSV (RR 0.81; 95% CI 0.62–1.06; low certainty) and HFNO (RR 0.90; 95% CI 0.65–1.25; very low certainty) were not associated with a significantly lower risk of mortality. Compared with IMV, no non-invasive respiratory management was associated with a significantly lower risk of mortality, although all certainties of evidence were very low. The probability of being best in reducing short-term mortality among all possible interventions was higher for CPAP, followed by PSV and HFNO; IMV and SOT were tied for the worst (surface under the cumulative ranking curve value: 93.2, 65.0, 44.1, 23.9, and 23.9, respectively). Conclusions When performing non-invasive ventilation among patients with de novo AHRF, it is important to avoid excessive tidal volume and lung injury. Although pressure support is needed for some of these patients, it should be applied with caution because this may lead to excessive tidal volume and lung injury. Trial registration protocols.io (Protocol integer ID 49375, April 23, 2021). 10.17504/protocols.io.buf7ntrn.

scholarly journals Efficacy and Safety of Hydroxychloroquine for Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (11) ◽  
pp. 2503
Author(s):  
Adrian V. Hernandez ◽  
Mi T. Phan ◽  
Jonathon Rocco ◽  
Vinay Pasupuleti ◽  
Joshuan J. Barboza ◽  
...  
Keyword(s):  
Adverse Events ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Serious Adverse Events ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Inverse Variance ◽  
Secondary Outcomes ◽  
Meta Analyses

We systematically reviewed the efficacy and safety of hydroxychloroquine as treatment for hospitalized COVID-19. Randomized controlled trials (RCTs) evaluating hydroxychloroquine as treatment for hospitalized COVID-19 patients were searched until 2nd of December 2020. Primary outcomes were all-cause mortality, need of mechanical ventilation, need of non-invasive ventilation, ICU admission and oxygen support at 14 and 30 days. Secondary outcomes were clinical recovery and worsening, discharge, radiological progression of pneumonia, virologic clearance, serious adverse events (SAE) and adverse events. Inverse variance random effects meta-analyses were performed. Thirteen RCTs (n=18,540) were included. Hydroxychloroquine total doses ranged between 2000 and 12,400 mg; treatment durations were from 5 to 16 days and follow up times between 5 and 30 days. Compared to controls, hydroxychloroquine non-significantly increased mortality at 14 days (RR 1.07, 95%CI 0.92–1.25) or 30 days (RR 1.08, 95%CI 1.00–1.16). Hydroxychloroquine did not affect other primary or secondary outcomes, except SAEs that were significantly higher than the control (RR 1.24, 95%CI 1.05–1.46). Eleven RCTs had high or some concerns of bias. Subgroup analyses were consistent with main analyses. Hydroxychloroquine was not efficacious for treating hospitalized COVID-19 patients and caused more severe adverse events. Hydroxychloroquine should not be recommended as treatment for hospitalized COVID-19 patients.

scholarly journals Sarcopenia Is Associated with Mortality in Adults: A Systematic Review and Meta-Analysis

Gerontology ◽  
2021 ◽  
pp. 1-16
Author(s):  
Jane Xu ◽  
Ching S. Wan ◽  
Kiriakos Ktoris ◽  
Esmee M. Reijnierse ◽  
Andrea B. Maier
Keyword(s):  
Systematic Review ◽  
Working Group ◽  
Meta Analysis ◽  
Nursing Home Residents ◽  
Community Dwelling ◽  
Risk Of Mortality ◽  
European Working ◽  
Subgroup Analyses ◽  
Meta Analyses

<b><i>Background:</i></b> Sarcopenia can predispose individuals to falls, fractures, hospitalization, and mortality. The prevalence of sarcopenia depends on the population studied and the definition used for the diagnosis. <b><i>Objective:</i></b> This systematic review and meta-analysis aimed to investigate the association between sarcopenia and mortality and if it is dependent on the population and sarcopenia definition. <b><i>Methods:</i></b> A systematic search was conducted in MEDLINE, EMBASE, and Cochrane from 1 January 2010 to 6 April 2020 for articles relating to sarcopenia and mortality. Articles were included if they met the following criteria – cohorts with a mean or median age ≥18 years and either of the following sarcopenia definitions: Asian Working Group for Sarcopenia (AWGS and AWGS2019), European Working Group on Sarcopenia in Older People (EWGSOP and EWGSOP2), Foundation for the National Institutes of Health (FNIH), International Working Group for Sarcopenia (IWGS), or Sarcopenia Definition and Outcomes Consortium (SDOC). Hazard ratios (HR) and odds ratios (OR) were pooled separately in meta-analyses using a random-effects model, stratified by population (community-dwelling adults, outpatients, inpatients, and nursing home residents). Subgroup analyses were performed for sarcopenia definition and follow-up period. <b><i>Results:</i></b> Out of 3,025 articles, 57 articles were included in the systematic review and 56 in the meta-analysis (42,108 participants, mean age of 49.4 ± 11.7 to 86.6 ± 1.0 years, 40.3% females). Overall, sarcopenia was associated with a significantly higher risk of mortality (HR: 2.00 [95% CI: 1.71, 2.34]; OR: 2.35 [95% CI: 1.64, 3.37]), which was independent of population, sarcopenia definition, and follow-up period in subgroup analyses. <b><i>Conclusions:</i></b> Sarcopenia is associated with a significantly higher risk of mortality, independent of population and sarcopenia definition, which highlights the need for screening and early diagnosis in all populations.

scholarly journals Non-Invasive Ventilation Strategies in Children With Acute Lower Respiratory Infection: A Systematic Review and Bayesian Network Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Zhili Wang ◽  
Yu He ◽  
Xiaolong Zhang ◽  
Zhengxiu Luo
Keyword(s):  
Treatment Failure ◽  
Airway Pressure ◽  
Lower Risk ◽  
Oxygen Therapy ◽  
Positive Airway Pressure ◽  
Supplemental Oxygen ◽  
Acute Lower Respiratory Infection ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Background: Multiple non-invasive ventilation (NIV) modalities have been identified that may improve the prognosis of pediatric patients with acute lower respiratory infection (ALRI). However, the effect of NIV in children with ALRI remains inconclusive. Hence, this study aimed to evaluate the efficacy of various NIV strategies including continuous positive airway pressure (CPAP), high flow nasal cannula (HFNC), bilevel positive airway pressure (BIPAP), and standard oxygen therapy in children with ALRI and the need for supplemental oxygen.Methods: Embase, PubMed, Cochrane Library, and Web of Science databases were searched from inception to July 2021. Randomized controlled trials (RCTs) that compared different NIV modalities for children with ALRI and the need for supplemental oxygen were included. Data were independently extracted by two reviewers. Primary outcomes were intubation and treatment failure rates. Secondary outcome was in-hospital mortality. Pairwise and Bayesian network meta-analyses within the random-effects model were used to synthesize data. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework.Results: A total of 21 RCTs involving 5,342 children were included. Compared with standard oxygen therapy, CPAP (OR: 0.40, 95% CrI: 0.16–0.90, moderate quality) was associated with a lower risk of intubation. Furthermore, both CPAP (OR: 0.42, 95% CrI: 0.19–0.81, low quality) and HFNC (OR: 0.51, 95% CrI: 0.29–0.81, low quality) reduced treatment failure compared with standard oxygen therapy. There were no significant differences among all interventions for in-hospital mortality. Network meta-regression showed that there were no statistically significant subgroup effects.Conclusion: Among children with ALRI and the need for supplemental oxygen, CPAP reduced the risk of intubation when compared to standard oxygen therapy. Both CPAP and HFNC were associated with a lower risk of treatment failure than standard oxygen therapy. However, evidence is still lacking to show benefits concerning mortality between different interventions. Further large-scale, multicenter studies are needed to confirm our results.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=172156, identifier: CRD42020172156.

scholarly journals The protective association between statins use and adverse outcomes among COVID-19 patients: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Ronald Chow ◽  
James Im ◽  
Nicholas Chiu ◽  
Leonard Chiu ◽  
Rahul Aggarwal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Odds Ratio ◽  
Lower Risk ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Risk Of Mortality ◽  
Before And After ◽  
Statin Usage ◽  
Similar Risk ◽  
Ventilation Studies

ABSTRACTIntroductionStatins may reduce a cytokine storm, which has been hypothesized as a possible mechanism of severe COVID-19 pneumonia. The aim of this study was to conduct a systematic review and meta-analysis to report on adverse outcomes among COVID-19 patients by statin usage.MethodsLiteratures were searched from January 2019 to December 2020 to identify studies that reported the association between statin usage and adverse outcomes, including mortality, ICU admissions, and mechanical ventilation. Studies were meta-analyzed for mortality by the subgroups of ICU status and statin usage before and after COVID-19 hospitalization. Studies reporting an odds ratio (OR) and hazard ratio (HR) were analyzed separately.ResultsThirteen cohorts, reporting on 110,078 patients, were included in this meta-analysis. Individuals who used statins before their COVID-19 hospitalization showed a similar risk of mortality, compared to those who did not use statins (HR 0.80, 95% CI: 0.50, 1.28; OR 0.62, 95% CI: 0.38, 1.03). Patients who were administered statins after their COVID-19 diagnosis were at a lower risk of mortality (HR 0.53, 95% CI: 0.46, 0.61; OR 0.57, 95% CI: 0.43, 0.75). The use of statins did not reduce the mortality of COVID-19 patients admitted to the ICU (OR 0.65; 95% CI: 0.26, 1.64). Among non-ICU patients, statin users were at a lower risk of mortality relative to non-statin users (HR 0.53, 95% CI: 0.46, 0.62; OR 0.64, 95% CI: 0.46, 0.88).ConclusionPatients administered statins after COVID-19 diagnosis or non-ICU admitted patients were at lower risk of mortality relative to non-statin users.

Acute severe asthma

2020 ◽  
pp. 55-66
Author(s):  
Andrew Nyman ◽  
Andrew Durward
Keyword(s):  
Severe Asthma ◽  
Airway Resistance ◽  
Acute Severe Asthma ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Risk Of Mortality ◽  
Non Invasive Ventilation ◽  
Ventilation Strategies ◽  
Outcomes For Children ◽  
Induction Of Anaesthesia

Children with acute severe asthma requiring invasive ventilation are among the most difficult to manage in the Intensive Care Unit (ICU). This chapter begins by explaining the pathophysiology of asthma before examining the approaches to its management on the ICU—starting with the evidence for the use of non-invasive ventilation and bronchodilators. Indications for invasive ventilation in acute severe asthma are discussed and important considerations in the conduct of induction of anaesthesia and intubation in this patient group. Ventilation strategies are explored, with particular reference to the concepts of airway resistance, driving pressure, inspiratory flow limitation, and auto-positive end expiratory pressure (PEEP). The use of the mucolytic therapy intratracheal DNAse is discussed, and indications for the use of extracorporeal membrane oxygenation in refractory cases. Finally, the chapter reports on outcomes for children with acute severe asthma and factors associated with higher risk of mortality.

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