scholarly journals Comparative Efficacy and Safety of Four Different Spontaneous Breathing Trials for Weaning From Mechanical Ventilation: A Systematic Review and Network Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Li-Juan Yi ◽  
Xu Tian ◽  
Min Chen ◽  
Jin-Mei Lei ◽  
Na Xiao ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Spontaneous Breathing ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Comparative Efficacy ◽  
Icu Mortality

Background: Spontaneous breathing trial (SBT) has been used to predict the optimal time of weaning from ventilator. However, it remains controversial which trial should be preferentially selected. We aimed to compare and rank four common SBT modes including automatic tube compensation (ATC), pressure support ventilation (PSV), continuous positive airway pressure (CPAP), and T-piece among critically ill patients receiving mechanical ventilation (MV).Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify studies that investigated the comparative efficacy and safety of at least two SBT strategies among critically ill patients up to May 17, 2020. We estimated the surface under the cumulative ranking curve (SUCRA) to rank SBT techniques, and determined the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation method. Primary outcome was weaning success. Secondary outcomes were reintubation, SBT success, duration of acute care, and intensive care unit (ICU) mortality. Statistical analysis was conducted by using RevMan 5.4, Stata, and R software.Results: We enrolled 24 trials finally. Extubation success rate was significantly higher in ATC than that in T-piece (OR, 0.28; 95% CI, 0.13–0.64) or PSV (OR, 0.53; 95% CI, 0.32–0.88). For SBT success, ATC was better than other SBT techniques, with a pooled OR ranging from 0.17 to 0.42. For reintubation rate, CPAP was worse than T-piece (OR, 2.76; 95% CI, 1.08 to 7.06). No significant difference was detected between SBT modes for the length of stay in ICU or long-term weaning unit (LWU). Similar result was also found for ICU mortality between PSV and T-piece. Majority direct results were confirmed by network meta-analysis. Besides, ATC ranks at the first, first, and fourth place with a SUCRA of 91.7, 99.7, and 39.9%, respectively in increasing weaning success and SBT success and in prolonging ICU or LWU length of stay among four SBT strategies. The confidences in evidences were rated as low for most comparisons.Conclusion: ATC seems to be the optimal choice of predicting successful weaning from ventilator among critically ill patients. However, randomized controlled trials (RCTs) with high quality are needed to further establish these findings.

Rotational Bed Therapy to Prevent and Treat Respiratory Complications: A Review and Meta-Analysis

2007 ◽  
Vol 16 (1) ◽  
pp. 50-61 ◽  
Author(s):  
David R. Goldhill ◽  
Michael Imhoff ◽  
Barbara McLean ◽  
Carl Waldmann
Keyword(s):  
Mechanical Ventilation ◽  
Randomized Controlled Trials ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Convincing Evidence ◽  
Controlled Trials ◽  
Respiratory Complications ◽  
Randomized Controlled ◽  
Meta Analyses

• Background Immobility is associated with complications involving many body systems. • Objective To review the effect of rotational therapy (use of therapeutic surfaces that turn on their longitudinal axes) on prevention and/or treatment of respiratory complications in critically ill patients. • Methods Published articles evaluating prophylaxis and/or treatment were reviewed. Prospective randomized controlled trials were assessed for quality and included in meta-analyses. • Results A literature search yielded 15 nonrandomized, uncontrolled, or retrospective studies. Twenty prospective randomized controlled trials on rotational therapy were published between 1987 and 2004. Various types of beds were studied, but few details on the rotational parameters were reported. The usual control was manual turning of patients by nurses every 2 hours. One animal investigation and 12 clinical trials addressed the effectiveness of rotational therapy in preventing respiratory complications. Significant benefits were reported in the animal study and 4 of the trials. Significant benefits to patients were reported in 2 of another 4 studies focused on treatment of established complications. Researchers have examined the effects of rotational therapy on mucus transport, intrapulmonary shunt, hemodynamic effects, urine output, and intracranial pressure. Little convincing evidence is available, however, on the most effective rotation parameters (eg, degree, pause time, and amount of time per day). Meta-analysis suggests that rotational therapy decreases the incidence of pneumonia but has no effect on duration of mechanical ventilation, number of days in intensive care, or hospital mortality. • Conclusions Rotational therapy may be useful for preventing and treating respiratory complications in selected critically ill patients receiving mechanical ventilation.

scholarly journals Mucoactive agents for acute respiratory failure in the critically ill: a systematic review and meta-analysis

Thorax ◽  
2020 ◽  
Vol 75 (8) ◽  
pp. 623-631 ◽  
Author(s):  
Rohan Anand ◽  
Daniel F McAuley ◽  
Bronagh Blackwood ◽  
Chee Yap ◽  
Brenda ONeill ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomised Controlled

PurposeAcute respiratory failure (ARF) is a common cause of admission to intensive care units (ICUs). Mucoactive agents are medications that promote mucus clearance and are frequently administered in patients with ARF, despite a lack of evidence to underpin clinical decision making. The aim of this systematic review was to determine if the use of mucoactive agents in patients with ARF improves clinical outcomes.MethodsWe searched electronic and grey literature (January 2020). Two reviewers independently screened, selected, extracted data and quality assessed studies. We included trials of adults receiving ventilatory support for ARF and involving at least one mucoactive agent compared with placebo or standard care. Outcomes included duration of mechanical ventilation. Meta-analysis was undertaken using random-effects modelling and certainty of the evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation.ResultsThirteen randomised controlled trials were included (1712 patients), investigating four different mucoactive agents. Mucoactive agents showed no effect on duration of mechanical ventilation (seven trials, mean difference (MD) −1.34, 95% CI −2.97 to 0.29, I2=82%, very low certainty) or mortality, hospital stay and ventilator-free days. There was an effect on reducing ICU length of stay in the mucoactive agent groups (10 trials, MD −3.22, 95% CI −5.49 to −0.96, I2=89%, very low certainty).ConclusionOur findings do not support the use of mucoactive agents in critically ill patients with ARF. The existing evidence is of low quality. High-quality randomised controlled trials are needed to determine the role of specific mucoactive agents in critically ill patients with ARF.PROSPERO registration numberCRD42018095408.

Thrombocytopenia in critically ill patients with sepsis or septic shock: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Yuting Li ◽  
Hongxiang Li ◽  
Jianxing Guo ◽  
Dong Zhang
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Short Term ◽  
Icu Length Of Stay ◽  
Short Term Mortality

Abstract Background Thrombocytopenia is a common feature of sepsis or septic shock, but few meta-analyses have specifically evaluated prognostic importance of thrombocytopenia in patients with sepsis or septic shock. The objective of this meta-analysis was to evaluate the prognosis of thrombocytopenia in critically ill patients with sepsis or septic shock.Methods We searched the PubMed, Cochrane, and Embase databases for studies from inception to the 30th of November 2019. Prospective or retrospective cohort studies comparing thrombocytopenia to no thrombocytopenia in critically ill patients with sepsis or septic shock were included. All authors reported our primary outcome of short-term mortality(defined as ICU or 48-hour mortality) with clinically relevant secondary outcomes(ICU length of stay, rate of AKI, rate of mechanical ventilation). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI).Results Seven studies including 4243 patients were included. The results of this meta-analysis showed that the short-term mortality of thrombocytopenia group was higher than that of the no thrombocytopenia group (odds ratio [OR]=2.01;95% CI, 1.73-2.33; P<0.00001; I2=78%).In addition, compared with no thrombocytopenia group, thrombocytopenia group showed higher rate of AKI(odds ratio [OR]=1.31;95% CI, 1.03-1.66; P=0.03 I2=65%) and longer ICU length of stay(Mean difference=1.31;95% CI, 0.66-1.96; P<0.0001; I2=50%). There was no statistically significant difference in the rate of mechanical ventilation between 2 groups (odds ratio [OR]=1.24;95% CI, 0.82-1.88; P=0.30; I2=0%).Conclusions Thrombocytopenia was associated with increased short-term mortality, ICU length of stay and rate of AKI in critically ill patients with sepsis or septic shock. The analysis of secondary outcomes showed no significant difference in the rate of mechanical ventilation between the two groups. Further randomized controlled studies of thrombocytopenia are still required.

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.

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