Comprehensive Comparisons among Inotropic Agents on Mortality and Risk of Renal Dysfunction in Patients Who Underwent Cardiac Surgery: A Network Meta-Analysis of Randomized Controlled Trials

Several kinds of inotropes have been used in critically ill patients to improve hemodynamics and renal dysfunction after cardiac surgery; however, the treatment strategies for reducing mortality and increasing renal protection in patients who underwent cardiac surgery remain controversial. Therefore, we performed a comprehensive network meta-analysis to overcome the lack of head-to-head comparisons. A systematic database was searched up to 31 December 2020, for randomized controlled trials that compared different inotropes on mortality outcomes and renal protective effects after cardiac surgery. A total of 29 trials were included and a frequentist network meta-analysis was performed. Inconsistency analyses, publication bias, and subgroup analyses were also conducted. Compared with placebo, use of levosimendan significantly decreased the risks of mortality (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.56–0.97) and risk of acute renal injury (OR: 0.61; 95% CI: 0.45–0.82), especially in low systolic function patients. Use of levosimendan also ranked the best treatment based on the P-score (90.1%), followed by placebo (64.5%), milrinone (49.6%), dopamine (49.5%), dobutamine (29.1%), and fenoldopam (17.0%). Taking all the available data into consideration, levosimendan was a safe renal-protective choice for the treatment of patients undergoing cardiac surgery, especially for those with low systolic function.

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Faculty Opinions recommendation of Remifentanil in cardiac surgery: a meta-analysis of randomized controlled trials.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717978052.793470960 ◽

2013 ◽

Author(s):

Michael Irwin

Keyword(s):

Cardiac Surgery ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled

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Strategies to Prevent Acute Kidney Injury after Pediatric Cardiac Surgery

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.05800421 ◽

2021 ◽

Vol 16 (10) ◽

pp. 1480-1490

Author(s):

Jef Van den Eynde ◽

Nicolas Cloet ◽

Robin Van Lerberghe ◽

Michel Pompeu B.O. Sá ◽

Dirk Vlasselaers ◽

...

Keyword(s):

Cardiac Surgery ◽

Randomized Controlled Trials ◽

Ischemic Preconditioning ◽

Relative Risk Reduction ◽

Meta Analysis ◽

Pediatric Cardiac Surgery ◽

Remote Ischemic Preconditioning ◽

Controlled Trials ◽

Content Type ◽

Randomized Controlled

Background and objectivesAKI is a common complication after pediatric cardiac surgery and has been associated with higher morbidity and mortality. We aimed to compare the efficacy of available pharmacologic and nonpharmacologic strategies to prevent AKI after pediatric cardiac surgery.Design, setting, participants, & measurementsPubMed/MEDLINE, Embase, Cochrane Controlled Trials Register, and reference lists of relevant articles were searched for randomized controlled trials from inception until August 2020. Random effects traditional pairwise, Bayesian network meta-analyses, and trial sequential analyses were performed.ResultsTwenty randomized controlled trials including 2339 patients and 11 preventive strategies met the eligibility criteria. No overall significant differences were observed compared with control for corticosteroids, fenoldopam, hydroxyethyl starch, or remote ischemic preconditioning in traditional pairwise meta-analysis. In contrast, trial sequential analysis suggested a 80% relative risk reduction with dexmedetomidine and evidence of <57% relative risk reduction with remote ischemic preconditioning. Nonetheless, the network meta-analysis was unable to demonstrate any significant differences among the examined treatments, including also acetaminophen, aminophylline, levosimendan, milrinone, and normothermic cardiopulmonary bypass. Surface under the cumulative ranking curve probabilities showed that milrinone (76%) was most likely to result in the lowest risk of AKI, followed by dexmedetomidine (70%), levosimendan (70%), aminophylline (59%), normothermic cardiopulmonary bypass (57%), and remote ischemic preconditioning (55%), although all showing important overlap.ConclusionsCurrent evidence from randomized controlled trials does not support the efficacy of most strategies to prevent AKI in the pediatric population, apart from limited evidence for dexmedetomidine and remote ischemic preconditioning.

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Dexmedetomidine prevents acute kidney injury after adult cardiac surgery: a meta-analysis of randomized controlled trials

BMC Anesthesiology ◽

10.1186/s12871-018-0472-1 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 26

Author(s):

Yang Liu ◽

Bo Sheng ◽

Suozhu Wang ◽

Feiping Lu ◽

Jie Zhen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Kidney Injury ◽

Controlled Trials ◽

Randomized Controlled ◽

Adult Cardiac Surgery

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Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.601470 ◽

2021 ◽

Vol 8 ◽

Author(s):

Zigang Liu ◽

Yongmei Zhao ◽

Ming Lei ◽

Guancong Zhao ◽

Dongcheng Li ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Randomized Controlled Trials ◽

Ischemic Preconditioning ◽

Meta Analysis ◽

Kidney Injury ◽

Controlled Trials ◽

Randomized Controlled ◽

Subgroup Analyses ◽

Meta Regression

Objective: Randomized controlled trials (RCTs) evaluating the influence of remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) after cardiac surgery showed inconsistent results. We performed a meta-analysis to evaluate the efficacy of RIPC on AKI after cardiac surgery.Methods: Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model was used to pool the results. Meta-regression and subgroup analyses were used to determine the source of heterogeneity.Results: Twenty-two RCTs with 5,389 patients who received cardiac surgery −2,702 patients in the RIPC group and 2,687 patients in the control group—were included. Moderate heterogeneity was detected (p for Cochrane's Q test = 0.03, I2 = 40%). Pooled results showed that RIPC significantly reduced the incidence of AKI compared with control [odds ratio (OR): 0.76, 95% confidence intervals (CI): 0.61–0.94, p = 0.01]. Results limited to on-pump surgery (OR: 0.78, 95% CI: 0.64–0.95, p = 0.01) or studies with acute RIPC (OR: 0.78, 95% CI: 0.63–0.97, p = 0.03) showed consistent results. Meta-regression and subgroup analyses indicated that study characteristics, including study design, country, age, gender, diabetic status, surgery type, use of propofol or volatile anesthetics, cross-clamp time, RIPC protocol, definition of AKI, and sample size did not significantly affect the outcome of AKI. Results of stratified analysis showed that RIPC significantly reduced the risk of mild-to-moderate AKI that did not require renal replacement therapy (RRT, OR: 0.76, 95% CI: 0.60–0.96, p = 0.02) but did not significantly reduce the risk of severe AKI that required RRT in patients after cardiac surgery (OR: 0.73, 95% CI: 0.50–1.07, p = 0.11).Conclusions: Current evidence supports RIPC as an effective strategy to prevent AKI after cardiac surgery, which seems to be mainly driven by the reduced mild-to-moderate AKI events that did not require RRT. Efforts are needed to determine the influences of patient characteristics, procedure, perioperative drugs, and RIPC protocol on the outcome.

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Network Meta-Analysis of Different Clinical Commonly Used Drugs for the Treatment of Hypertrophic Scar and Keloid

Frontiers in Medicine ◽

10.3389/fmed.2021.691628 ◽

2021 ◽

Vol 8 ◽

Author(s):

Sha Yang ◽

Yujia J. Luo ◽

Cong Luo

Keyword(s):

Clinical Trials ◽

Randomized Controlled Trials ◽

Topical Treatment ◽

Hypertrophic Scar ◽

Meta Analysis ◽

Treatment Strategies ◽

Controlled Trials ◽

Cochrane Central Register ◽

Randomized Controlled ◽

Silicone Gels

Background: There is no uniform treatment for pathological scars, including keloids and hypertrophic scars, in clinic currently. Previously, multiple randomized controlled trials have examined the clinical efficacy of different treatments. Nonetheless, the results are inconsistent, and many treatments have not been directly compared. This makes it difficult to conclude which approach is more favorable, in terms of efficacy and safety, for the treatment of pathological scarring. This study aimed at evaluating the efficacy of different injection and topical treatment strategies for hypertrophic scar and keloid.Methods: Relevant literature from PubMed, Medline, Embase, Scopus, the Cochrane Central Register of Controlled Trials (CCRCT), and WHO International Clinical Trials Registry Platform (WHO-ICTRP) were searched, from database inception through November 2020. Randomized clinical trials evaluating different treatment strategies of pathological scars, including triamcinolone acetonide (TAC), verapamil (VER), 5-fluorouracil (5-FU), botulinum toxin A (BTA), bleomycin (BLM), and silicone gels were included in the study.Results: The network meta-analysis included a total of 2,009 patients from 29 studies. A network meta-analysis of injection and topical treatment strategies showed that the efficacy of TAC combined with BTA was best in the treatment of pathological scars. Combination therapies of TAC with 5-FU and TAC with BTA significantly improved the clinical efficiency. However, there was no statistically significant difference between other treatment strategies. The order of efficacy predicted by the surface under the cumulative ranking (SUCRA) curve was as follows: TAC+BTA (82.2%) > TAC+5-FU (69.8%) > BTA (67.3%) > 5-FU+silicone (59.4%) > TAC+silicone (58.3%) > 5-FU (49.8%) > BLM (42.0%) > TAC (26.7%) > VER (26.2%) > silicone (18.3%). There was no publication bias revealed based on the funnel diagram.Conclusion: This study recommends intralesional injection of TAC-BTA and TAC-5-FU combined therapies. But for patients who cannot tolerate the side effects, the use of silicone gels in combination with TAC is recommended. However, these conclusions need to be further confirmed by more randomized controlled trials.

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Effect of Early Mobilization on Physical Function in Patients after Cardiac Surgery: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17197091 ◽

2020 ◽

Vol 17 (19) ◽

pp. 7091

Author(s):

Yuji Kanejima ◽

Takayuki Shimogai ◽

Masahiro Kitamura ◽

Kodai Ishihara ◽

Kazuhiro P. Izawa

Keyword(s):

Cardiac Surgery ◽

Randomized Controlled Trials ◽

Physical Function ◽

Hospital Discharge ◽

Meta Analysis ◽

Artery Bypass ◽

Early Mobilization ◽

Controlled Trials ◽

Walking Test ◽

Randomized Controlled

The objective effects of early mobilization on physical function in patients after cardiac surgery remain unknown. The purpose of the present study was to clarify the effects of early mobilization on physical function in patients after cardiac surgery through meta-analysis. Four electronic databases were searched on 2 August 2019. We used search keywords related to “early mobilization”, “cardiac surgery”, and “randomized controlled trials”. All randomized controlled trials conducting early mobilization after cardiac surgery were included. We defined early mobilization as the application of physical activity within the first five postoperative days. Citations and data extraction were independently screened in duplicate by two authors. The meta-analysis was conducted using random-effects modeling with EZR software. The primary outcome was the distance walked during the six-minute walking test at hospital discharge. Six randomized controlled trials comprising 391 patients were included following screening of 591 studies. All studies included coronary artery bypass grafting as the cardiac surgery conducted. Early mobilization started on postoperative days 1–2 and was conducting twice daily. Early mobilization showed a trend of being combined with respiratory exercise or psychoeducation. The meta-analysis showed that the distance walked during the 6-min walking test improved by 54 m (95% confidence interval, 31.1–76.9; I2 = 52%) at hospital discharge. The present study suggested that early mobilization after cardiac surgery may improve physical function at discharge.

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