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Effect of Surgically Assisted Rapid Maxillary Expansion on Upper Airway Volume: A Systematic Review.Journal of Oral and Maxillofacial... May 2016Surgically assisted rapid maxillary expansion (SARME) is required in non-growing patients when maturity or resistance precludes desired sutural separation by noninvasive... (Review)
Review
PURPOSE
Surgically assisted rapid maxillary expansion (SARME) is required in non-growing patients when maturity or resistance precludes desired sutural separation by noninvasive techniques. The aim of this review was to determine what volumetric changes occur in the upper airway spaces after SARME in adults.
MATERIALS AND METHODS
A systematic review was performed with data assessed for suitability of meta-analysis. The primary outcome measurement of volumetric changes in an upper airway space was sought in non-growing patients undergoing SARME. Electronic database searches were performed for published literature in Medline (by Ovid), Pre-Medline, Old Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) spanning all available years to August 1, 2015. Unpublished literature was searched electronically through ClinicalTrials.gov and the National Research Register. Additional hand searching of reference lists of relevant articles, grey searching, and expert correspondence was conducted for any additional studies. Two authors independently screened search results, extracted data, and assessed the risk of bias of included studies.
RESULTS
Twenty-one studies were located by initial screening; 10 were excluded after full-text review, leaving 11 studies eligible that met all inclusion criteria for this systematic review. In total, 204 treated patients (mean age, 18 to 31 yr) were included in the qualitative synthesis. Ten studies evaluated nasal cavity volume, 2 evaluated palatal volume, and 1 evaluated oropharyngeal volume. Appliances used included tooth-borne hyrax and transpalatal distractor devices.
CONCLUSIONS
SARME was found to produce substantial short-term volume increases in the nasal cavity in non-growing patients that were maintained for at least 63 months. Evidence weakly suggested no effect on oropharyngeal volume. However, most studies were evaluated as having a high risk of bias. The effect of such volume changes on respiratory function still needs to be determined; thus, SARME cannot be recommended for respiratory purposes.
Topics: Adult; Humans; Nasopharynx; Palatal Expansion Technique; Respiratory Physiological Phenomena
PubMed: 26778518
DOI: 10.1016/j.joms.2015.11.035 -
The Cochrane Database of Systematic... Aug 2015The vicious cycle hypothesis for bronchiectasis predicts that bacterial colonisation of the respiratory tract perpetuates inflammatory change. This damages the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The vicious cycle hypothesis for bronchiectasis predicts that bacterial colonisation of the respiratory tract perpetuates inflammatory change. This damages the mucociliary escalator, preventing bacterial clearance and allowing persistence of pro-inflammatory mediators. Conventional treatment with physiotherapy and intermittent antibiotics is believed to improve the condition of people with bronchiectasis, although no conclusive data show that these interventions influence the natural history of the condition. Various strategies have been tried to interrupt this cycle of infection and inflammation, including prolonging antibiotic treatment with the goal of allowing the airway mucosa to heal.
OBJECTIVES
To determine the benefits of prolonged antibiotic therapy in the treatment of patients with bronchiectasis.
SEARCH METHODS
We searched the Cochrane Airways Group Trials Register and reference lists of identified articles. Searches were current as of February 2014.
SELECTION CRITERIA
Randomised trials examining the use of prolonged antibiotic therapy (for four or more weeks) in the treatment of bronchiectasis compared with placebo or usual care.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and extracted data. We contacted study authors to ask for missing information.
MAIN RESULTS
Eighteen trials met the inclusion criteria, randomly assigning a total of 1157 participants. Antibiotics were given for between four weeks and 83 weeks. Limited meta-analysis was possible because of the diversity of outcomes reported in these trials. Based on the number of participants with at least one exacerbation, the meta-analysis showed significant effects in favour of the intervention (odds ratio (OR) 0.31, 95% confidence interval (CI) 0.19 to 0.52; P value < 0.00001), with events occurring in 271 per 1000 people in the intervention arm (95% CI 126 to 385) and in 546 per 1000 in the control population, based on evidence of moderate quality. A non-statistically significant reduction in hospitalisation favoured the use of prolonged antibiotics with a moderate quality grade of supporting evidence (37 per 1000 in the intervention arm (95% CI 13 to 96) and 87 per 1000 in control (OR 0.40, 95% CI 0.14 to 1.11; P value = 0.08). Drug resistance developed in 36 of 220 participants taking antibiotics compared with 10 of 211 participants given placebo or standard therapy (OR 3.48, 95% CI 1.20 to 10.07; P value = 0.02), translating to natural frequencies of 155 per 1000 in the intervention arm (95% CI 59 to 346) and 50 per 1000 in the control arm. The intervention was well tolerated with no overall significant difference in withdrawal between treatment and placebo groups (OR 0.91, 95% CI 0.56 to 1.49). Diarrhoea was commonly reported as an adverse event, particularly with an oral intervention.
AUTHORS' CONCLUSIONS
Available evidence shows benefit associated with use of prolonged antibiotics in the treatment of patients with bronchiectasis, at least halving the odds of exacerbation (with 275 fewer exacerbations per every 1000 people treated in the antibiotic arm compared with the control arm) and hospitalisation (50 fewer hospitalisations per 1000 people in the antibiotic arm compared with the control arm). However, the risk of emerging drug resistance is increased more than threefold. This review is limited by diversity of trials and by evidence of moderate to low quality. Further randomised controlled trials with adequate power and standardised end points are required.
Topics: Adult; Anti-Bacterial Agents; Bronchiectasis; Child; Diarrhea; Disease Progression; Drug Resistance, Bacterial; Hospitalization; Humans; Middle Aged; Odds Ratio; Randomized Controlled Trials as Topic; Time Factors
PubMed: 26270620
DOI: 10.1002/14651858.CD001392.pub3 -
The Cochrane Database of Systematic... Jul 2015Bronchiectasis is a chronic respiratory disease characterised by abnormal dilatation of the bronchi, and presents typically with a chronic productive cough (or chronic... (Review)
Review
BACKGROUND
Bronchiectasis is a chronic respiratory disease characterised by abnormal dilatation of the bronchi, and presents typically with a chronic productive cough (or chronic wet cough in children) and recurrent infective exacerbations. It significantly impacts daily activities and quality of life, and can lead to recurrent hospitalisations, severe lung function impairment, respiratory failure and even death.
OBJECTIVES
To provide an overview of the efficacy and safety of interventions for adults and children with bronchiectasis from Cochrane reviews.To identify gaps in the evidence base that will inform recommendations for new research and reviews, and to summarise information on reported outcomes and make recommendations for the reporting of standard outcomes in future trials and reviews.
METHODS
We included Cochrane reviews of non-cystic fibrosis (CF) bronchiectasis. We searched the Cochrane Database of Systematic Reviews. The search is current to 11 February 2015. We also identified trials that were potentially eligible for, but not currently included in, published reviews to make recommendations for new Cochrane reviews. We assessed the quality of included reviews using the AMSTAR criteria. We presented an evidence synthesis of data from reviews alongside an evidence map of clinical trials and guideline data. The primary outcomes were exacerbations, lung function and quality of life.
MAIN RESULTS
We included 21 reviews but extracted data from, and rated the quality of, only nine reviews that reported results for people with bronchiectasis alone. Of the reviews with no usable data, two reviews included studies with mixed clinical populations where data were not reported separately for people with bronchiectasis and 10 reviews did not contain any trials. Of the 40 studies included across the nine reviews, three (number of participants nine to 34) included children. The studies ranged from single session to year-long studies. Each review included from one to 11 trials and 28 (70%) trials in the overview included 40 or fewer participants. The total number of participants included in reviews ranged from 40 to 1040. The age range of adult participants was from 36 to 73 years and children ranged from six to 16 years. The proportion of male participants ranged from 21% to 72%. Where reported, mean baseline forced expiratory volume in one second (FEV1) ranged from 1.17 L to 1.66 L and from 47% to 88% predicted. Most of the reviews had search dates older than two years.We have summarised the published evidence as outlined in Cochrane reviews, but it was not possible to draw definitive conclusions. There was inconclusive evidence on the use of long-term antibiotics and nebulised hypertonic saline for reducing exacerbation frequency and evidence that human deoxyribonuclease (RhDNase) increases exacerbation frequency. Improvements in lung function were reported for inhaled corticosteroids (ICS) though this was small and not clinically relevant. Evidence of benefit for hyperosmolar agents and mucolytics was inconclusive. There was limited evidence of improvements in quality of life with airway clearance techniques and physical therapy but evidence of benefit for hyperosmolar agents was inconclusive. Secondary outcomes were not clearly reported in all trials in the included reviews. Improvements in dyspnoea, wheeze and cough-free days were reported for small trials of ICS and LABA (long-acting beta2-agonsts)/ICS and cough reduction was also reported for a small bromhexine trial. Reduction in sputum production was reported for long-term antibiotics and airway clearance techniques but evidence of benefit for hyperosmolar agents was inconclusive.Adverse events were included as outcomes in seven reviews. The review of long-term (four weeks to one year) prophylactic courses of antibiotics reported significantly more cases of wheeze (Peto odd ratio (OR) 8.56, 95% confidence intervals (CI) 1.63 to 44.93), dyspnoea (12 versus three, P value = 0.01) and chest pain (seven versus zero, P value = 0.01) from the same trial (74 participants) but no differences in occurrence of diarrhoea, rash or number of withdrawals. In the review of mucolytics versus placebo, relevant outcomes were not reported for erdosteine comparisons and no significant adverse effects were reported for bromhexine, though adverse events were associated with RhDNase (OR 28.19, 95% CI 3.77 to 210.85, 1 study). Of the remaining five reviews, adverse events were not reported in the single trials included in the ICS review or the physical therapy review and the impact of adverse events in the single trial included in the inhaled LABA/ICS combination versus ICS review were unclear. The reviews of short-term courses of antibiotics and inhaled hyperosmolar agents reported no significant differences in occurrence of adverse events. Fewer admissions to hospital were reported for long-term antibiotics, but this outcome was not reported in all reviews. No reviews reported differences in mortality, but again this outcome was not included in all reviews.We did not explicitly include antibiotic resistance as an outcome in the review, but this was unclear in the Cochrane reviews and evidence from other trials should be considered.We rated all reviews as high quality (AMSTAR), though opportunities for improved reporting (e.g. summary of findings and GRADE evaluation of the evidence) were identified for inclusion in future updates of the reviews. However, the majority of trials were not high quality and confidence in the effects of treatments, therefore, requires additional evidence from larger and more methodologically robust trials. We evaluated the overall coverage of important topics in bronchiectasis by mapping the quality of the current evidence base against published guidelines and identifying high priority areas for new research on; use of short-course and long-term antibiotics, ICS and oral corticosteroids, inhaled hyperosmolars, mucolytics, and use of airway clearance techniques.
AUTHORS' CONCLUSIONS
This overview clearly points to significant opportunities for further research aimed at improving outcomes for people with bronchiectasis. We have highlighted important endpoints for studies (particularly exacerbations, quality of life and lung function), and areas of clinical practice that are in most urgent need of evidence-based support (including long-term antibiotics, ICSs and mucolytics).As the evidence is confined to small trials of short duration, it is not currently possible to assess the balance between the benefits and potential harms of treatments for bronchiectasis.
Topics: Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Bronchiectasis; Child; Deoxyribonucleases; Expectorants; Humans; Nebulizers and Vaporizers; Review Literature as Topic; Saline Solution, Hypertonic
PubMed: 26171905
DOI: 10.1002/14651858.CD010337.pub2 -
The Cochrane Database of Systematic... Mar 2018Inhaled antibiotics are commonly used to treat persistent airway infection with Pseudomonas aeruginosa that contributes to lung damage in people with cystic fibrosis.... (Review)
Review
BACKGROUND
Inhaled antibiotics are commonly used to treat persistent airway infection with Pseudomonas aeruginosa that contributes to lung damage in people with cystic fibrosis. Current guidelines recommend inhaled tobramycin for individuals with cystic fibrosis and persistent Pseudomonas aeruginosa infection who are aged six years or older. The aim is to reduce bacterial load in the lungs so as to reduce inflammation and deterioration of lung function. This is an update of a previously published review.
OBJECTIVES
To evaluate the effects long-term inhaled antibiotic therapy in people with cystic fibrosis on clinical outcomes (lung function, frequency of exacerbations and nutrition), quality of life and adverse events (including drug sensitivity reactions and survival).
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched ongoing trials registries.Date of last search: 13 February 2018.
SELECTION CRITERIA
We selected trials if inhaled anti-pseudomonal antibiotic treatment was used for at least three months in people with cystic fibrosis, treatment allocation was randomised or quasi-randomised, and there was a control group (either placebo, no placebo or another inhaled antibiotic).
DATA COLLECTION AND ANALYSIS
Two authors independently selected trials, judged the risk of bias, extracted data from these trials and judged the quality of the evidence using the GRADE system.
MAIN RESULTS
The searches identified 333 citations to 98 trials; 18 trials (3042 participants aged between five and 56 years) met the inclusion criteria. Limited data were available for meta-analyses due to the variability of trial design and reporting of results. A total of 11 trials (1130 participants) compared an inhaled antibiotic to placebo or usual treatment for a duration between three and 33 months. Five trials (1255 participants) compared different antibiotics, two trials (585 participants) compared different regimens of tobramycin and one trial (90 participants) compared intermittent tobramycin with continuous tobramycin alternating with aztreonam. One of the trials (18 participants) compared to placebo and a different antibiotic and so fell into both groups. The most commonly studied antibiotic was tobramycin which was studied in 12 trials.We found limited evidence that inhaled antibiotics improved lung function (four of the 11 placebo-controlled trials, n = 814). Compared to placebo, inhaled antibiotics also reduced the frequency of exacerbations (three trials, n = 946), risk ratio 0.66 (95% confidence interval (CI) 0.47 to 0.93). There were insufficient data for us to be able to report an effect on nutritional outcomes or survival and there were insufficient data for us to ascertain the effect on quality of life. There was no significant effect on antibiotic resistance seen in the two trials that were included in meta-analyses. Tinnitus and voice alteration were the only adverse events significantly more common in the inhaled antibiotics group. The overall quality of evidence was deemed to be low for most outcomes due to risk of bias within the trials and imprecision due to low event rates.Of the eight trials that compared different inhaled antibiotics or different antibiotic regimens, there was only one trial in each comparison. Forced expiratory volume at one second (FEV) % predicted was only found to be significantly improved with aztreonam lysine for inhalation compared to tobramycin (n = 273), mean difference -3.40% (95% CI -6.63 to -0.17). However, the method of defining the endpoint was different to the remaining trials and the participants were exposed to tobramycin for a long period making interpretation of the results problematic. No significant differences were found in the remaining comparisons with regard to lung function. Pulmonary exacerbations were measured in different ways, but one trial (n = 273) found that the number of people treated with antibiotics was lower in those receiving aztreonam than tobramycin, risk ratio 0.66 (95% CI 0.51 to 0.86). We found the quality of evidence for these comparisons to be directly related to the risk of bias within the individual trials and varied from low to high.
AUTHORS' CONCLUSIONS
Inhaled anti-pseudomonal antibiotic treatment probably improves lung function and reduces exacerbation rate, but pooled estimates of the level of benefit were very limited. The best evidence is for inhaled tobramycin. More evidence from trials measuring similar outcomes in the same way is needed to determine a better measure of benefit. Longer-term trials are needed to look at the effect of inhaled antibiotics on quality of life, survival and nutritional outcomes.
PubMed: 29607494
DOI: 10.1002/14651858.CD001021.pub3 -
Journal of Oral and Maxillofacial... Jul 2018The effects of noncontinuous positive airway pressure (non-CPAP) therapies on the airflow in the upper airway in obstructive sleep apnea (OSA) patients are not...
The Effects of Noncontinuous Positive Airway Pressure Therapies on the Aerodynamic Characteristics of the Upper Airway of Obstructive Sleep Apnea Patients: A Systematic Review.
PURPOSE
The effects of noncontinuous positive airway pressure (non-CPAP) therapies on the airflow in the upper airway in obstructive sleep apnea (OSA) patients are not completely clear yet. Therefore, the primary aim of this systematic review was to determine the effects of various non-CPAP therapies on the aerodynamic characteristics of the upper airway in OSA patients.
MATERIALS AND METHODS
A PICO (population or patient, intervention, comparison, outcome) search strategy, focusing on the effects of various non-CPAP therapies on the aerodynamic characteristics of the upper airway (ie, velocity, wall shear stress, wall static pressure, airway resistance, pressure drop, and pressure effort) of OSA patients, was conducted in the following databases: MEDLINE (PubMed), Embase (Excerpta Medica), and Web of Science. In this systematic review, the inclusion criteria were 1) adults diagnosed with OSA by polysomnography, 2) treatment outcome assessed by a second polysomnography, and 3) computational fluid dynamics (CFD) applied.
RESULTS
Of 51 unique studies retrieved, 9 fulfilled the criteria for this systematic review. Seven studies were on maxillomandibular advancement (MMA) surgery, and 2 were on mandibular advancement device (MAD) therapy. The aerodynamic characteristics of the upper airway improved in OSA patients who underwent MMA surgery. However, the studies on MMA surgery included only responders to MMA surgery. In the responders to MAD therapy, the velocity, wall static pressure, and airway resistance of the upper airway decreased. In nonresponders to MAD therapy, the wall static pressure and airway resistance of the upper airway increased.
CONCLUSIONS
This systematic review suggests that MMA surgery and MAD therapy may improve several aerodynamic characteristics of the upper airway in OSA patients by CFD analysis. However, because of limitations of the selected studies, there is not enough evidence yet to support CFD analysis as a routine tool to predict the treatment outcome in OSA patients.
Topics: Humans; Pharynx; Positive-Pressure Respiration; Sleep Apnea, Obstructive
PubMed: 29567436
DOI: 10.1016/j.joms.2018.02.017 -
International Orthodontics Mar 2019This systematic review aims to determine the effects of non-surgical rapid maxillary expansion (RME) on breathing and upper airway structures.
OBJECTIVE
This systematic review aims to determine the effects of non-surgical rapid maxillary expansion (RME) on breathing and upper airway structures.
MATERIALS AND METHODS
An electronic search of the scientific literature from January 2005 to June 2016 was done using Web of Science, Dentistry & Oral Sciences Source and PubMed databases. A combination of search terms "rapid maxillary expansion", "nasal", "airway" and "breathing" were used. Studies that involved surgical or combined RME-surgical treatments and patients with craniofacial anomalies were excluded.
RESULTS
The initial screening yielded a total of 183 articles. After evaluation of the titles, abstracts and accessing the full text, a total of 20 articles fulfilled both inclusion/exclusion criteria and possessed adequate evidence to be incorporated into this review.
CONCLUSIONS
Non-surgical RME was found to improve breathing, increase nasal cavity geometry and decrease nasal airway resistance in children and adolescents.
Topics: Adolescent; Airway Resistance; Child; Databases, Factual; Humans; Nasal Cavity; Nasopharynx; Nose; Orthodontics; Palatal Expansion Technique; Respiration
PubMed: 30732977
DOI: 10.1016/j.ortho.2019.01.001 -
Sleep Medicine Reviews Jun 2015Reducing cardiometabolic risk may represent an important target for effective obstructive sleep apnea (OSA) treatment. The impact of continuous positive airway pressure... (Review)
Review
Impact of obstructive sleep apnea treatment by continuous positive airway pressure on cardiometabolic biomarkers: a systematic review from sham CPAP randomized controlled trials.
Reducing cardiometabolic risk may represent an important target for effective obstructive sleep apnea (OSA) treatment. The impact of continuous positive airway pressure (CPAP), the first line therapy of OSA, on metabolic or inflammatory markers is still debated. A systematic literature search using several databases was performed. We provide a systematic analysis of randomized studies comparing therapeutic versus sham CPAP intervention and also include studies using a CPAP withdrawal design. We addressed the impact of CPAP on the following cardiometabolic biomarkers: 1) plasma and urine catecholamines and their metabolites that reflect sympathetic activity; 2) insulin resistance and lipid metabolism biomarkers; 3) oxidative stress, systemic and vascular inflammation biomarkers; 4) liver enzymes highlighting the association between OSA and nonalcoholic fatty liver disease (NAFLD); 5) coagulation biomarkers. The impact of CPAP on sympathetic activity is robust across studies and occurs rapidly. In contrast to sympathetic activity, the well-designed studies included in this review failed to demonstrate that CPAP alters metabolic or inflammatory markers in OSA. CPAP did not change glucose, lipids, insulin resistance levels or the ratio of patients with metabolic syndrome. In unselected OSA patients, it is not realistic to expect a clinically relevant decrease in cardiometabolic biomarkers with CPAP therapy.
Topics: Biomarkers; Catecholamines; Continuous Positive Airway Pressure; Glucose; Humans; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive
PubMed: 25220580
DOI: 10.1016/j.smrv.2014.07.004 -
American Journal of Rhinology & Allergy 2014The middle turbinate (MT) is a structure that is often carefully preserved during endoscopic sinus surgery (ESS) in an effort to preserve nasal physiology and serve as... (Review)
Review
BACKGROUND
The middle turbinate (MT) is a structure that is often carefully preserved during endoscopic sinus surgery (ESS) in an effort to preserve nasal physiology and serve as an anatomic landmark. However, resection is performed in select cases because of involvement of the MT in the inflammatory process, obstruction, or instability. Therefore, significant controversy exists among surgeons regarding the indications for proceeding with MT resection in ESS. This study evaluates clinical outcomes of MT resection after ESS.
METHODS
An English language search of the PubMed and Ovid databases was conducted for publications examining clinical outcomes of MT resection after ESS performed for chronic rhinosinusitis. Two authors independently examined the articles to identify those meeting inclusion criteria. Any differences over which studies to include were resolved by discussion and consensus. Bias assessment was conducted using the Cochrane Collaboration bias tool for randomized controlled trials and the Newcastle-Ottawa bias tool for cohort and case-control studies.
RESULTS
After initial screening, search results revealed 71 articles that warranted detailed evaluation. After applying inclusion criteria, 9 studies were selected. A total of 2123 patients were included among the studies. All studies were controlled. Within the limited available data, olfaction scores may be improved in the MT resection patients compared with MT preservation patients. No difference between the groups was noted for quality of life outcomes, nasal airway resistance, or rates of postoperative frontal sinusitis. In regard to postoperative endoscopic examinations, some studies note greater improvement in the MT resection group compared with the MT preservation group, while others were equivalent.
CONCLUSION
Although some studies show outcome benefit in MT resection patients compared with MT preservation patients, several others show no difference. When MT resection was appropriately indicated, no studies showed detrimental effects compared with MT preservation in their designated outcomes. Additional more stringent studies are warranted.
Topics: Animals; Endoscopy; Humans; Paranasal Sinuses; Randomized Controlled Trials as Topic; Rhinoplasty; Treatment Outcome; Turbinates
PubMed: 25514487
DOI: 10.2500/ajra.2014.28.4097 -
Entropy (Basel, Switzerland) May 2018Asthma is a chronic respiratory disease featured with unpredictable flare-ups, for which continuous lung function monitoring is the key for symptoms control. To find new... (Review)
Review
Asthma is a chronic respiratory disease featured with unpredictable flare-ups, for which continuous lung function monitoring is the key for symptoms control. To find new indices to individually classify severity and predict disease prognosis, continuous physiological data collected from monitoring devices is being studied from different perspectives. Entropy, as an analysis method for quantifying the inner irregularity of data, has been widely applied in physiological signals. However, based on our knowledge, there is no such study to summarize the complexity differences of various physiological signals in asthmatic patients. Therefore, we organized a systematic review to summarize the complexity differences of important signals in patients with asthma. We searched several medical databases and systematically reviewed existing asthma clinical trials in which entropy changes in physiological signals were studied. As a conclusion, we find that, for airflow, heart rate variability, center of pressure and respiratory impedance, their entropy values decrease significantly in asthma patients compared to those of healthy people, while, for respiratory sound and airway resistance, their entropy values increase along with the progression of asthma. Entropy of some signals, such as respiratory inter-breath interval, shows strong potential as novel indices of asthma severity. These results will give valuable guidance for the utilization of entropy in physiological signals. Furthermore, these results should promote the development of management and diagnosis of asthma using continuous monitoring data in the future.
PubMed: 33265493
DOI: 10.3390/e20060402 -
The Clinical Respiratory Journal Mar 2018Chronic obstructive pulmonary disease (COPD) is often accompanied by acute exacerbations. Patients of COPD exacerbation suffering from respiratory failure often need the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is often accompanied by acute exacerbations. Patients of COPD exacerbation suffering from respiratory failure often need the support of mechanical ventilation. Helium-oxygen can be used to reduce airway resistance during mechanical ventilation. The aim of this study is to evaluate the effect of helium-oxygen-assisted mechanical ventilation on COPD exacerbation through a meta-analysis.
METHODS
A comprehensive literature search through databases of Pub Med (1966∼2016), Ovid MEDLINE (1965∼2016), Cochrane EBM (1991∼2016), EMBASE (1974∼2016) and Ovid MEDLINE was performed to identify associated studies. Randomized clinical trials met our inclusion criteria that focus on helium-oxygen-assisted mechanical ventilation on COPD exacerbation were included. The quality of the papers was evaluated after inclusion and information was extracted for meta-analysis.
RESULTS
Six articles and 392 patients were included in total. Meta-analysis revealed that helium-oxygen-assisted mechanical ventilation reduced Borg dyspnea scale and increased arterial PH compared with air-oxygen. No statistically significant difference was observed between helium-oxygen and air-oxygen as regards to WOB, PaCO , OI, tracheal intubation rates and mortality within hospital.
CONCLUSIONS
Our study suggests helium-oxygen-assisted mechanical ventilation can help to reduce Borg dyspnea scale. In terms of the tiny change of PH, its clinical benefit is negligible. There is no conclusive evidence indicating the beneficial effect of helium-oxygen-assisted mechanical ventilation on clinical outcomes or prognosis of COPD exacerbation.
Topics: Helium; Humans; Oxygen; Positive-Pressure Respiration; Pulmonary Disease, Chronic Obstructive; Recurrence; Respiratory Insufficiency
PubMed: 28544519
DOI: 10.1111/crj.12654