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Frontiers in Pediatrics 2024In refractory respiratory failure (RF), extracorporeal membrane oxygenation (ECMO) is a salvage therapy that seeks to reduce lung injury induced by mechanical... (Review)
Review
BACKGROUND
In refractory respiratory failure (RF), extracorporeal membrane oxygenation (ECMO) is a salvage therapy that seeks to reduce lung injury induced by mechanical ventilation. The parameters of optimal mechanical ventilation in children during ECMO are not known. Pulmonary ventilatory management during this therapy may impact mortality. The objective of this study was to evaluate the association between ventilatory parameters in children during ECMO therapy and in-hospital mortality.
METHODS
A systematic search of PubMed/MEDLINE, Embase, Cochrane, and Google Scholar from January 2013 until May 2022 (PROSPERO 450744), including studies in children with ECMO-supported RF assessing mechanical ventilation parameters, was conducted. Risk of bias was assessed using the Newcastle-Ottawa scale; heterogeneity, with absence <25% and high >75%, was assessed using I. Sensitivity and subgroup analyses using the Mantel-Haenszel random-effects model were performed to explore the impact of methodological quality on effect size.
RESULTS
Six studies were included. The median age was 3.4 years (IQR: 3.2-4.2). Survival in the 28-day studies was 69%. Mechanical ventilation parameters associated with higher mortality were a very low tidal volume ventilation (<4 ml/kg; OR: 4.70; 95% CI: 2.91-7.59; < 0.01; : 38%), high plateau pressure (mean Dif: -0.70 95% CI: -0.18, -0.22; < 0.01), and high driving pressure (mean Dif: -0.96 95% CI: -1.83, -0.09: = 0.03). The inspired fraction of oxygen ( = 0.09) and end-expiratory pressure ( = 0.69) were not associated with higher mortality. Patients who survived had less multiple organ failure ( < 0.01).
CONCLUSION
The mechanical ventilation variables associated with higher mortality in children with ECMO-supported respiratory failure are high plateau pressures, high driving pressure and very low tidal volume ventilation. No association between mortality and other parameters of the mechanical ventilator, such as the inspired fraction of oxygen or end-expiratory pressure, was found.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023450744, PROSPERO 2023 (CRD42023450744).
PubMed: 38292212
DOI: 10.3389/fped.2024.1302049 -
PloS One 2018Patients in an emergency department are diverse. Some are more seriously ill than others and some even arrive in multi-organ failure. Knowledge of the prevalence of...
INTRODUCTION
Patients in an emergency department are diverse. Some are more seriously ill than others and some even arrive in multi-organ failure. Knowledge of the prevalence of organ failure and its prognosis in unselected patients is important from a diagnostic, hospital planning, and from a quality evaluation point of view, but is not reported systematically.
OBJECTIVES
To analyse the prevalence and prognosis of new onset organ failure in unselected acute patients at arrival to hospital.
METHODS
A systematic review of studies of prevalence and prognosis of acutely ill patients with organ failure at arrival to hospital. We searched PubMed, Cochrane Library, Embase and Cinahl, and read references in included studies. Two authors decided independently on study eligibility and extracted data. Results were summarised qualitatively.
RESULTS
Four studies were included with a total of 678,960 patients. The number of different organ failures reported in the studies ranged from one to six, and the settings were emergency departments and wards. The definitions of organ failure varied between studies. The prevalence of organ failure was 7%, 14%, 14%, and 23%, and in-hospital mortality was 5%, 11% and 15% respectively. The relative risk of in-hospital mortality for patients with organ failure compared to patients without organ failure varied from 2.58 to 8.65. Numbers of organ failures per 1,000 visits varied from 71 to 256.
CONCLUSION
The results of this review indicate that clinicians have good reasons to be alert when a patient arrives to the emergency department; as a state of organ failure seems both frequent and highly severe. However, most studies identified were performed in patients after a diagnosis was established, and only very few studies were performed in unselected patients.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO: CRD42017060871.
Topics: Acute Disease; Hospitals; Humans; Multiple Organ Failure; Patient Admission; Prevalence; Prognosis
PubMed: 30383864
DOI: 10.1371/journal.pone.0206610 -
The Journal of Pediatrics Sep 2023To determine which risk prediction model best predicts clinical deterioration in children at different stages of hospital admission in low- and middle-income countries. (Meta-Analysis)
Meta-Analysis
Predicting Clinical Deterioration and Mortality at Differing Stages During Hospitalization: A Systematic Review of Risk Prediction Models in Children in Low- and Middle-Income Countries.
OBJECTIVE
To determine which risk prediction model best predicts clinical deterioration in children at different stages of hospital admission in low- and middle-income countries.
METHODS
For this systematic review, Embase and MEDLINE databases were searched, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The key search terms were "development or validation study with risk-prediction model" AND "deterioration or mortality" AND "age 0-18 years" AND "hospital-setting: emergency department (ED), pediatric ward (PW), or pediatric intensive care unit (PICU)" AND "low- and middle-income countries." The Prediction Model Risk of Bias Assessment Tool was used by two independent authors. Forest plots were used to plot area under the curve according to hospital setting. Risk prediction models used in two or more studies were included in a meta-analysis.
RESULTS
We screened 9486 articles and selected 78 publications, including 67 unique predictive models comprising 1.5 million children. The best performing models individually were signs of inflammation in children that can kill (SICK) (ED), pediatric early warning signs resource limited settings (PEWS-RL) (PW), and Pediatric Index of Mortality (PIM) 3 as well as pediatric sequential organ failure assessment (pSOFA) (PICU). Best performing models after meta-analysis were SICK (ED), pSOFA and Pediatric Early Death Index for Africa (PEDIA)-immediate score (PW), and pediatric logistic organ dysfunction (PELOD) (PICU). There was a high risk of bias in all studies.
CONCLUSIONS
We identified risk prediction models that best estimate deterioration, although these risk prediction models are not routinely used in low- and middle-income countries. Future studies should focus on large scale external validation with strict methodological criteria of multiple risk prediction models as well as study the barriers in the way of implementation.
TRIAL REGISTRATION
PROSPERO International Prospective Register of Systematic Reviews: Prospero ID: CRD42021210489.
Topics: Child; Humans; Infant, Newborn; Infant; Child, Preschool; Adolescent; Clinical Deterioration; Developing Countries; Hospitalization; Hospital Mortality
PubMed: 37121311
DOI: 10.1016/j.jpeds.2023.113448 -
Pulmonary Medicine 2019Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of vasculitis disorder which involves multiple organ systems and is characterized by asthma,...
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of vasculitis disorder which involves multiple organ systems and is characterized by asthma, pulmonary infiltrates, sinusitis, neuropathy, and peripheral eosinophilia. It also has an effect on the heart, skin, kidneys, and gastrointestinal tract. Interlukin-5 (IL-5) is involved in maturation and activation of eosinophil, the production of which is increased in the EGPA. Treatments of EGPA are limited to systemic corticosteroids and immunomodulators. These drugs are associated with significant side effects. Besides this, the response of patients to these drugs may be disappointing. Frequent relapses, the need for long-term medium-to-high-dose glucocorticoid therapy, and failure to achieve remission are not uncommon findings. There is a need for noble agents that could reduce frequent relapses and the dose of systemic glucocorticoids and maintain a sustained remission without significant side effects. Mepolizumab is IL-5 antagonist and may have value in treating patients with EGPA. Therefore, we did a systematic review to evaluate the efficacy and safety of mepolizumab in patients with EGPA.
Topics: Antibodies, Monoclonal, Humanized; Eosinophilia; Granulomatosis with Polyangiitis; Humans; Interleukin-5
PubMed: 30941214
DOI: 10.1155/2019/4376380 -
Biomedical Reports Jan 2019Sepsis may directly lead to multiple organ failure, which is among the leading causes of mortality in critically ill patients. According to data released by the Global...
Sepsis may directly lead to multiple organ failure, which is among the leading causes of mortality in critically ill patients. According to data released by the Global Sepsis Alliance, the number of mortalities due to sepsis exceeded the combined number for prostate cancer, breast cancer and AIDS in 2012. To date, studies have reported that resveratrol has marked positive effects including anti-inflammatory, anti-oxidative and pro-microcirculatory functions in sepsis-induced organ injury, significantly improving the survival time and mortality of sepsis animals. The present systematic review sought to further clarify the efficacy and safety of resveratrol in the treatment of sepsis. Studies on resveratrol application in the treatment of sepsis-induced organ injury in animal models were reviewed by searching various Chinese and other language databases (PubMed, Embase, CNKI, WanFang and WeiPu) and by manually searching the references of related articles. The selection and evaluation of the studies was performed by two independent reviewers. A total of 260 related studies were initially identified. Following application of the exclusion factors and inclusion criteria, 11 studies were included. Meta-analysis revealed that resveratrol exerted significant protective effect in sepsis-induced animal models of organ injury, through anti-inflammatory, anti-oxidant and pro-microcirculatory functions compared with in the placebo group. While nuclear factor κB (NF-κB) and nuclear factor E2-related factor 2 (NRF-2) are the two major signaling pathways to have been associated with the anti-inflammatory and anti-oxidative effects of resveratrol, these factors were not quantified for mean values, therefore not suitable for systematic evaluation. For related factors, the results of meta-analysis were as follows: For tumor necrosis factor-α (TNF-α), the standardized mean difference (SMD) was -13.50 [95% confidence interval (CI): -22.08, -4.91; P=0.002]; for malondialdehyde (MDA), the SMD was -3.10 (95% CI: -5.27, -0.93; P=0.005); for mean arterial pressure the SMD was 1.34 (95% CI: 0.07, 2.62; P=0.04); for interleukin (IL)-6 the SMD was -9.57 (95% CI: -20.90, 1.75; P=0.10); and for IL-10 the SMD was 0.80 (95% CI: -0.73, 2.34; P=0.31). It was concluded that resveratrol exerted significant anti-inflammatory and anti-oxidative effects through NF-κB and NRF-2 signaling pathways in animal models of sepsis-induced multiple organ injury, manifesting as significant downregulation of TNF-α and MDA expression and improved microcirculation, therefore ameliorating septic damage to the body, which may ultimately improve survival ratios.
PubMed: 30588304
DOI: 10.3892/br.2018.1169 -
Biologics : Targets & Therapy 2023Global pandemic identified as coronavirus disease 2019 (COVID-19) has resulted in a variety of clinical symptoms, from asymptomatic carriers to those with severe acute... (Review)
Review
BACKGROUND
Global pandemic identified as coronavirus disease 2019 (COVID-19) has resulted in a variety of clinical symptoms, from asymptomatic carriers to those with severe acute respiratory distress syndrome (SARS) and moderate upper respiratory tract symptoms (URTS). This systematic review aimed to determine effectiveness of stem cell (SC) applications among COVID-19 patients.
METHODS
Multiple databases of PubMed, EMBASE, Science Direct, Google Scholar, Scopus, Web of Science, and Cochrane Library were used. Studies were screened, chosen, and included in this systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flowchart diagram and PRISMA checklist. Included studies' quality was assessed employing Critical Appraisal Skills Programme (CASP) quality evaluation criteria for 14 randomized controlled trials (RCTs).
RESULTS
Fourteen RCTs were performed between the years of 2020 to 2022, respectively, with a sample size n = 574 (treatment group (n = 318); control group (n = 256)) in multiple countries of Indonesia, Iran, Brazil, Turkey, China, Florida, UK, and France. The greatest sample size reported from China among 100 COVID-19 patients, while the lowest sample of 9 COVID-19 patients from Jakarta, Indonesia, and the patient's age ranges from 18 to 69 years. Studies applied to the type of SC were "Umbilical cord MSCs, MSCs secretome, MSCs, Placenta-derived MSCs, Human immature dental pulp SC, DW-MSC infusion, Wharton Jelly-derived MSCs". The injected therapeutic dose was 1 × 10 cells/kg, 1 × 10 cells/kg, 1 × 10 cells/kg, and 1 million cells/kg as per the evidence from the different studies. Studies focused on demographic variables, clinical symptoms, laboratory tests, Comorbidities, respiratory measures, concomitant therapies, Sequential Organ Failure Assessment score, mechanical ventilation, body mass index, adverse events, inflammatory markers, and PaO/FiO ratio were all recorded as study characteristics.
CONCLUSION
Clinical evidence on MSC's therapeutic applications during COVID-19 pandemic has proven to be a promising therapy for COVID-19 patient recovery with no consequences and applied as a routine treatment for challenging ailments.
PubMed: 37223116
DOI: 10.2147/BTT.S404421 -
Journal of Medical Virology Sep 2020Currently, the epidemic of coronavirus disease 2019 (COVID-19) has begun to spread worldwide. We aim to explore reliable evidence for the diagnosis and treatment of the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Currently, the epidemic of coronavirus disease 2019 (COVID-19) has begun to spread worldwide. We aim to explore reliable evidence for the diagnosis and treatment of the COVID-19 by analyzing all the published studies by Chinese scholars on the clinical and imaging features in novel coronavirus pneumonia caused by SARS-CoV-2.
METHODS
We searched five medical databases including two Chinese and three English databases for all published articles on COVID-19 since the outbreak. A random-effects model was designed, and the imaging and clinical data from all studies were collected for meta-analysis.
RESULTS
Overall, 31 articles and 46 959 patients were included, including 10 English articles and 21 Chinese articles. The results of meta-analysis showed that the most common clinical manifestations were fever (87.3%; 0.838-0.909), cough (58.1%; 0.502-0.660), dyspnea (38.3%; 0.246-0.520), muscle soreness or fatigue (35.5%; 0.253-0.456), and chest distress (31.2%; -0.024 to 0.648). The main imaging findings were bilateral pneumonia (75.7%; 0.639-0.871) and ground-glass opacification (69.9%; 0.602-0.796). Among the patients, the incidence that required intensive care unit (ICU) was (29.3%; 0.190-0.395), the incidence with acute respiratory distress syndrome was (28.8%; 0.147-0.429), the incidence with multiple organ dysfunction syndrome was (8.5%; -0.008 to 0.179), and the case fatality rate of patients with COVID-19 was (6.8%; 0.044-0.093).
CONCLUSION
COVID-19 is a new clinical infectious disease that mainly causes bilateral pneumonia and lung function deteriorates rapidly. Nearly a third of patients need to be admitted to the ICU, and patients are likely to present respiratory failure or even death.
Topics: Adult; COVID-19; Female; Humans; Lung; Male; Middle Aged; Respiratory Insufficiency; Tomography, X-Ray Computed
PubMed: 32242947
DOI: 10.1002/jmv.25822 -
Pediatrics Jan 2022Acute neurologic dysfunction is common in critically ill children and contributes to outcomes and end of life decision-making.
CONTEXT
Acute neurologic dysfunction is common in critically ill children and contributes to outcomes and end of life decision-making.
OBJECTIVE
To develop consensus criteria for neurologic dysfunction in critically ill children by evaluating the evidence supporting such criteria and their association with outcomes.
DATA SOURCES
Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020, by using a combination of medical subject heading terms and text words to define concepts of neurologic dysfunction, pediatric critical illness, and outcomes of interest.
STUDY SELECTION
Studies were included if the researchers evaluated critically ill children with neurologic injury, evaluated the performance characteristics of assessment and scoring tools to screen for neurologic dysfunction, and assessed outcomes related to mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. Studies with an adult population or premature infants (≤36 weeks' gestational age), animal studies, reviews or commentaries, case series with sample size ≤10, and studies not published in English with an inability to determine eligibility criteria were excluded.
DATA EXTRACTION
Data were abstracted from each study meeting inclusion criteria into a standard data extraction form by task force members.
DATA SYNTHESIS
The systematic review supported the following criteria for neurologic dysfunction as any 1 of the following: (1) Glasgow Coma Scale score ≤8; (2) Glasgow Coma Scale motor score ≤4; (3) Cornell Assessment of Pediatric Delirium score ≥9; or (4) electroencephalography revealing attenuation, suppression, or electrographic seizures.
CONCLUSIONS
We present consensus criteria for neurologic dysfunction in critically ill children.
Topics: Child; Clinical Decision-Making; Critical Illness; Electroencephalography; Glasgow Coma Scale; Humans; Multiple Organ Failure; Nervous System Diseases; Neurologic Examination; Prognosis; Severity of Illness Index
PubMed: 34970681
DOI: 10.1542/peds.2021-052888E -
Journal of Clinical Gastroenterology Mar 2024In this study, we conducted this network meta-analysis (based on the ANOVA model) to evaluate the predictive efficacy of each early predictor. (Meta-Analysis)
Meta-Analysis
GOALS
In this study, we conducted this network meta-analysis (based on the ANOVA model) to evaluate the predictive efficacy of each early predictor.
BACKGROUND
Persistent organ failure (POF) is one of the determining factors in patients with acute pancreatitis (AP); however, the diagnosis of POF has a long-time lag (>48 h). It is of great clinical significance for the early noninvasive prediction of POF.
STUDY
We conducted a comprehensive and systematic search in PubMed, Cochrane library, Embase, and Web of Science to identify relevant clinical trials, case-control studies, or cohort studies, extracted the early indicators of POF in studies, and summarized the predictive efficacy of each indicator through network meta-analysis. The diagnostic odds ratio (DOR) was used to rank the prediction efficiency of each indicator.
RESULTS
We identified 23 studies in this network meta-analysis, including 10,393 patients with AP, of which 2014 patients had POF. A total of 10 early prediction indicators were extracted. The mean and 95% CI lower limit of each predictive indicator were greater than 1.0. Albumin had the largest diagnostic odds ratio, followed by high-density lipoprotein-cholesterol (HDL-C), Ranson Score, beside index for severity in acute pancreatitis Score, acute physiology and chronic health evaluation II, C-reactive protein (CRP), Interleukin 6 (IL-6), Interleukin 8 (IL-8), Systemic Inflammatory Response Syndrome (SIRS) and blood urea nitrogen.
CONCLUSIONS
Albumin, high-density lipoprotein-cholesterol, Ranson Score, and beside index for severity in acute pancreatitis Score are effective in the early prediction of POF in patients with AP, which can provide evidence for developing effective prediction systems. However, due to the limitations of the extraction method of predictive indicators in this study, some effective indicators may not be included in this meta-analysis.
Topics: Humans; Pancreatitis; Acute Disease; Network Meta-Analysis; Prognosis; Retrospective Studies; Multiple Organ Failure; C-Reactive Protein; Lipoproteins, HDL; Cholesterol; Severity of Illness Index
PubMed: 36930726
DOI: 10.1097/MCG.0000000000001843 -
Critical Care Medicine Dec 2021Coronavirus disease 2019 is a heterogeneous disease most frequently causing respiratory tract infection, which can induce respiratory failure and multiple organ... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Coronavirus disease 2019 is a heterogeneous disease most frequently causing respiratory tract infection, which can induce respiratory failure and multiple organ dysfunction syndrome in its severe forms. The prevalence of coronavirus disease 2019-related sepsis is still unclear; we aimed to describe this in a systematic review.
DATA SOURCES
MEDLINE (PubMed), Cochrane, and Google Scholar databases were searched based on a prespecified protocol (International Prospective Register for Systematic Reviews: CRD42020202018).
STUDY SELECTION
Studies reporting on patients with confirmed coronavirus disease 2019 diagnosed with sepsis according to sepsis-3 or according to the presence of infection-related organ dysfunctions necessitating organ support/replacement were included in the analysis. The primary end point was prevalence of coronavirus disease 2019-related sepsis among adults hospitalized in the ICU and the general ward. Among secondary end points were the need for ICU admission among patients initially hospitalized in the general ward and the prevalence of new onset of organ dysfunction in the ICU. Outcomes were expressed as proportions with respective 95% CI.
DATA EXTRACTION
Two reviewers independently screened and reviewed existing literature and assessed study quality with the Newcastle-Ottawa Scale and the Methodological index for nonrandomized studies.
DATA SYNTHESIS
Of 3,825 articles, 151 were analyzed, only five of which directly reported sepsis prevalence. Noting the high heterogeneity observed, coronavirus disease 2019-related sepsis prevalence was 77.9% (95% CI, 75.9-79.8; I2 = 91%; 57 studies) in the ICU, and 33.3% (95% CI, 30.3-36.4; I2 = 99%; 86 studies) in the general ward. ICU admission was required for 17.7% (95% CI, 12.9-23.6; I2 = 100%) of ward patients. Acute respiratory distress syndrome was the most common organ dysfunction in the ICU (87.5%; 95% CI, 83.3-90.7; I2 = 98%).
CONCLUSIONS
The majority of coronavirus disease 2019 patients hospitalized in the ICU meet Sepsis-3 criteria and present infection-associated organ dysfunction. The medical and scientific community should be aware and systematically report viral sepsis for prognostic and treatment implications.
Topics: COVID-19; Hospitalization; Humans; Intensive Care Units; Multiple Organ Failure; Patient Admission; SARS-CoV-2; Sepsis; Severity of Illness Index
PubMed: 34259663
DOI: 10.1097/CCM.0000000000005195