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Journal of Personalized Medicine Mar 2024The use of closed suction drains post posterior spinal fusion for adolescent idiopathic scoliosis (AIS) is common practice, although evidence on its impact is limited... (Review)
Review
The use of closed suction drains post posterior spinal fusion for adolescent idiopathic scoliosis (AIS) is common practice, although evidence on its impact is limited compared to that for knee and hip arthroplasty. This study aimed to assess the effect of closed suction drainage on short-term post-operative outcomes in AIS surgery. A systematic review following PRISMA guidelines was conducted, including studies comparing outcomes with and without drainage. Data on blood loss, transfusions, hospital stay, and complications were collected and subjected to meta-analysis. Five studies involving 772 patients were analyzed. The meta-analysis found no significant difference in blood transfusion rates ( = 0.107) or hospital stay ( = 0.457) between groups. Complications, including surgical site infections, were more common without drainage, though not statistically significant ( = 0.356). Reintervention rates were higher in the no-drainage group, but not significantly ( = 0.260). Overall, this review found no significant short-term outcome differences, suggesting clinical judgment should guide drainage decisions. Further research, particularly with enhanced recovery protocols, is warranted to clarify drainage's role in AIS surgery.
PubMed: 38672966
DOI: 10.3390/jpm14040339 -
Interventional Neuroradiology : Journal... Dec 2023Although direct contact aspiration has emerged as one of the leading techniques for mechanical thrombectomy (MT), there is still ongoing debate about the... (Review)
Review
BACKGROUND
Although direct contact aspiration has emerged as one of the leading techniques for mechanical thrombectomy (MT), there is still ongoing debate about the aspiration/suction pump devices that can optimize recanalization rates. To address this gap, we conducted a meta-analysis comparing the aspiration efficacy of 60 ml syringe and pump devices in benchtop MT models.
METHODS
Systematic literature review was conducted using Medline, Embase, Web of Science, and Scopus in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Outcomes of interest included flow rate and vacuum pressure delivered by a 60 ml syringe and several aspiration pumps. We used a random effects model to calculate the mean difference (MD) with 95% confidence intervals (CIs) and a statistically significant difference was considered as a two-sided -value of less than 0.05.
RESULTS
We included six benchtop studies comparing 60 ml syringes and vacuum pumps. Our meta-analysis showed that there were no significant differences in vacuum pressure (MD:0.71inHg, 95% CI: [-0.81;2.23], = 0.359) and flow rate (MD:0.27 mL/s, 95% CI: [-3,07; 3.61], = 0.873) between 60 ml syringes and vacuum pumps groups.
CONCLUSIONS
Our study demonstrated comparable performance in terms of vacuum pressure and flow rates between a 60 ml syringe and a heterogeneous combination of commercially available aspiration pumps.
PubMed: 38151033
DOI: 10.1177/15910199231222305 -
Nursing Outlook 2024The high burden of pressure ulcers (PUs) in Sub-Saharan Africa (SSA), coupled with the limited resources, underscores the need for preventive and context-specific... (Review)
Review
BACKGROUND
The high burden of pressure ulcers (PUs) in Sub-Saharan Africa (SSA), coupled with the limited resources, underscores the need for preventive and context-specific treatment strategies.
PURPOSE
Therefore, the purpose of this systematic review was to establish and elucidate PU prevention and treatment interventions tested in SSA.
METHODS
This systematic review of the literature used, PRISMA to guide the search.
FINDINGS
The review identified nine studies on PU prevention (three) and treatment (six). Low-cost interventions assembled from locally available materials and multifaceted policies significantly prevented and treated PUs. The interventions included wound dressing agents, simple negative pressure suction devices that significantly treated PUs, and water-based bed surfaces.
DISCUSSION
There were gaps in the interventions that have been proven successful in other global settings.
CONCLUSION
In SSA, there is a need for nurses to tailor, test, and disseminate findings from evidence-based projects for PU prevention that have been successful in similar settings.
Topics: Pressure Ulcer; Humans; Africa South of the Sahara; Female; Male; Adult; Middle Aged
PubMed: 38490058
DOI: 10.1016/j.outlook.2024.102151 -
Journal of Clinical Medicine Apr 2024Different suction-assisted nephrostomic sheaths have been developed for percutaneous nephrolithotomy (PCNL). (1) To examine PCNL techniques performed with different... (Review)
Review
Assessment of Effectiveness and Safety of Aspiration-Assisted Nephrostomic Access Sheaths in PCNL and Intrarenal Pressures Evaluation: A Systematic Review of the Literature.
Different suction-assisted nephrostomic sheaths have been developed for percutaneous nephrolithotomy (PCNL). (1) To examine PCNL techniques performed with different aspiration-assisted sheaths (Clear Petra sheath, Superperc, SuperminiPCNL, and a miniPCNL patented sheath), with specific regard to effectiveness and safety outcomes in adult and paediatric patients; (2) to extrapolate intrarenal pressure (IRP) data during these procedures. A systematic literature search was performed in accordance with PRISMA guidelines. Relevant articles up to 8 February 2024 were included. Twenty-five studies were selected, thirteen retrospective and twelve prospective. The use of four different aspirating sheaths for miniPCNL was reported: Clear Petra sheath, Superperc, SuperminiPCNL, and a miniPCNL patented sheath. Stone free rates (SFRs) across techniques ranged from 71.3% to 100%, and complication rates from 1.5% to 38.9%. Infectious complication rates varied from 0 to 27.8% and bleeding complication rates from 0 to 8.9%. Most complications were low grade ones. The trend among studies comparing aspiration- and non-aspiration-assisted miniPCNL was towards equivalent or better SFRs and lower overall infectious and bleeding complication rates in suction techniques. Operation time was consistently lower in suction procedures, with a mean shortening of the procedural time of 19 min. Seven studies reported IRP values during suction miniPCNL. Two studies reported satisfactory SFRs and adequate safety profiles in paediatric patient cohorts. MiniPCNL with aspirating sheaths appears to be safe and effective in both adult and paediatric patients. A trend towards a reduction of overall infectious and bleeding complications with respect to non-suction procedures is evident, with comparable or better SFRs and consistently shorter operative times. The IRP profile seems to be safe with the aid of aspirating sheaths. However, high quality evidence on this topic is still lacking.
PubMed: 38731086
DOI: 10.3390/jcm13092558 -
The American Journal of Sports Medicine Feb 2024Previous biomechanical studies have identified capsular closure, labral repair or reconstruction, and osteochondroplasty as important surgical interventions to improve...
BACKGROUND
Previous biomechanical studies have identified capsular closure, labral repair or reconstruction, and osteochondroplasty as important surgical interventions to improve hip stability.
PURPOSE
To investigate the outcome metrics used to quantify hip stability and assess and measure the relative contributions of the labrum, capsule, and bone to hip stability through a quantitative analysis.
STUDY DESIGN
Systematic review and meta-analysis; Level of evidence, 4.
METHODS
PubMed and Embase databases were searched using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies evaluated cadaveric hip biomechanics related to capsular, labral, and bony management during hip arthroscopy. Studies were assessed for distraction force and distance, fluid measures, and contact forces used to quantify the suction seal. Exclusion criteria included open surgery, arthroplasty, reorientation osteotomy, or traumatic dislocation.
RESULTS
A total of 33 biomechanical studies comprising 322 hips that evaluated 1 or more of the following were included: distraction force or distance (24 studies), fluid measures (10 studies), and contact forces (6 studies). Compared with a capsulotomy or capsulectomy, capsular repair or reconstruction demonstrated greater resistance to distraction (standardized mean difference [SMD], 1.13; 95% CI, 0.46-1.80; = .0009). Compared with a labral tear, a labral repair or reconstruction demonstrated less resistance to distraction (SMD, -0.67; 95% CI, -1.25 to -0.09; = .02). Compared with a labral debridement, repair or reconstruction demonstrated greater resistance to distraction (SMD, 1.74; 95% CI, 1.23 to 2.26; < .00001). No quantitative analysis was feasible from studies evaluating the effect of osseous resection due to the heterogeneity in methodology and outcome metrics assessed.
CONCLUSION
Most biomechanical evidence supports capsulotomy repair or reconstruction to improve hip distractive stability at the end of hip arthroscopic surgery. While the repair of a torn labrum does not improve distractive resistance, it is superior to labral debridement in most biomechanical studies.
PubMed: 38318815
DOI: 10.1177/03635465231208193 -
The Journal of Maternal-fetal &... Dec 2024Postpartum hemorrhage is a leading cause of maternal mortality and morbidity around the globe. The novel low-suction vacuum hemorrhage device (VHD) provides an... (Review)
Review
OBJECTIVE
Postpartum hemorrhage is a leading cause of maternal mortality and morbidity around the globe. The novel low-suction vacuum hemorrhage device (VHD) provides an alternative treatment option for cases of postpartum hemorrhage when first-line uterotonic agents fail. This systematic review aims to review current data evaluating the overall efficacy and safety of VHDs in treating postpartum hemorrhage.
METHODS
We searched CINAHL Ultimate, Academic Search Premier, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE with Full Text, and PubMed and reference lists of retrieved studies for eligible studies that included outcomes of effectiveness, efficacy, or safety. Two independent reviewers used Covidence.org to screen Titles and Abstracts for 69 studies of which six were included in the analysis. Secondary outcomes measured across studies included time to bleeding control, total device deployment time, and adverse effects.
RESULTS
Six nonrandomized trials ( = 1018 participants) included studies conducted in Indonesia, the United States, Switzerland, and Canada. The VHDs were found to have 90% effectiveness in achieving bleeding control across the studies. For most patients, this was achieved in <5 min and required a total device deployment time of 3 h. Reported adverse events were not considered life-threatening, including endometritis in 11 patients and red blood cell transfusions in 38% of patients.
CONCLUSION
VHDs have the potential to be used as a rapidly effective means for mechanical intervention of postpartum hemorrhage. The efficacy and safety of VHDs must be further studied at the randomized controlled trial level to determine their clinical usage.
Topics: Humans; Postpartum Hemorrhage; Female; Pregnancy
PubMed: 38735867
DOI: 10.1080/14767058.2024.2349957 -
Actas Urologicas Espanolas 2024High intrarenal pressure (IRP) is a potential risk factor for infectious complications related to URS. Methods to lower IRP have been described. However, it is still not... (Review)
Review
INTRODUCTION
High intrarenal pressure (IRP) is a potential risk factor for infectious complications related to URS. Methods to lower IRP have been described. However, it is still not possible to assess live IRP values during URS. The objective of this study was to perform a systematic review of the literature regarding endoscopic methods to measure IRP during URS.
METHODS
A systematic search and review of Medline, PubMed and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) checklist and a narrative synthesis of the study results was performed.
RESULTS
A total of 19 articles were included in the review. Four non invasive (i.e. endoscopic) methods to measure IRP were reported: ureteral catheter, sensor wire, pressure sensor proximal to an irrigation system and a novel ureteral access sheath that integrates suction, irrigation, and IRP measurement.
CONCLUSIONS
We provide here a comprehensive overview of the reported clinical measuring systems of IRP during URS. The ideal system has not been developed yet, but urologists will be able to measure IRP during their daily practice soon. The implications of having this type of data during surgery remains unknown. Systems that could integrate irrigation, suction, IRP and temperature seems to be ideal.
Topics: Inventions; Kidney; Pressure; Ureter; Ureteroscopy; Humans
PubMed: 37832846
DOI: 10.1016/j.acuroe.2023.10.007 -
Arthroscopy : the Journal of... Feb 2024To systematically review and compare biomechanical properties of labral reconstruction to labral repair, intact native labrum, and labral excision in cadaveric studies. (Review)
Review
Acetabular Labral Reconstruction Does Not Demonstrate Superior Biomechanical Properties Compared to Labral Repair or Intact Native Labrum but Is Superior to Labral Excision: A Systematic Review of Cadaveric Studies.
PURPOSE
To systematically review and compare biomechanical properties of labral reconstruction to labral repair, intact native labrum, and labral excision in cadaveric studies.
METHODS
A search of the PubMed and Embase databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Cadaveric studies focused on hip biomechanics related to intact labrum, labral repair, labral reconstruction, labral augmentation, and labral excision were included. Investigated parameters included biomechanical data measures, such as distraction force, distance to suction seal rupture, peak negative pressure, contact area, and fluid efflux. Review articles, duplicates, technique reports, case reports, opinion articles, articles written in a language other than English, clinical studies focusing on patient-reported outcomes, studies performed in animals, and articles with no abstract available were also excluded.
RESULTS
Fourteen cadaveric biomechanical studies were included that compared labral reconstruction to labral repair (4 studies), labral reconstruction to labral excision (4 studies); and evaluation of distractive force of the labrum (3 studies), the distance to suction seal rupture (3 studies), fluid dynamics (2 studies), displacement at peak force (1 study), and stability ratio (1 study). Data pooling was not performed because of methodological heterogenicity of the studies. Labral reconstruction did not outperform labral repair in restoring the hip suction seal or any other biomechanical property. Labral repair significantly prevented greater fluid efflux when compared to labral reconstruction. Labral repair and reconstruction improved the distractive stability of the hip fluid seal from the labral tear and labral excision stage, respectively. Furthermore, labral reconstruction demonstrated to have better biomechanical properties than labral excision.
CONCLUSIONS
In cadaveric studies, labral repair or intact native labrum was biomechanically more superior than labral reconstruction; however, labral reconstruction can restore acetabular labral biomechanical properties and was biomechanically superior to labral excision.
CLINICAL RELEVANCE
In cadaveric models, labral repair outperforms segmental labral reconstruction in preserving the hip suction seal; nonetheless, segmental labral reconstruction biomechanically outperforms labral excision at time 0.
Topics: Humans; Acetabulum; Cadaver; Hip Joint; Fibrocartilage; Lacerations
PubMed: 37270115
DOI: 10.1016/j.arthro.2023.05.025 -
Surgical Endoscopy Feb 2024Postoperative pain is a common issue following laparoscopic cholecystectomy. This meta-analysis aimed to determine if active gas aspiration is more effective than... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postoperative pain is a common issue following laparoscopic cholecystectomy. This meta-analysis aimed to determine if active gas aspiration is more effective than passive gas aspiration in reducing postoperative pain and analgesic requirements.
METHODOLOGY
The study conducted a systematic search of various databases, including Embase, Medline, and Cochrane Central Register of Controlled Trials (CENTRAL) via Ovid. It also searched trial registries and reference lists of included studies, with no date restrictions but limited to English language, up to December 21, 2022. The study included all randomized clinical trials that had documented elective laparoscopic cholecystectomy procedure and reported at least one relevant outcome. Articles that included subdiaphragmatic drain, intraperitoneal normal saline infusion, or pulmonary recruitment maneuver were excluded from the analysis. Two reviewers independently and in duplicate assessed the eligibility of studies and extracted data. The study reported findings according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The risk of bias of the included trials was assessed using the Revised Cochrane Risk of Bias Assessment Tool. The study used a random-effects model to pool data.
RESULTS
This meta-analysis included 5 randomized clinical trials with 367 participants and found that active gas aspiration resulted in significantly lower residual gas volume and total analgesia requirements compared to passive gas aspiration. Active gas aspiration also led to significantly lower shoulder pain scores at 24 h postoperatively. However, no significant differences were observed in hospital stay duration or abdominal pain scores.
CONCLUSION
The study found that active gas aspiration can be effective in reducing postoperative shoulder pain and analgesic requirements after laparoscopic cholecystectomy, which has important implications for patient care and healthcare costs. Importantly, this intervention does not impose any additional time or financial burden. However, further research is needed to evaluate its impact on other laparoscopic procedures.
Topics: Humans; Cholecystectomy, Laparoscopic; Shoulder Pain; Randomized Controlled Trials as Topic; Analgesics; Pain, Postoperative
PubMed: 38212468
DOI: 10.1007/s00464-023-10651-4 -
Acta Chirurgiae Plasticae 2024Breast reduction mammaplasty is the only effective therapeutic intervention for patients with symptomatic breast hypertrophy. In this procedure, closed suction drains...
Breast reduction mammaplasty is the only effective therapeutic intervention for patients with symptomatic breast hypertrophy. In this procedure, closed suction drains have become a standard of care, while the literature supporting use of drains is lacking. In fact, with emerging data we found out that drains might not be so necessary. This review aimed to systematically compare the number of complications in drained and undrained breasts and to evaluate the safety of omitting drains in reduction mammaplasty in clinical practice. A systematic review of literature was conducted identifying all studies on drainage in reduction mammaplasty. The analysed databases revealed 13 eligible studies to be included in this review. There were 308 drained breasts and 859 undrained breasts in total in patients from 16 to 73 years of age. The resected tissue weight per side fluctuated from 108 to 1,296 grams. In total, there was only 2.4% incidence of haematoma complications in undrained breasts and 3.9% in drained breasts. Closed suction drains are still being routinely used in reduction mammaplasty, although aborting drain use is proven to be not only safe, but advantageous. The clear benefit is increased patient comfort, shortened hospital stay, decreased cost of the procedure and nurse care, and decreased rate of complications.
Topics: Humans; Mammaplasty; Female; Drainage; Postoperative Complications; Suction; Breast; Middle Aged; Adult; Hypertrophy
PubMed: 38704230
DOI: 10.48095/ccachp20246