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Annals of Cardiac Anaesthesia 2022High prevalence of cerebral desaturation is associated with postoperative neurological complications in cardiac surgery. However, the evidence use of cerebral oximetry... (Meta-Analysis)
Meta-Analysis Review
High prevalence of cerebral desaturation is associated with postoperative neurological complications in cardiac surgery. However, the evidence use of cerebral oximetry by correcting cerebral desaturation in the reduction of postoperative complications remains uncertain in the literature. This systematic review and meta-analysis aimed to examine the effect of cerebral oximetry on the incidence of postoperative cognitive dysfunction in cardiac surgery. Databases of MEDLINE, EMBASE, and CENTRAL were searched from their inception until April 2021. All randomized controlled trials comparing cerebral oximetry and blinded/no cerebral oximetry in adult patients undergoing cardiac surgery were included. Observational studies, case series, and case reports were excluded. A total of 14 trials (n = 2,033) were included in this review. Our pooled data demonstrated that patients with cerebral oximetry were associated with a lower incidence of postoperative cognitive dysfunction than the control group (studies = 4, n = 609, odds ratio [OR]: 0.15, 95% confidence interval [CI]: 0.04 to 0.54, P = 0.003, I = 88%; certainty of evidence = very low). In terms of postoperative delirium (OR: 0.75, 95%CI: 0.50-1.14, P = 0.18, I = 0%; certainty of evidence = low) and postoperative stroke (OR: 0.81 95%CI: 0.37-1.80, P = 0.61, I = 0%; certainty of evidence = high), no significant differences (P > 0.05) were reported between the cerebral oximetry and control groups. In this meta-analysis, the use of cerebral oximetry monitoring in cardiac surgery demonstrated a lower incidence of postoperative cognitive dysfunction. However, this finding must be interpreted with caution due to the low level of evidence, high degree of heterogeneity, lack of standardized cognitive assessments, and cerebral desaturation interventions.
Topics: Adult; Cardiac Surgical Procedures; Delirium; Humans; Oximetry; Postoperative Cognitive Complications; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 36254901
DOI: 10.4103/aca.aca_149_21 -
The Lancet. Digital Health Apr 2022The COVID-19 pandemic has led health systems to increase the use of tools for monitoring and triaging patients remotely. In this systematic review, we aim to assess the... (Review)
Review
The COVID-19 pandemic has led health systems to increase the use of tools for monitoring and triaging patients remotely. In this systematic review, we aim to assess the effectiveness and safety of pulse oximetry in remote patient monitoring (RPM) of patients at home with COVID-19. We searched five databases (MEDLINE, Embase, Global Health, medRxiv, and bioRxiv) from database inception to April 15, 2021, and included feasibility studies, clinical trials, and observational studies, including preprints. We found 561 studies, of which 13 were included in our narrative synthesis. These 13 studies were all observational cohorts and involved a total of 2908 participants. A meta-analysis was not feasible owing to the heterogeneity of the outcomes reported in the included studies. Our systematic review substantiates the safety and potential of pulse oximetry for monitoring patients at home with COVID-19, identifying the risk of deterioration and the need for advanced care. The use of pulse oximetry can potentially save hospital resources for patients who might benefit the most from care escalation; however, we could not identify explicit evidence for the effect of RPM with pulse oximetry on health outcomes compared with other monitoring models such as virtual wards, regular monitoring consultations, and online or paper diaries to monitor changes in symptoms and vital signs. Based on our findings, we make 11 recommendations across the three Donabedian model domains and highlight three specific measurements for setting up an RPM system with pulse oximetry.
Topics: COVID-19; Humans; Monitoring, Physiologic; Oximetry; Pandemics
PubMed: 35337644
DOI: 10.1016/S2589-7500(21)00276-4 -
Annals of Plastic Surgery Nov 2023Tissue oximetry monitoring has shown superior outcomes to conventional monitoring methods for autologous breast reconstruction in retrospective studies with consecutive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Tissue oximetry monitoring has shown superior outcomes to conventional monitoring methods for autologous breast reconstruction in retrospective studies with consecutive cohorts. A recent study used consecutive cohorts with tissue oximetry as the earlier cohort and found that tissue oximetry was nonsuperior. We hypothesize that improvement in microsurgical outcomes with institutional experience confounds the superiority of tissue oximetry demonstrated in prior studies. This study aimed to perform a systematic review and meta-analysis of the outcomes of tissue oximetry monitoring compared with conventional monitoring.
METHODS
Relevant studies were found using PubMed, Embase, and Web of Science searches for keywords such as near-infrared spectroscopy or tissue oximetry and microsurgery. Studies included compared tissue oximetry and conventional monitoring in autologous breast reconstruction patients. Studies were excluded if they did not contain a comparison group. Random-effective models were used to analyze early returns to the operating room, the total number of partial or complete flap loss, and late fat necrosis.
RESULTS
Six hundred sixty-nine studies were identified; 3 retrospective cohort studies met the inclusion criteria. A total of 1644 flaps were in the tissue oximetry cohort, and 1387 flaps were in the control cohort. One study contained tissue oximetry as the former cohort; 2 had tissue oximetry as the latter. Neither technique was superior for any measured outcomes. The estimated mean differences between tissue oximetry and conventional monitoring method were early returns, -0.06 (95% confidence interval [CI], -0.52 to 0.410; P = 0.82); partial flap loss, -0.04 (95% CI, -0.86 to 0.79; P = 0.93); complete flap loss, -1.29 (95% CI, -3.45 to 0.87; P = 0.24); and late fat necrosis -0.02 (95% CI, -0.42 to, 0.39; P = 0.94).
CONCLUSIONS
In a systematic review and meta-analysis of mixed timeline retrospective cohort studies, tissue oximetry does not provide superior patient outcomes and shifts our current understanding of postoperative breast reconstruction monitoring. Prospective studies and randomized trials comparing monitoring methods need to be included in the existing literature.
Topics: Humans; Retrospective Studies; Prospective Studies; Fat Necrosis; Mammaplasty; Postoperative Complications; Oximetry
PubMed: 37823627
DOI: 10.1097/SAP.0000000000003705 -
The Journal of Cardiovascular Nursing Sep 2023Lower limb peripheral artery disease (PAD) is associated with poor outcomes including ulceration, gangrene, amputations, and mortality. Clinicians therefore routinely...
BACKGROUND
Lower limb peripheral artery disease (PAD) is associated with poor outcomes including ulceration, gangrene, amputations, and mortality. Clinicians therefore routinely perform point-of-care tests in high-risk populations to identify PAD and subsequently implement cardiovascular management and appropriate interventions. Pulse oximetry has been suggested as a useful adjunct test for identifying PAD.
OBJECTIVE
The aim of this systematic review was to determine the sensitivity and specificity of pulse oximetry in the lower limb for identifying PAD.
METHODS
MEDLINE, EMBASE, and CINAHL were searched up until January 10, 2023, to identify studies of sensitivity and specificity of pulse oximetry that used criterion standard diagnostic imaging as a reference standard. Two authors screened articles for inclusion and appraised quality of included studies using the Quality Appraisal for Diagnostic Accuracy Studies, version 2.
RESULTS
A total of 6371 records were screened, and 4 were included. The included studies had a total of 471 participants, with an age range of 41 to 80.6 years. All studies were cross-sectional and conducted in hospital settings. Sensitivity values for pulse oximetry compared with diagnostic imaging in identifying PAD ranged from 44% to 76%, and specificity values ranged from 85% to 96%. There was no consensus regarding measurement techniques and diagnostic thresholds for pulse oximetry, which precluded meta-analysis.
CONCLUSIONS
There is currently inadequate evidence to support the use of pulse oximetry for identifying PAD. Current evidence suggests that pulse oximetry has low levels of sensitivity and is therefore likely to miss PAD when it is present.
PubMed: 37787731
DOI: 10.1097/JCN.0000000000001030 -
Journal of Cardiothoracic and Vascular... Jul 2022The evidence on the use of cerebral oximetry during surgery to minimize postoperative neurologic complications remains uncertain in the literature. The present authors... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The evidence on the use of cerebral oximetry during surgery to minimize postoperative neurologic complications remains uncertain in the literature. The present authors aimed to assess the value of cerebral oximetry in the prevention of postoperative cognitive dysfunction, postoperative delirium, and postoperative stroke in adults undergoing surgery.
DESIGN
A systematic review and meta-analysis.
SETTING
The surgery room.
PARTICIPANTS
Adult patients (ages ≥18 years) undergoing surgery.
INTERVENTIONS
Cerebral oximetry monitoring.
MEASUREMENTS AND MAIN RESULTS
Databases of Ovid MEDLINE, Ovid EMBASE, and CENTRAL were systematically searched from their inception until December 2020 for randomized controlled trials comparing cerebral oximetry monitoring with either blinded or no cerebral oximetry monitoring in adults undergoing surgery. Observational studies, case reports, and case series were excluded. Seventeen studies (n = 2,120 patients) were included for quantitative meta-analysis. Patients who were randomized to cerebral oximetry monitoring had a lower incidence of postoperative cognitive dysfunction (studies = seven, n = 969, odds ratio [OR] 0.23, 95% confidence interval [CI] 0.11-0.48, p = 0.0001; evidence = very low). However, no significant differences were observed in the incidence of postoperative delirium (studies = five, n = 716, OR 0.81, 95% CI 0.53-1.25, p = 0.35; evidence = high), and postoperative stroke (studies = seven, n = 1,087, OR 0.72, 95% CI 0.30-1.69, p = 0.45; evidence = moderate).
CONCLUSION
Adult patients with cerebral oximetry monitoring were associated with a significant reduction of postoperative cognitive dysfunction. However, given the low certainty of evidence and substantial heterogeneity, more randomized controlled trials using standardized assessment tools for postoperative cognitive dysfunction and interventions of correcting cerebral desaturation are warranted to improve the certainty of evidence and homogeneity.
Topics: Adolescent; Adult; Cerebrovascular Circulation; Delirium; Humans; Oximetry; Postoperative Cognitive Complications; Postoperative Complications; Randomized Controlled Trials as Topic; Stroke
PubMed: 34657798
DOI: 10.1053/j.jvca.2021.09.046 -
Journal of Clinical Anesthesia Jun 2024The current standards of postoperative respiratory monitoring on medical-surgical floors involve spot-pulse oximetry checks every 4-8 h, which can miss the opportunity... (Meta-Analysis)
Meta-Analysis Review
Role of continuous pulse oximetry and capnography monitoring in the prevention of postoperative respiratory failure, postoperative opioid-induced respiratory depression and adverse outcomes on hospital wards: A systematic review and meta-analysis.
OBJECTIVE
The current standards of postoperative respiratory monitoring on medical-surgical floors involve spot-pulse oximetry checks every 4-8 h, which can miss the opportunity to detect prolonged hypoxia and acute hypercapnia. Continuous respiratory monitoring can recognize acute respiratory depression episodes; however, the existing evidence is limited. We sought to review the current evidence on the effectiveness of continuous pulse oximetry (CPOX) with and without capnography versus routine monitoring and their effectiveness for detecting postoperative respiratory failure, opioid-induced respiratory depression, and preventing downstream adverse events.
METHODS
We performed a systematic literature search on Ovid Medline, Embase, and Cochrane Library databases for articles published between 1990 and April 2023. The study protocol was registered in Prospero (ID: 439467), and PRISMA guidelines were followed. The NIH quality assessment tool was used to assess the quality of the studies. Pooled analysis was conducted using the software R version 4.1.1 and the package meta. The stability of the results was assessed using sensitivity analysis.
DESIGN
Systematic Review and Meta-Analysis.
SETTING
Postoperative recovery area.
PATIENTS
56,538 patients, ASA class II to IV, non-invasive respiratory monitoring, and post-operative respiratory depression.
INTERVENTIONS
Continuous pulse oximetry with or without capnography versus routine monitoring.
MEASUREMENTS
Respiratory rate, oxygen saturation, adverse events, and rescue events.
RESULTS
23 studies (17 examined CPOX without capnography and 5 examined CPOX with capnography) were included in this systematic review. CPOX was better at recognizing desaturation (SpO < 90%) OR: 11.94 (95% CI: 6.85, 20.82; p < 0.01) compared to standard monitoring. No significant differences were reported for ICU transfer, reintubation, and non-invasive ventilation between the two groups.
CONCLUSIONS
Oxygen desaturation was the only outcome better detected with CPOX in postoperative patients in hospital wards. These comparisons were limited by the small number of studies that could be pooled for each outcome and the heterogeneity between the studies.
Topics: Humans; Analgesics, Opioid; Respiratory Rate; Capnography; Monitoring, Physiologic; Respiratory Insufficiency; Oximetry; Postoperative Complications; Hospitals
PubMed: 38184918
DOI: 10.1016/j.jclinane.2024.111374 -
JAMA Network Open Mar 2023High-dose docosahexaenoic acid (DHA), a long-chain polyunsaturated fatty acid, may affect the risk of bronchopulmonary dysplasia (BPD). However, high-level summative... (Meta-Analysis)
Meta-Analysis
Association Between Enteral Supplementation With High-Dose Docosahexaenoic Acid and Risk of Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review and Meta-analysis.
IMPORTANCE
High-dose docosahexaenoic acid (DHA), a long-chain polyunsaturated fatty acid, may affect the risk of bronchopulmonary dysplasia (BPD). However, high-level summative evidence supporting such clinical association in very preterm infants is lacking.
OBJECTIVE
To examine the association between enteral supplementation with high-dose DHA during the neonatal period and the risk of BPD in preterm infants born at less than 29 weeks' gestation.
DATA SOURCES
PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, medRxiv, and ClinicalTrials.gov were searched from inception to August 1, 2022, for eligible articles with no language restrictions.
STUDY SELECTION
Randomized clinical trials (RCTs) were eligible for inclusion (1) if their interventions involved direct administration of a minimum DHA supplementation of 40 mg/kg/d or breast milk or formula feeding of at least 0.4% of total fatty acids, and (2) if they reported data on either BPD, death, BPD severity, or a combined outcome of BPD and death.
DATA EXTRACTION AND SYNTHESIS
Two investigators completed independent review of titles and abstracts, full text screening, data extraction, and quality assessment using the Cochrane Risk of Bias 2.0. Risk ratios (RRs) with 95% CIs were pooled using random-effect meta-analyses.
MAIN OUTCOMES AND MEASURES
Primary outcome was BPD using trial-specific definitions, which was further stratified for RCTs that used a more stringent BPD definition based on systematic pulse oximetry assessment at 36 weeks' postmenstrual age. Other outcomes were BPD, death, BPD severity, or combined BPD and death.
RESULTS
Among the 2760 studies screened, 4 RCTs were included, which involved 2304 infants (1223 boys [53.1%]; mean [SD] gestational age, 26.5 [1.6] weeks). Enteral supplementation with high-dose DHA was associated with neither BPD (4 studies [n = 2186 infants]; RR, 1.07 [95% CI, 0.86-1.34]; P = .53; I2 = 72%) nor BPD or death (4 studies [n = 2299 infants]; RR, 1.04 [95% CI, 0.91-1.18]; P = .59; I2 = 61%). However, an inverse association with BPD was found in RCTs that used a more stringent BPD definition (2 studies [n = 1686 infants]; RR, 1.20 [95% CI, 1.01-1.42]; P = .04; I2 = 48%). Additionally, DHA was inversely associated with moderate-to-severe BPD (3 studies [n = 1892 infants]; RR, 1.16 [95% CI, 1.04-1.29]; P = .008; I2 = 0%).
CONCLUSIONS AND RELEVANCE
Results of this study showed that enteral supplementation with high-dose DHA in the neonatal period was not associated overall with BPD, but an inverse association was found in the included RCTs that used a more stringent BPD definition. These findings suggest that high-dose DHA supplementation should not be recommended to prevent BPD in very preterm infants.
Topics: Infant, Newborn; Infant; Male; Female; Humans; Adult; Docosahexaenoic Acids; Bronchopulmonary Dysplasia; Infant, Premature; Gestational Age; Infant, Premature, Diseases; Fetal Growth Retardation; Dietary Supplements
PubMed: 36943265
DOI: 10.1001/jamanetworkopen.2023.3934 -
International Wound Journal Dec 2023Ankle Brachial Pressure Index (ABPI) measurement has long been considered the gold standard of vascular assessment for people with lower limb ulceration. Despite this,... (Review)
Review
Ankle Brachial Pressure Index (ABPI) measurement has long been considered the gold standard of vascular assessment for people with lower limb ulceration. Despite this, only around 15% of patients in the United Kingdom who require an ABPI measurement undergo the assessment. The Lanarkshire Oximetry Index (LOI) is a cheaper and arguably more accessible approach to vascular assessment and was initially proposed as an alternative to the ABPI in 2000. No synthesis of evidence related to the LOI has been performed since its introduction into the literature. Primary studies were sought to determine the clinimetric properties of the LOI and its level of agreement with ABPI assessments. Systematic searches of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, BNI, ProQuest Health and Medicine, Science Direct, Google Scholar and the British Library (online search) were conducted. Reference lists of identified studies were also reviewed to identify additional studies. Three primary studies met the inclusion criteria, reporting data from 307 patients and 584 limbs assessed using both the LOI and ABPI. All three studies reported fair to moderate kappa values for interrater reliability (κ = 0.290-0.747) and statistically significant positive correlation coefficients (r = 0.37, p < 0.001 in two studies) between the LOI and ABPI. The combined data from the three studies indicated a sensitivity of 52% (41.78-62.1, 95% confidence interval [CI]) and specificity of 96.08% (93.4-97.9, 95% CI) for the LOI using the ABPI as a reference. Additional data are required to indicate the safety of the LOI in practice. Data are also required to determine if the LOI is more acceptable to clinicians compared to the ABPI and whether there are any barriers/enablers to its implementation in practice. Given the relatively low specificity of the LOI, it may be beneficial to combine measurement of the LOI with a subjective clinical risk assessment tool to improve the sensitivity of this alternative approach to vascular assessment.
PubMed: 38050665
DOI: 10.1111/iwj.14519 -
Evidence-based Dentistry Dec 2022Data sources Medline, Web of Science and the Cochrane Central Register of Controlled Trials databases along with Google Scholar, Greylist and OpenGrey were... (Meta-Analysis)
Meta-Analysis Review
Data sources Medline, Web of Science and the Cochrane Central Register of Controlled Trials databases along with Google Scholar, Greylist and OpenGrey were systematically searched (up to December 2020).Study selection In vivo observational studies and clinical trials assessing the diagnostic accuracy of pulp vitality tests and sensibility tests in adult human teeth were screened. Exclusion criteria included non-English articles, deciduous teeth, case reports and in vitro studies.Data extraction and synthesis Data extracted included basic study location, sample size, age of participants, pathology of teeth, type of teeth and the vitality (pulse oximetry or Laser Doppler flowmetry) or sensibility test (cold, hot and electric pulp testing) used. Measures of diagnostic accuracy were synthesised (sensitivity, sensibility, predictive values, and likelihood ratios). Meta-analysis was performed using a bivariate random-effects model producing summary values for sensitivity and specificity. Results were presented as a ROC curve. Risk of bias and the quality of the studies were assessed using the QUADAS-2 tool.Results A total of ten studies were included in the review, of which five were included in the meta-analysis. Overall risk of bias was unclear. Pulse oximetry showed higher diagnostic accuracy than electric pulp testing and thermal testing. Insufficient data precluded quantitative analysis for Laser Doppler flowmetry.Conclusions Pulse oximetry demonstrates greater diagnostic accuracy when compared to sensibility testing. Limited sample size and heterogeneity among the included studies limits their applicability.
Topics: Adult; Humans; Dental Pulp; Dental Pulp Test; Dentition, Permanent; Laser-Doppler Flowmetry; Sensitivity and Specificity
PubMed: 36526833
DOI: 10.1038/s41432-022-0847-5 -
Respiratory Care Sep 2023The effect of application of fingernail polish on S measurement remains unclear. We conducted this systematic review to ascertain the impact of fingernail polish on S... (Review)
Review
BACKGROUND
The effect of application of fingernail polish on S measurement remains unclear. We conducted this systematic review to ascertain the impact of fingernail polish on S measurement.
METHODS
We queried PubMed, Embase, and CINAHL databases for publications indexed through December 2022. We included studies providing paired S data from fingertips without and after nail polish application or reporting the number of subjects whose S could not be measured due to fingernail polish. We used random effects modeling to summarize standardized mean differences (SMDs) and corresponding 95% CI for different nail polish colors from comparative studies.
RESULTS
We retrieved 122 studies and included 21 publications, mostly performed on healthy volunteers. Of these, 17 (81.0%) studies had a low risk of bias. We summarized mean SMD for 10 nail polish colors (black, blue, brown, green, orange, pink, purple, red, white, and yellow) from 25 paired data sets on S across 20 studies. We found small (likely clinically insignificant) but statistically significant differences in mean S when fingers were coated with black, blue, brown, or purple nail polish (SMD -0.57, -0.47, -0.33, and -0.25, respectively; 95% CI -0.86 to -0.29, -0.84 to -0.10, -0.59 to -0.07, and -0.48 to -0.02, respectively). Only one of 4 studies reported a high proportion of unsuccessful oximeter readings from fingers painted with black (88.0%) or brown (36.0%) nail polish.
CONCLUSIONS
Although fingernail polish of some colors can marginally reduce S reading or occasionally impede S measurement, the variability is clinically insignificant.
Topics: Humans; Color; Cosmetics; Nails; Oximetry; Oxygen
PubMed: 37185113
DOI: 10.4187/respcare.10399