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BMC Gastroenterology Jan 2021Sedation is commonly used in gastrointestinal endoscopy; however, considerable variability in sedation practices has been reported. The objective of this review was to...
BACKGROUND
Sedation is commonly used in gastrointestinal endoscopy; however, considerable variability in sedation practices has been reported. The objective of this review was to identify and synthesize existing recommendations on sedation practices for routine gastrointestinal endoscopy procedures.
METHODS
We systematically reviewed guidelines and position statements identified through a search of PubMed, guidelines databases, and websites of relevant professional associations from January 1, 2005 to May 10, 2019. We included English-language guidelines/position statements with recommendations relating to sedation for adults undergoing routine gastrointestinal endoscopy. Documents with guidance only for complex endoscopic procedures were excluded. We extracted and synthesized recommendations relating to: 1) choice of sedatives, 2) sedation administration, 3) personnel responsible for monitoring sedated patients, 4) skills and training of individuals involved in sedation, and 5) equipment required for monitoring sedated patients. We assessed the quality of included documents using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool.
RESULTS
We identified 19 guidelines and 7 position statements meeting inclusion criteria. Documents generally agreed that a single, trained registered nurse can administer moderate sedation, monitor the patient, and assist with brief, interruptible tasks. Documents also agreed on the routine use of pulse oximetry and blood pressure monitoring during endoscopy. However, recommendations relating to the drugs to be used for sedation, the healthcare personnel capable of administering propofol and monitoring patients sedated with propofol, and the need for capnography when monitoring sedated patients varied. Only 9 documents provided a grade or level of evidence in support of their recommendations.
CONCLUSIONS
Recommendations for sedation practices in routine gastrointestinal endoscopy differ across guidelines/position statements and often lack supporting evidence with potential implications for patient safety and procedural efficiency.
Topics: Adult; Anesthesia; Conscious Sedation; Endoscopy, Gastrointestinal; Humans; Hypnotics and Sedatives; Propofol
PubMed: 33413147
DOI: 10.1186/s12876-020-01561-z -
Critical Care (London, England) May 2023Since oxygen content and oxygen consumption typically remain unchanged within a short period, variation in central venous oxygen saturation (ΔScvO) during fluid... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Since oxygen content and oxygen consumption typically remain unchanged within a short period, variation in central venous oxygen saturation (ΔScvO) during fluid challenge can theoretically track the changes in cardiac output (CO). We conducted this meta-analysis to systematically assess the diagnostic performance of ΔScvO during a fluid challenge for fluid responsiveness in mechanically ventilated patients receiving volume expansion.
METHODS
Electronic databases were systematically searched to identify relevant studies published before October 24, 2022. As the cutoff value of ΔScvO was expected to vary across the included studies, we estimated the area under the hierarchical summary receiver operating characteristic curve (AUHSROC) as the primary measure of diagnostic accuracy. The optimal threshold of ΔScvO and the corresponding 95% confidential interval (CI) were also estimated.
RESULTS
This meta-analysis included 5 observational studies comprising 240 participants, of whom 133 (55%) were fluid responders. Overall, the ΔScvO during the fluid challenge exhibited excellent performance for defining fluid responsiveness in mechanically ventilated patients receiving volume expansion, with an AUHSROC of 0.86 (95% CI 0.83-0.89), a pooled sensitivity of 0.78 (95% CI 0.69-0.85), a pooled specificity of 0.84 (95% CI 0.72-0.91), and a pooled diagnostic odds ratio of 17.7 (95% CI 5.9-53.2). The distribution of the cutoff values was nearly conically symmetrical and concentered between 3 and 5%; the mean and median cutoff values were 4% (95% CI 3-5%) and 4% (95% CI not estimable), respectively.
CONCLUSIONS
In mechanically ventilated patients receiving volume expansion, the ΔScvO2 during the fluid challenge is a reliable indicator of fluid responsiveness. Clinical trial registration PROSPERO, https://www.crd.york.ac.uk/prospero/ , registry number: CRD42022370192.
Topics: Humans; Respiration, Artificial; Oxygen Saturation; Oximetry; Cardiac Output; ROC Curve; Fluid Therapy; Hemodynamics; Observational Studies as Topic
PubMed: 37237410
DOI: 10.1186/s13054-023-04480-z -
PloS One 2020The present meta-analysis was based on the available studies to determine the potential role of the initial and regional cerebral oxygen saturation (rSO2) in monitoring... (Meta-Analysis)
Meta-Analysis
The present meta-analysis was based on the available studies to determine the potential role of the initial and regional cerebral oxygen saturation (rSO2) in monitoring the efficiency of cardiopulmonary resuscitation (CPR) and predicting the return of spontaneous circulation (ROSC). Three electronic databases of PubMed, Embase, and the Cochrane Library were searched to identify the studies that investigated the role of rSO2 on ROSC in CA patients throughout May 2018. The weighted mean difference (WMD) with 95% confidence interval (CI) was calculated to estimate the pooled effect using a random-effects model. Sensitivity, subgroup analyses, and publication bias were conducted. A total of 13 studies involving 678 CA patients (300 in-hospital (IH) patients, and 378 out-hospital (OH) patients) were included. The summary WMD suggested that ROSC patients were associated with higher initial rSO2 (WMD: 10.10%; 95% CI: 5.66-14.55; P<0.001) and mean rSO2 (WMD: 14.16%; 95% CI: 10.51-17.81; P<0.001) levels during CA and ROSC as compared to the non-ROSC. The results of meta-regression suggested that the male percentage and the location of cardiac arrest might bias the initial or mean rSO2 and the incidence of ROSC. These significant differences were observed in nearly all subsets. The findings of this study suggested that high initial or mean rSO2 levels were both associated with an increased incidence of ROSC in CA patients undergoing CPR. These correlations might be affected by the percentage of males or the location of cardiac arrest, thereby necessitating further large-scale studies to substantiate whether these correlations differ according to gender and the location of cardiac arrest.
Topics: Aged; Aged, 80 and over; Blood Circulation; Cardiopulmonary Resuscitation; Cerebrovascular Circulation; Female; Heart Arrest; Humans; Male; Middle Aged; Out-of-Hospital Cardiac Arrest; Outcome Assessment, Health Care; Oximetry; Oxygen; Prognosis; Spectroscopy, Near-Infrared
PubMed: 32857778
DOI: 10.1371/journal.pone.0234979 -
PloS One 2023Recovery of cognitive and physiological responses following a hypoxic exposure may not be considered in various operational and research settings. Understanding recovery...
Recovery of cognitive and physiological responses following a hypoxic exposure may not be considered in various operational and research settings. Understanding recovery profiles and influential factors can guide post-hypoxia restrictions to reduce the risk of further cognitive and physiological deterioration, and the potential for incidents and accidents. We systematically evaluated the available evidence on recovery of cognitive and basic physiological responses following an acute hypoxic exposure to improve understanding of the performance and safety implications, and to inform post-hypoxia restrictions. This systematic review summarises 30 studies that document the recovery of either a cognitive or physiological index from an acute hypoxic exposure. Titles and abstracts from PubMed (MEDLINE) and Scopus were searched from inception to July 2022, of which 22 full text articles were considered eligible. An additional 8 articles from other sources were identified and also considered eligible. The overall quality of evidence was moderate (average Rosendal score, 58%) and there was a large range of hypoxic exposures. Heart rate, peripheral blood haemoglobin-oxygen saturation and heart rate variability typically normalised within seconds-to-minutes following return to normoxia or hyperoxia. Whereas, cognitive performance, blood pressure, cerebral tissue oxygenation, ventilation and electroencephalogram indices could persist for minutes-to-hours following a hypoxic exposure, and one study suggested regional cerebral tissue oxygenation requires up to 24 hours to recover. Full recovery of most cognitive and physiological indices, however, appear much sooner and typically within ~2-4 hours. Based on these findings, there is evidence to support a 'hypoxia hangover' and a need to implement restrictions following acute hypoxic exposures. The severity and duration of these restrictions is unclear but should consider the population, subsequent requirement for safety-critical tasks and hypoxic exposure.
Topics: Humans; Hypoxia; Oximetry; Respiration; Blood Pressure; Cognition
PubMed: 37585402
DOI: 10.1371/journal.pone.0289716 -
The Canadian Journal of Cardiology Nov 2021In this study, we sought to estimate the prevalence of concomitant sleep-disordered breathing (SDB) in patients with atrial fibrillation (AF) and to systematically... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In this study, we sought to estimate the prevalence of concomitant sleep-disordered breathing (SDB) in patients with atrial fibrillation (AF) and to systematically evaluate how SDB is assessed in this population.
METHODS
We searched Medline, Embase and Cinahl databases through August 2020 for studies reporting on SDB in a minimum 100 patients with AF. For quantitative analysis, studies were required to have systematically assessed for SDB in consecutive AF patients. Pooled prevalence estimates were calculated with the use of the random effects model. Weighted mean differences and odds ratios were calculated when possible to assess the strength of association between baseline characteristics and SDB.
RESULTS
The search yielded 2758 records, of which 33 studies (n = 23,894 patients) met the inclusion criteria for qualitative synthesis and 13 studies (n = 2660 patients) met the meta-analysis criteria. The pooled SDB prevalence based on an SDB diagnosis cutoff of apnea-hypopnea index (AHI) ≥ 5/h was 78% (95% confidence interval [CI] 70%-86%; P < 0.001). For moderate-to-severe SDB (AHI ≥ 15/h), the pooled SDB prevalence was 40% (95% CI 32%-48%; P < 0.001). High degrees of heterogeneity were observed (I = 96% and 94%, respectively; P < 0.001). Sleep testing with the use of poly(somno)graphy or oximetry was the most common assessment tool used (in 22 studies, 66%) but inconsistent diagnostic thresholds were used.
CONCLUSIONS
SDB is highly prevalent in patients with AF. Wide variation exists in the diagnostic tools and thresholds used to detect concomitant SDB in AF. Prospective systematic testing for SDB in unselected cohorts of AF patients may be required to define the true prevalence of SDB in this population.
Topics: Atrial Fibrillation; Global Health; Humans; Morbidity; Oximetry; Polysomnography; Risk Assessment; Risk Factors; Sleep Apnea Syndromes; Survival Rate
PubMed: 34606918
DOI: 10.1016/j.cjca.2021.09.026 -
Cranio : the Journal of... May 2023To review the available bibliographic data to identify the best screening methods to detect potential obstructive sleep apnea (OSA) patients during dental clinical... (Review)
Review
OBJECTIVE
To review the available bibliographic data to identify the best screening methods to detect potential obstructive sleep apnea (OSA) patients during dental clinical practice.
METHODS
Relevant studies published up to April 2020 were sourced from PubMed, Embase, MEDLINE, Cochrane, and LILACS databases.
RESULTS
Thirty studies were selected. For adults, the screening methods available to the dentist included questionnaires, scales, indexes, pulse oximetry, and anatomical factors. A combination of questionnaires is potentially the most reliable method to detect OSA risk. For children, only information on questionnaires and anatomical factors was found; two questionnaires accurately identified potential OSA risk cases. Anatomical factors also displayed a significant relation with OSA for both populations.
CONCLUSION
Dentists have a fundamental role in early detection of potential OSA cases since they can use the methods identified in this review to perform an initial screening of the population.
ABBREVIATIONS
OSA: Obstructive sleep apnea; PSG: Polysomnography; HST: Home sleep study; BMI: Body mass index; PPV: Positive predictive value; NPV: Negative predictive value; AHI: Apnea hypopnea index; RDI: Respiratory disturbance index; ODI: Oxygen desaturation index; PSQ: Pediatric Sleep Questionnaire; SRBD: Sleep-related breathing disorder; CSHQ: Children's Sleep Habits Questionnaire; ESS: Epworth Sleepiness Scale; PSQI: Pittsburgh Sleep Quality Index.
Topics: Adult; Humans; Child; Dental Clinics; Sleep Apnea, Obstructive; Predictive Value of Tests; Oximetry; Oxygen; Surveys and Questionnaires; Mass Screening
PubMed: 32981480
DOI: 10.1080/08869634.2020.1823104 -
BMC Pulmonary Medicine Jun 2021Patients undergoing bronchoscopy in spontaneous breathing are prone to hypoxaemia and hypercapnia. Sedation, airway obstruction, and lung diseases impair respiration and...
BACKGROUND
Patients undergoing bronchoscopy in spontaneous breathing are prone to hypoxaemia and hypercapnia. Sedation, airway obstruction, and lung diseases impair respiration and gas exchange. The restitution of normal respiration takes place in the recovery room. Nonetheless, there is no evidence on the necessary observation time. We systematically reviewed current guidelines on bronchoscopy regarding sedation, monitoring and recovery.
METHODS
This review was registered at the PROSPERO database (CRD42020197476). MEDLINE and awmf.org were double-searched for official guidelines, recommendation or consensus statements on bronchoscopy from 2010 to 2020. The PICO-process focussed on adults (Patients), bronchoscopy with maintained spontaneous breathing (Interventions), and recommendations regarding the intra- and postprocedural monitoring and sedation (O). The guideline quality was graded. A catalogue of 54 questions was answered. Strength of recommendation and evidence levels were recorded for each recommendation.
RESULTS
Six guidelines on general bronchoscopy and three expert statements on special bronchoscopic procedures were identified. Four guidelines were evidence-based. Most guidelines recommend sedation to improve the patient's tolerance. Midazolam combined with an opioid is preferred. The standard monitoring consists of non-invasive blood pressure, and pulse oximetry, furthermore electrocardiogram in cardiac patients. Only one guideline discusses hypercapnia and capnometry, but without consensus. Two guidelines discuss a recovery time of two hours, but a recommendation was not given because of lack of evidence.
CONCLUSION
Evidence for most issues is low to moderate. Lung-diseased patients are not represented by current guidelines. Capnometry and recovery time lack evidence. More primary research in these fields is needed so that future guidelines may address these issues, too.
Topics: Adult; Analgesics, Opioid; Blood Gas Monitoring, Transcutaneous; Bronchoscopy; Carbon Dioxide; Conscious Sedation; Guidelines as Topic; Humans; Hypercapnia; Midazolam; Patient Safety
PubMed: 34112130
DOI: 10.1186/s12890-021-01532-4 -
The Journal of Pediatrics Dec 2019To evaluate the efficacy of high-flow nasal cannula (HFNC) oxygen therapy in providing respiratory support of children with acute lower respiratory infection (ALRI),... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To evaluate the efficacy of high-flow nasal cannula (HFNC) oxygen therapy in providing respiratory support of children with acute lower respiratory infection (ALRI), hypoxemia, and respiratory distress.
STUDY DESIGN
We performed a meta-analysis of randomized controlled trials that compared HFNC and standard flow oxygen therapy or nasal continuous positive airway pressure (nCPAP) and reported treatment failure as an outcome. Data were synthesized using Mann-Whitney U test.
RESULTS
Compared with standard oxygen therapy, HFNC significantly reduced treatment failure (risk ratio [RR] 0.49, 95% CI 0.40-0.60, P < .001) in children with mild hypoxemia (arterial pulse oximetry [SpO] >90% on room air). HFNC had an increased risk of treatment failure compared with nCPAP in infants age 1-6 months with severe hypoxemia (SpO <90% on room air or SpO >90% on supplemental oxygen) (RR 1.77, 95% CI 1.17-2.67, P = .007). No significant differences were found in intubation rates and mortality between HFNC and standard oxygen therapy or nCPAP. HFNC had a lower risk of nasal trauma compared with nCPAP (RR 0.35, 95% CI 0.16-0.77, P = .009).
CONCLUSIONS
Among children <5 years of age with ALRI, respiratory distress, and mild hypoxemia, HFNC reduced the risk of treatment failure when compared with standard oxygen therapy. However, nCPAP was associated with a lower risk of treatment failure than HFNC in infants age 1-6 months with ALRI, moderate-to-severe respiratory distress, and severe hypoxemia. No differences were found in intubation and mortality between HFNC and standard oxygen therapy or nCPAP.
Topics: Cannula; Continuous Positive Airway Pressure; Humans; Hypoxia; Oxygen Inhalation Therapy; Randomized Controlled Trials as Topic; Respiratory Insufficiency
PubMed: 31570155
DOI: 10.1016/j.jpeds.2019.07.059 -
Indian Journal of Anaesthesia Aug 2020Evaluations of adverse heart rate (HR)-responses and HR-variations during anaesthesia in beach-chair-position (BCP) for shoulder surgeries have not been done earlier. We...
Adverse heart rate responses during beach-chair position for shoulder surgeries - A systematic review and meta-analysis of their incidence, interpretations and associations.
BACKGROUND AND AIMS
Evaluations of adverse heart rate (HR)-responses and HR-variations during anaesthesia in beach-chair-position (BCP) for shoulder surgeries have not been done earlier. We analysed the incidence, associations, and interpretations of adverse HR-responses in this clinical setting.
METHODS
We performed a meta-analysis of trials that reported HR-related data in anaesthetised subjects undergoing elective shoulder surgeries in BCP. Studies included prospective, randomised, quasi-randomised and non-randomised, controlled clinical trials as well as observational cohorts. Literature search was conducted in MEDLINE, EMBASE, CINHAL and the Cochrane Central Register of Controlled Trials of the 21 century. In the first analysis, we studied the incidence and associations of bradycardia/hypotension-bradycardia episodes (HBE) with respect to the type of anaesthesia and different pharmacological agents. In the second, we evaluated anaesthetic influences, associations and inter-relationships between monitored parameters with respect to HR-behaviours.
RESULTS
Among the trials designed with bradycardia/HBE as a primary end point, the observed incidence of bradycardia was 9.1% and that of HBE, 14.9% and 22.7% [(for Interscalene block (ISB) ± sedation) subjects and general anaesthesia (GA) + ISB, respectively]. There was evidence of higher observed risk of developing adverse HR-responses for GA subjects over ISB (Risk Difference, < 0.05). Concomitant use of β-agonists did not increase risk of HBEs ( = 0.29, = 11.4%) or with fentanyl ( = 0.45, = 0%) for ISB subjects (subgroup analysis). Fentanyl significantly influenced the HR-drop over time [meta-regression, estimates (standard error), 14.9 (5.4), 9.8 (4.3) and 17 (2.6); = 0.007, 0.024 and <0.001; for early, mid and delayed periods, respectively] in GA subjects. With respect to number of subjects experiencing cerebral desaturation events (CDEs), total intravenous anaesthesia (TIVA)- propofol had higher risk over inhalational anaesthesia ( = 0.006, = 86.7%). Meta-correlation analysis showed relationships between the HR and rSO(regional cerebral oxygen saturation) or SjvO(jugular venous oxygen saturation) values (r = 0.608, 95%CI, 0.439 to 0.735, < 0.001, = 77.4% and r = 0.397, 95%CI, 0.151 to 0.597, < 0.001, = 64.3%, respectively).
CONCLUSIONS
There is not enough evidence to claim the associations of adverse HR-responses with any specific factor. HR-fall is maximal with fentanyl and its variability is associated with changes in rSO. Fall in rSO could be the common link triggering adverse HR-responses in BCP.
PubMed: 32934399
DOI: 10.4103/ija.IJA_228_20 -
Journal of Clinical Sleep Medicine :... Aug 2021Identifying optimal treatment for infants with Robin sequence (RS) is challenging due to substantial variability in the presentation of upper airway obstruction (UAO) in...
STUDY OBJECTIVES
Identifying optimal treatment for infants with Robin sequence (RS) is challenging due to substantial variability in the presentation of upper airway obstruction (UAO) in this population. Objective assessments of UAO and treatments are not standardized. A systematic review of objective measures of UAO was conducted as a step toward evidence-based clinical decision-making for RS.
METHODS
A literature search was performed in the PubMed and Embase databases (1990-2020) following PRISMA guidelines. Articles reporting on RS and UAO treatment were included if the following objective measures were studied: oximetry, polysomnography, and blood gas. Quality was appraised by the methodological index for nonrandomized studies (range: 0-24).
RESULTS
A total of 91 articles met the inclusion criteria. The mean methodological index for nonrandomized studies score was 7.1 (range: 3-14). Polysomnography was most frequently used (76%) followed by oximetry (20%) and blood gas (11%). Sleep position of the infant was reported in 35% of studies, with supine position most frequently, and monitoring time in 42%, including overnight recordings, in more than half. Of 71 studies that evaluated UAO interventions, the majority used polysomnography (90%), of which 61% did not specify the polysomnography technique. Reported polysomnography metrics included oxygen saturation (61%), apnea-hypopnea index (52%), carbon dioxide levels (31%), obstructive apnea-hypopnea index (27%), and oxygen desaturation index (16%). Only 42 studies reported indications for UAO intervention, with oximetry and polysomnography thresholds used equally (both 40%). In total, 34 distinct indications for treatment were identified.
CONCLUSIONS
This systematic review demonstrates a lack of standardization, interpretation, and reporting of assessment and treatment indications for UAO in RS. An international, multidisciplinary consensus protocol is needed to guide clinicians on optimal UAO assessment in RS.
CITATION
Logjes RJH, MacLean JE, de Cort NW, et al. Objective measurements for upper airway obstruction in infants with Robin sequence: what are we measuring? A systematic review. . 2021;17(8):1717-1729.
Topics: Airway Obstruction; Humans; Infant; Oxygen Saturation; Pierre Robin Syndrome; Polysomnography; Sleep
PubMed: 33960296
DOI: 10.5664/jcsm.9394