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Resuscitation Apr 2020The International Liaison Committee on Resuscitation sought to review the initial management of non-vigorous newborns delivered through meconium stained amniotic fluid... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
The International Liaison Committee on Resuscitation sought to review the initial management of non-vigorous newborns delivered through meconium stained amniotic fluid (MSAF).
OBJECTIVE
To complete a systematic review and meta-analysis comparing endotracheal intubation and suctioning to immediate resuscitation without intubation for non-vigorous infants born at ≥34 weeks gestation delivered through MSAF.
DATA SOURCES
Medline, EMBASE, the Cochrane Database of Systematic Reviews, and other registries were searched from 1966 to November 7, 2019.
STUDY SELECTION
Studies were selected by pairs of independent reviewers in 2 stages.
DATA EXTRACTION
Reviewers extracted data, appraised risk of bias, and assessed Grading of Recommendations Assessment, Development and Evaluation certainty of evidence for each outcome.
RESULTS
Four randomized controlled trials (RCTs) included 581 patients and one observational study included 231 patients. No significant differences were observed between the group treated with tracheal suctioning compared with immediate resuscitation for survival at discharge (4 RCTs; risk ratio [RR] = 1.01; 95 % CI, 0.96-1.06; p = 0.69; observational study; no deaths), hypoxic ischemic encephalopathy and meconium aspiration syndrome.
LIMITATIONS
The certainty of evidence was low for survival at discharge and very low for all other outcomes.
CONCLUSIONS
For non-vigorous newborns delivered through MSAF, there is insufficient evidence to suggest routine immediate direct laryngoscopy with tracheal suctioning.
PROSPERO
CRD42019122778.
CLINICAL TRIALS REGISTRATION
PROSPERO; CRD42019122778.
Topics: Amniotic Fluid; Humans; Infant; Infant, Newborn; Intubation, Intratracheal; Meconium; Meconium Aspiration Syndrome; Observational Studies as Topic; Suction
PubMed: 32097677
DOI: 10.1016/j.resuscitation.2020.01.038 -
Journal of Neurosurgery. Spine May 2023Closed suction drains, often used after posterior spinal surgery, pose a potential risk of infection. To combat this risk, many surgeons opt for a prolonged prophylactic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Closed suction drains, often used after posterior spinal surgery, pose a potential risk of infection. To combat this risk, many surgeons opt for a prolonged prophylactic antibiotic regimen. Since 2015, several studies have shown that prolonged prophylactic systemic antibiotics (PPSA) for drains provides no additional benefit in reducing surgical site infection (SSI) rates. However, most of these studies lacked sufficient power to make reliable conclusions. To date, there has been no meta-analysis conducted to further investigate this issue. The aim of this study was to investigate whether a regimen of PPSA reduces the incidence of deep SSIs in adult patients with closed suction drains following posterior spinal surgeries.
METHODS
The protocol of the current systematic review was registered with PROSPERO. A systematic review of the literature in PubMed (Medline), Europe PMC, Embase, and Cochrane Review databases was conducted for all relevant literature with the keywords "spine," "antibiotics," "surgical site infection," "prophylaxis," and "drain." Retrospective and prospective studies investigating the effectiveness of PPSA in patients 18 years or older who underwent posterior cervical or thoracolumbar surgery and had postoperative wound drains were included. The primary outcome was the odds ratio for deep SSI based on the intervention (PPSA vs non-PPSA). The secondary outcomes were the rates of superficial and overall SSIs.
RESULTS
From a total of 2558 titles identified from the search, 7 studies were chosen for final analysis. Three were randomized controlled trials (RCTs), and 4 were retrospective reviews. A total of 2446 patients were analyzed; 1149 received a PPSA regimen and 1297 received a non-PPSA regimen. Deep SSIs occurred in 45 patients (3.9%) and 46 patients (3.5%) in the PPSA and non-PPSA groups, respectively. The odds ratio for deep SSIs in the PPSA group compared with the non-PPSA group was 1.10 (95% CI 0.69-1.74), which was not statistically significant. Additionally, there were no differences in the rates of superficial and overall SSIs. There was a trend toward increased infections with multidrug-resistant bacteria (Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus) in the PPSA group; however, it was not possible to perform a durable statistical analysis because of the small number of reported organisms in the selected publications.
CONCLUSIONS
This meta-analysis demonstrates that there is no reduction in rate of deep, superficial, and overall SSIs with prolonged prophylactic antibiotics after posterior spinal surgery involving the use of closed suction drains.
Topics: Adult; Humans; Surgical Wound Infection; Anti-Bacterial Agents; Spine; Powders; Retrospective Studies
PubMed: 36708541
DOI: 10.3171/2022.12.SPINE221218 -
International Journal of Hyperthermia :... 2024Caesarean scar pregnancy (CSP) presents a significant clinical challenge owing to the associated risks of uterine scar rupture, severe haemorrhage and adverse maternal... (Meta-Analysis)
Meta-Analysis Review
Efficacy and safety of high-intensity focused ultrasound combined with suction curettage for the treatment of caesarean scar pregnancy: a systematic review and single-arm meta-analysis.
PURPOSE
Caesarean scar pregnancy (CSP) presents a significant clinical challenge owing to the associated risks of uterine scar rupture, severe haemorrhage and adverse maternal outcomes. This study aimed to assess the safety and efficacy of combining high-intensity focused ultrasound (HIFU) with suction curettage for treating CSP.
METHODS
We conducted a comprehensive search in four databases, namely PubMed, Web of Science, Embase and Cochrane Library, to identify published studies evaluating the use of HIFU combined with suction curettage to treat CSP. Intraoperative blood loss, treatment success rate, and reproductive results were the primary outcomes assessed.
RESULTS
A total of 18 studies involving 1251 patients with CSP, all of whom received preoperative HIFU therapy were included. The average hospital stay was 6.22 days, the intraoperative blood loss was 26.29 ml and the incidence of adverse events was 15.60%, including abdominal or lower limb pain, fever, vaginal bleeding, haematuria and vomiting. Furthermore, post-treatment follow-up showed that serum β-human chorionic gonadotropin levels were rapidly normalized (average of 25.48 days) and menstruation returned (average of 33.03 days). The treatment had a remarkable success rate of 97.60% and a subsequent pregnancy rate of 68.70%.
CONCLUSION
While the combination of HIFU and suction-curettage may induce common adverse effects such as lower abdominal or limb pain, these reactions typically do not necessitate therapeutic intervention. Additionally, the size of the gestational sac is a determinant of the procedure's success. In conclusion, HIFU combined with suction curettage demonstrates promising clinical efficacy, safety and favourable reproductive outcomes in managing CSP.
Topics: Humans; Female; Pregnancy; Blood Loss, Surgical; Vacuum Curettage; Cicatrix; Pain; Cesarean Section
PubMed: 38329796
DOI: 10.1080/02656736.2024.2310019 -
Dimensions of Critical Care Nursing :... 2020Normal saline instillation (NSI) and lung recruitment manoeuvres (RMs) are used in conjunction with endotracheal suction (ETS) in mechanically ventilated children....
BACKGROUND
Normal saline instillation (NSI) and lung recruitment manoeuvres (RMs) are used in conjunction with endotracheal suction (ETS) in mechanically ventilated children. Practice is varied, and it is not currently understood what clinical practice guidelines (CPGs) are available to inform practice decisions.
OBJECTIVE
The aim of this study was to identify and systematically review the quality of existing ETS CPGs, specifically in the context of NSI and RM use.
METHODS
A systematic search for ETS CPGs in children (<18 years old) was conducted in Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, EMBASE, and Google Scholar. Two independent assessors evaluated CPGs using the Appraisal of Guidelines for Research and Evaluation II instrument. Standardised scores were calculated for individual CPGs, and scale domain scores were calculated.
RESULTS
Four CPGs and practice recommendations from 2 literature reviews were identified and evaluated. The routine use of NSI and RMs with paediatric ETS was not recommended. Recommendations reflected the low quality and limited availability of evidence to inform NSI and RM application. Collectively, the highest scoring domain was clarity of presentation, followed by scope and purpose (78). Overall assessments ranged from 8 to 100 from a possible 100 points. Four ETS CPGs (100%) were recommended for use with modification.
CONCLUSIONS
Clinical practice guidelines and practice recommendations pertaining to NSI and RM were consistent but, however, limited by the quality and volume of available evidence. Clinical practice guideline developers should focus on improving the applicability and rigour in development processes. Further consensus work and rigorous trials are needed to inform future CPGs.
Topics: Adolescent; Child; Humans; Lung; Saline Solution; Suction
PubMed: 33009272
DOI: 10.1097/DCC.0000000000000442 -
Translational Andrology and Urology Jan 2022With advances in medicine, there have been more and more ways to treat renal calculi in recent years. Percutaneous nephrolithotomy (PCNL) is a safe and effective...
BACKGROUND
With advances in medicine, there have been more and more ways to treat renal calculi in recent years. Percutaneous nephrolithotomy (PCNL) is a safe and effective treatment. The purpose of this paper is to study the efficacy and safety of PCNL combined with negative pressure suction in the treatment of renal calculi by meta-analysis.
METHODS
The PubMed, EMBASE, Cochrane Library, Chinese Journal Full-Text Database, VIP, Wanfang Science and Technology Journal Full-Text Database, and Chinese Biomedical Literature Search databases were searched for articles related to the efficacy and safety of PCNL combined with negative pressure suction in the treatment of renal calculi from the establishment of the databases to October 2021. Endnote X9 software was first used to check and eliminate the articles, and the quality of the included articles were evaluated according to the risk of bias tool of Cochrane Collaboration. Stata 15.1 software was used to record the data. A meta-analysis was performed on the stone clearance rate, operation time, postoperative complications, postoperative fever, septic shock, intrapelvic pressure, and blood loss of PCNL combined with negative pressure suction in the treatment of renal calculi. The reliability of the results was assessed by a sensitivity analysis. Egger's linear test was used to test the publication bias of the articles.
RESULTS
A total of 10 articles were included in the meta-analysis, and the total sample size of the study was 820. The meta-analysis showed that when PCNL combined with negative pressure suction was used to treat renal calculi, the stone clearance rate and the occurrence of septic shock of the test group did not differ significantly from that of the control group; the incidence rate of postoperative complications、the operation time, the intraoperative bleeding and the postoperative fever of the test group was significantly better than that of the control group.
DISCUSSION
Compared to the group without negative pressure, PCNL reduces the operation time, postoperative complications, postoperative fever, septic shock, and intraoperative blood loss without increasing the risk of septic shock.
PubMed: 35242643
DOI: 10.21037/tau-21-1067 -
BJU International Mar 2023To systematically review the literature to ascertain the upper tract pressures generated during endourology, the relevant influencing variables and clinical implications. (Review)
Review
OBJECTIVES
To systematically review the literature to ascertain the upper tract pressures generated during endourology, the relevant influencing variables and clinical implications.
MATERIALS AND METHODS
A systematic review of the MEDLINE, Scopus and Cochrane databases was performed by two authors independently (S.C., N.D.). Studies reporting ureteric or intrarenal pressures (IRP) during semi-rigid ureteroscopy (URS)/flexible ureterorenoscopy (fURS)/percutaneous nephrolithotomy (PCNL)/miniaturized PCNL (mPCNL) in the period 1950-2021 were identified. Both in vitro and in vivo studies were considered for inclusion. Findings were independently screened for eligibility based on content, with disagreements resolved by author consensus. Data were assessed for bias and compiled based on predefined variables.
RESULTS
Fifty-two studies met the inclusion criteria. Mean IRP appeared to frequently exceed a previously proposed threshold of 40 cmH O. Semi-rigid URS with low-pressure irrigation (gravity <1 m) resulted in a wide mean IRP range (lowest reported 6.9 cmH O, highest mean 149.5 ± 6.2 cmH O; animal models). The lowest mean observed with fURS without a ureteric access sheath (UAS) was 47.6 ± 4.1 cmH O, with the maximum peak IRP being 557.4 cmH O (in vivo human data). UAS placement significantly reduced IRP during fURS, but did not guarantee pressure control with hand-operated pump/syringe irrigation. Miniaturization of PCNL sheaths was associated with increased IRP; however, a wide mean human IRP range has been recorded with both mPCNL (lowest -6.8 ± 2.2 cmH O [suction sheath]; highest 41.2 ± 5.3 cmH O) and standard PCNL (lowest 6.5 cmH O; highest 41.2 cmH O). Use of continuous suction in mPCNL results in greater control of mean IRP, although short pressure peaks >40 cmH O are not entirely prevented. Definitive conclusions are limited by heterogeneity in study design and results. Postoperative pain and pyrexia may be correlated with increased IRP, however, few in vivo studies correlate clinical outcome with measured IRP.
CONCLUSIONS
Intrarenal pressure generated during upper tract endoscopy often exceeds 40 cmH O. IRP is multifactorial in origin, with contributory variables discussed. Larger prospective human in vivo studies are required to further our understanding of IRP thresholds and clinical sequelae.
Topics: Animals; Humans; Prospective Studies; Ureteroscopy; Ureter; Nephrolithotomy, Percutaneous; Ureteroscopes; Kidney Calculi
PubMed: 35485243
DOI: 10.1111/bju.15764 -
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 -
Australian Critical Care : Official... Jan 2021The objective of this study was to investigate the effects of different types of faecal collection devices on incontinence-associated dermatitis (IAD) in critically ill... (Meta-Analysis)
Meta-Analysis Review
The effectiveness of faecal collection devices in preventing incontinence-associated dermatitis in critically ill patients with faecal incontinence: A systematic review and meta-analysis.
OBJECTIVE
The objective of this study was to investigate the effects of different types of faecal collection devices on incontinence-associated dermatitis (IAD) in critically ill patients with faecal incontinence.
REVIEW METHOD USED
This was a systematic review and meta-analysis.
DATA SOURCES
A comprehensive electronic literature search was performed in PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang, and WeiPu. All the databases were searched from their inception to July 31, 2019, and the data were updated on November 2, 2019.
REVIEW METHODS
Randomised controlled trials (RCTs) and quasi-experimental studies were included. Participants were critically ill patients with faecal incontinence, and the interventions involved care with faecal collection devices. Comparisons were usual care, and the outcome was the incidence of IAD. Odds ratios (ORs) were used to calculate the pooled effect sizes. Heterogeneity was tested using the inconsistency index (I) method.
RESULTS
Nineteen studies were included in this systematic review including 16 RCTs and three quasi-experimental studies. Twelve RCTs were included in the meta-analysis, which showed that the use of faecal collection devices significantly reduced the incidence of IAD. Subgroup analyses based on device type showed significant effects for anal pouch collection devices (OR, 0.14; 95% confidence interval [CI], 0.07-0.26; P < 0.00001), anal pouch connected to negative-pressure suction devices (OR, 0.18; 95% CI, 0.08-0.42; P < 0.00001), anal catheter/tube collection devices (OR, 0.24; 95% CI, 0.13-0.44; P < 0.00001), and anal catheter/tube connected to negative-pressure suction devices (OR, 0.20; 95% CI, 0.07-0.59, P < 0.00001).
CONCLUSIONS
Faecal collection devices can reduce the incidence of IAD in critically ill patients with faecal incontinence. It is suggested that when using a device to care for critically ill patients with faecal incontinence, an anal pouch connected to continuous low-negative-pressure suction device should be preferred. Further high-quality research is still needed regarding anal catheter/tube collection devices and anal catheter/tube connected to continuous low-negative-pressure suction devices.
Topics: China; Critical Illness; Dermatitis; Fecal Incontinence; Humans; Incidence
PubMed: 32646766
DOI: 10.1016/j.aucc.2020.04.152 -
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 -
World Journal of Surgery Sep 2021Postoperative pancreatic fistula (POPF) is a major source of morbidity following pancreatic resection. Surgically placed drains under suction or gravity are routinely... (Meta-Analysis)
Meta-Analysis Review
Postoperative pancreatic fistula (POPF) is a major source of morbidity following pancreatic resection. Surgically placed drains under suction or gravity are routinely used to help mitigate the complications associated with POPF. Controversy exists as to whether one of these drain management strategies is superior. The objective was to identify and compare the incidence of POPF, adverse events, and resource utilization associated with passive gravity (PG) versus active suction (AS) drainage following pancreatic resection. MEDLINE, EMBASE, CINAHL, and Cochrane Library databases were searched from inception to May 18, 2020. Outcomes of interest included POPF, post-pancreatectomy hemorrhage (PPH), surgical site infection (SSI), other major morbidity, and resource utilization. Descriptive qualitative and pooled quantitative meta-analyses were performed. One randomized control trial and five cohort studies involving 10 663 patients were included. Meta-analysis found no difference in the odds of developing POPF between AS and PG (p = 0.78). There were no differences in other endpoints including PPH (p = 0.58), SSI (wound p = 0.21, organ space p = 0.05), major morbidity (p = 0.71), or resource utilization (p = 0.72). The risk of POPF or other adverse outcomes is not impacted by drain management following pancreatic resection. Based on current evidence, a suggestion cannot be made to support the use of one drain over another at this time. There is a trend toward increased intra-abdominal wound infections with AS drains (p = 0.05) that merits further investigation.
Topics: Drainage; Humans; Length of Stay; Pancreas; Pancreatectomy; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 34046692
DOI: 10.1007/s00268-021-06158-5