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European Journal of Medical Research Mar 2023Studies suggest that high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) can prevent reintubation in critically ill patients with a low risk of extubation... (Meta-Analysis)
Meta-Analysis Review
The efficacy of high-flow nasal cannula (HFNC) versus non-invasive ventilation (NIV) in patients at high risk of extubation failure: a systematic review and meta-analysis.
BACKGROUND
Studies suggest that high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) can prevent reintubation in critically ill patients with a low risk of extubation failure. However, the safety and effectiveness in patients at high risk of extubation failure are still debated. Therefore, we conducted a systematic review and meta-analysis to compare the efficacies of HFNC and NIV in high-risk patients.
METHODS
We searched eight databases (MEDLINE, Cochrane Library, EMBASE, CINAHL Complete, Web of Science, China National Knowledge Infrastructure, Wan-Fang Database, and Chinese Biological Medical Database) with reintubation as a primary outcome measure. The secondary outcomes included mortality, intensive care unit (ICU) length of stay (LOS), incidence of adverse events, and respiratory function indices. Statistical data analysis was performed using RevMan software.
RESULTS
Thirteen randomized clinical trials (RCTs) with 1457 patients were included. The HFNC and NIV groups showed no differences in reintubation (RR 1.10, 95% CI 0.87-1.40, I = 0%, P = 0.42), mortality (RR 1.09, 95% CI 0.82-1.46, I = 0%, P = 0.54), and respiratory function indices (partial pressure of carbon dioxide [PaCO]: MD - 1.31, 95% CI - 2.76-0.13, I = 81%, P = 0.07; oxygenation index [P/F]: MD - 2.18, 95% CI - 8.49-4.13, I = 57%, P = 0.50; respiratory rate [Rr]: MD - 0.50, 95% CI - 1.88-0.88, I = 80%, P = 0.47). However, HFNC reduced adverse events (abdominal distension: RR 0.09, 95% CI 0.04-0.24, I = 0%, P < 0.01; aspiration: RR 0.30, 95% CI 0.09-1.07, I = 0%, P = 0.06; facial injury: RR 0.27, 95% CI 0.09-0.88, I = 0%, P = 0.03; delirium: RR 0.30, 95%CI 0.07-1.39, I = 0%, P = 0.12; pulmonary complications: RR 0.67, 95% CI 0.46-0.99, I = 0%, P = 0.05; intolerance: RR 0.22, 95% CI 0.08-0.57, I = 0%, P < 0.01) and may have shortened LOS (MD - 1.03, 95% CI - 1.86-- 0.20, I = 93%, P = 0.02). Subgroup analysis by language, extubation method, NIV parameter settings, and HFNC flow rate revealed higher heterogeneity in LOS, PaCO, and Rr.
CONCLUSIONS
In adult patients at a high risk of extubation failure, HFNC reduced the incidence of adverse events but did not affect reintubation and mortality. Consequently, whether or not HFNC can reduce LOS and improve respiratory function remains inconclusive.
Topics: Adult; Humans; Cannula; Noninvasive Ventilation; Airway Extubation; Intensive Care Units; Intubation, Intratracheal; Randomized Controlled Trials as Topic
PubMed: 36915204
DOI: 10.1186/s40001-023-01076-9 -
Journal of Critical Care Dec 2018To identify, describe and discuss the parameters used to predict weaning from mechanical ventilation and extubation outcomes.
PURPOSE
To identify, describe and discuss the parameters used to predict weaning from mechanical ventilation and extubation outcomes.
METHODS
Systematic review of scientific articles using four electronic databases: PubMed, Embase, PEDro and Cochrane Library. Search terms included "weaning", "extubation", "withdrawal" and "discontinuation", combined with "mechanical ventilation" and "predictive factors", "predictive parameters" and "predictors for success". In this study, we included original articles that presented predictive factors for weaning or extubation outcomes in adult patients and not restricted to a single disease. Articles not written in English were excluded.
RESULTS
A total of 43 articles were included, with a total of 7929 patients and 56 different parameters related to weaning and extubation outcomes. Rapid Shallow Breathing Index (RSBI) was the most common predictor, discussed in 15 studies (2159 patients), followed by Age and Maximum Inspiratory Pressure in seven studies. The other 53 parameters were found in less than six studies.
CONCLUSION
There are several parameters used to predict weaning and extubation outcomes. RSBI was the most frequently studied and seems to be an important measurement tool in deciding whether to wean/extubate a patient. Furthermore, the results demonstrated that weaning and extubation should be guided by several parameters, and not only to respiratory ones.
Topics: APACHE; Airway Extubation; Critical Illness; Humans; Predictive Value of Tests; Respiration, Artificial; Respiratory Function Tests; Ventilator Weaning
PubMed: 30172034
DOI: 10.1016/j.jcrc.2018.08.023 -
Journal of Critical Care Apr 2022To compare neurally adjusted ventilatory assist (NAVA), proportional assist ventilation (PAV), adaptive support ventilation (ASV) and Smartcare pressure support... (Meta-Analysis)
Meta-Analysis Review
Comparison of advanced closed-loop ventilation modes with pressure support ventilation for weaning from mechanical ventilation in adults: A systematic review and meta-analysis.
PURPOSE
To compare neurally adjusted ventilatory assist (NAVA), proportional assist ventilation (PAV), adaptive support ventilation (ASV) and Smartcare pressure support (Smartcare/PS) with standard pressure support ventilation (PSV) regarding their effectiveness for weaning critically ill adults from invasive mechanical ventilation (IMV).
METHODS
Electronic databases were searched to identify parallel-group randomized controlled trials (RCTs) comparing NAVA, PAV, ASV, or Smartcare/PS with PSV, in adult patients under IMV through July 28, 2021. Primary outcome was weaning success. Secondary outcomes included weaning time, total MV duration, reintubation or use of non-invasive MV (NIMV) within 48 h after extubation, in-hospital and intensive care unit (ICU) mortality, in-hospital and ICU length of stay (LOS) (PROSPERO registration No:CRD42021270299).
RESULTS
Twenty RCTs were finally included. Compared to PSV, NAVA was associated with significantly lower risk for in-hospital and ICU death and lower requirements for post-extubation NIMV. Moreover, PAV showed significant advantage over PSV in terms of weaning rates, MV duration and ICU LOS. No significant differences were found between ASV or Smart care/PS and PSV.
CONCLUSIONS
Moderate certainty evidence suggest that PAV increases weaning success rates, shortens MV duration and ICU LOS compared to PSV. It is also noteworthy that NAVA seems to improve in-hospital and ICU survival.
Topics: Adult; Humans; Intensive Care Units; Interactive Ventilatory Support; Positive-Pressure Respiration; Respiration, Artificial; Ventilator Weaning
PubMed: 34839229
DOI: 10.1016/j.jcrc.2021.11.010 -
Journal of Burn Care & Research :... Sep 2022Burn injury is a common cause of trauma. Non-fatal burn injuries are a leading cause of morbidity, and significant numbers of the victims are children. Scar contracture...
Burn injury is a common cause of trauma. Non-fatal burn injuries are a leading cause of morbidity, and significant numbers of the victims are children. Scar contracture after burn injury can cause severe functional limitation, pain, and aesthetic and psychological problems and patients may present for contracture release and reconstructive surgery. The aim of this systematic review was to identify research relevant to airway management of children with burn contracture of the face and neck with special emphasis on awake airway management and airway anesthesia, and synthesize results that can aid practice. Literature search was performed on Medline, PubMed, Cochrane Library, and Google Scholar with selected keywords. The search was restricted to human subjects of ≤18 year age, there was no language or time restriction, and the final search was concluded in July 2021. The review included 41 articles involving airway management of 56 patients in 61 anesthesia episodes. Patients aged between 8 months to 18 years. Mask ventilation and direct laryngoscopy, video laryngoscopy, optical stylet, supraglottic airway, flexible scope intubation and tracheostomy, and extracorporeal membrane oxygenation were the devices and methods used for securing the airway and oxygenation while the patients were awake or after anesthesia induction. Detailed planning and patient preparation are the fundamentals of airway management of pediatric patients with burn contracture of the face and neck; awake airway management with airway anesthesia can be safely used in selected patients. This review provides information for good clinical practice and might serve to improve the care of such children.
Topics: Airway Management; Anesthesia, General; Burns; Child; Contracture; Humans; Infant; Intubation, Intratracheal
PubMed: 35137105
DOI: 10.1093/jbcr/irac016 -
AANA Journal Feb 2012We studied the current literature on human patient simulation for preparing anesthesia and other healthcare providers for advanced airway management. A systematic review... (Review)
Review
We studied the current literature on human patient simulation for preparing anesthesia and other healthcare providers for advanced airway management. A systematic review was conducted of articles published between 1990 and 2009 on advanced airway management for patients undergoing anesthesia and patients who are not. The search used 4 electronic databases: Cumulative Index to Nursing & Allied Health Literature, MEDLINE, PsycINFO, and Web of Science. We included 34 articles in the analysis; 15 were experimental or quasi-experimental designs, 8 descriptive studies and reports, and 11 analyses of equipment or technique evaluations using simulation. The majority of the studies included simulation education evaluation for a variety of medical, nursing, and allied health providers and students. Only 6 studies addressed the use of simulation as an educational or evaluation tool to enhance training of anesthesia providers in difficult airway management. Those studies included analyses of different types of training and the perceived value of simulated training, and evaluations of equipment. Few studies have analyzed the effects of this modality on trainer skills and patient safety. There is a clear need for well-designed studies to examine these effects.
Topics: Airway Management; Allied Health Personnel; Anesthesia; Competency-Based Education; Humans; Intubation, Intratracheal; Laryngoscopy; Nurse Anesthetists
PubMed: 22474801
DOI: No ID Found -
The Annals of Otology, Rhinology, and... Aug 2023To investigate whether implementation of a multidisciplinary airway team was associated with improvement in (1) rate of successful airway securement at first attempt;... (Review)
Review
OBJECTIVE
To investigate whether implementation of a multidisciplinary airway team was associated with improvement in (1) rate of successful airway securement at first attempt; (2) time to secure airway; and (3) overall complication rate in patients with a difficult airway, as compared with usual care.
DATA SOURCES
Ovid Medline, Embase, Scopus, Cochrane Central, and CINAHL databases.
REVIEW METHODS
Systematic review of literature on inpatient multidisciplinary team management of difficult airways, including all studies performed in inpatient settings, excluding studies of ventilator weaning, flight/military medicine, EXIT procedures, and simulation or educational studies. DistillerSR was used for article screening and risk of a bias assessment to evaluate article quality. Data was extracted on study design, airway team composition, patient characteristics, and clinical outcomes including airway securement, complications, and mortality.
RESULTS
From 5323 studies screened, 19 studies met inclusion criteria with 4675 patients. Study designs included 12 quality improvement projects, 6 cohort studies, and 1 randomized controlled trial. Four studies evaluated effect of multidisciplinary difficult airway teams on airway securement; all reported higher first attempt success rate with team approach. Three studies reported time to secure the difficult airways, all reporting swifter airway securement with team approach. The most common difficult airway complications were hypoxia, esophageal intubation, hemodynamic instability, and aspiration. Team composition varied, including otolaryngologists, anesthesiologists, intensivists, nurses, and respiratory care practitioners.
CONCLUSION
Multidisciplinary difficult airway teams are associated with improved clinical outcomes compared to unstructured emergency airway management; however, studies have significant heterogeneity in team composition, algorithms for airway securement, and outcomes reported. Further evidence is necessary to define the clinical efficacy, cost-effectiveness, and best practices relating to implementing difficult airway teams in inpatient settings.
Topics: Humans; Airway Management
PubMed: 36189709
DOI: 10.1177/00034894221123124 -
BMJ Open Sep 2021This systematic review aimed in assessing the effects of different weaning protocols in people with neuromuscular disease (NMD) receiving invasive mechanical...
OBJECTIVE
This systematic review aimed in assessing the effects of different weaning protocols in people with neuromuscular disease (NMD) receiving invasive mechanical ventilation, identifying which protocol is the best and how different protocols can affect weaning outcome success, duration of weaning, intensive care unit (ICU) and hospital stay and mortality.
DESIGN
Systematic review.
DATA SOURCES
Electronic databases (MEDLINE, EMBASE, Web of Science and Scopus) were searched from January 2009 to August 2020.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised controlled trials (RCTs) and non-RCT that evaluated patients with NMD (adults and children from 5 years old) in the weaning process managed with a protocol (pressure support ventilation; synchronised intermittent mandatory ventilation; continuous positive airway pressure; 'T' piece).
PRIMARY OUTCOME
Weaning success.
SECONDARY OUTCOMES
Weaning duration, ICU stay, hospital stay, ICU mortality, complications (pneumothorax, ventilation-associated pneumonia).
DATA EXTRACTION AND SYNTHESIS
Two review authors assessed the titles and the abstracts for inclusion and reviewed the full texts independently.
RESULTS
We found no studies that fulfilled the inclusion criteria.
CONCLUSIONS
The absence of studies about different weaning protocols for patients with NMD does not allow concluding the superiority of any specific weaning protocol for patients with NMD or determining the impact of different types of protocols on other outcomes. The result of this review encourages further studies.
PROSPERO REGISTRATION NUMBER
CRD42019117393.
Topics: Adult; Child; Child, Preschool; Continuous Positive Airway Pressure; Humans; Intensive Care Units; Neuromuscular Diseases; Respiration, Artificial; Ventilator Weaning
PubMed: 34521661
DOI: 10.1136/bmjopen-2020-047449 -
Advanced airway management in out of hospital cardiac arrest: A systematic review and meta-analysis.The American Journal of Emergency... Dec 2018To assess the difference in survival and neurological outcomes between endotracheal tube (ETT) intubation and supraglottic airway (SGA) devices used during... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To assess the difference in survival and neurological outcomes between endotracheal tube (ETT) intubation and supraglottic airway (SGA) devices used during out-of-hospital cardiac arrest (OHCA).
METHODS
A systematic search of five databases was performed by two independent reviewers until September 2018. Included studies reported on (1) OHCA or cardiopulmonary resuscitation, and (2) endotracheal intubation versus supraglottic airway device intubation. Exclusion criteria (1) stimulation studies, (2) selectively included/excluded patients, (3) in-hospital cardiac arrest. Odds Ratios (OR) with random effect modelling was used. Primary outcomes: (1) return of spontaneous circulation (ROSC), (2) survival to hospital admission, (3) survival to hospital discharge, (4) discharge with a neurologically intact state.
RESULTS
Twenty-nine studies (n = 539,146) showed that overall, ETT use resulted in a heterogeneous, but significant increase in ROSC (OR = 1.44; 95%CI = 1.27 to 1.63; I = 91%; p < 0.00001) and survival to admission (OR = 1.36; 95%CI = 1.12 to 1.66; I = 91%; p = 0.002). There was no significant difference in survival to discharge or neurological outcome (p > 0.0125). On sensitivity analysis of RCTs, there was no significant difference in ROSC, survival to admission, survival to discharge or neurological outcome (p > 0.0125). On analysis of automated chest compression, without heterogeneity, ETT provided a significant increase in ROSC (OR = 1.55; 95%CI = 1.20 to 2.00; I = 0%; p = 0.0009) and survival to admission (OR = 2.16; 95%CI = 1.54 to 3.02; I = 0%; p < 0.00001).
CONCLUSIONS
The overall heterogeneous benefit in survival with ETT was not replicated in the low risk RCTs, with no significant difference in survival or neurological outcome. In the presence of automated chest compressions, ETT intubation may result in survival benefits.
Topics: Airway Management; Cardiopulmonary Resuscitation; Databases, Factual; Emergency Medical Services; Humans; Intubation, Intratracheal; Out-of-Hospital Cardiac Arrest; Patient Discharge
PubMed: 30293843
DOI: 10.1016/j.ajem.2018.09.045 -
Anaesthesia Sep 2018Awake fibreoptic intubation is often considered the technique of choice when a difficult airway is anticipated. However, videolaryngoscopes are being used more commonly.... (Comparative Study)
Comparative Study Meta-Analysis
Awake fibreoptic intubation is often considered the technique of choice when a difficult airway is anticipated. However, videolaryngoscopes are being used more commonly. We searched the current literature and performed a meta-analysis to compare the use of videolaryngoscopy and fibreoptic bronchoscopy for awake tracheal intubation. Our primary outcome was the time needed to intubate the patient's trachea. Secondary outcomes included: failed intubation; the rate of successful intubation at the first attempt; patient-reported satisfaction with the technique; and any complications resulting from intubation. Eight studies examining 429 patients were included in this review. The intubation time was shorter when videolaryngoscopy was used instead of fibreoptic bronchoscopy (seven trials, 408 participants, mean difference (95%CI) -45.7 (-66.0 to -25.4) s, p < 0.0001, low-quality evidence). There was no significant difference between the two techniques in the failure rate (six studies, 355 participants, risk ratio (95%CI) 1.01 (0.24-4.35), p = 0.99, low-quality evidence) or the first-attempt success rate (six studies, 391 participants, risk ratio (95%CI) 1.01 (0.95-1.06), p = 0.8, moderate quality evidence). The level of patient satisfaction was similar between both groups. No difference was found in two reported adverse events: hoarseness/sore throat (three studies, 167 participants, risk ratio (95%CI) 1.07 (0.62-1.85), p = 0.81, low-quality evidence), and low oxygen saturation (five studies, 337 participants, risk ratio (95%CI) 0.49 (0.22-1.12), p = 0.09, low-quality evidence). In summary, videolaryngoscopy for awake tracheal intubation is associated with a shorter intubation time. It also seems to have a success rate and safety profile comparable to fibreoptic bronchoscopy.
Topics: Bronchoscopy; Fiber Optic Technology; Humans; Intubation, Intratracheal; Laryngoscopy; Patient Satisfaction; Time Factors; Treatment Failure; Video Recording
PubMed: 29687891
DOI: 10.1111/anae.14299 -
Thorax Aug 2022Extubation to non-invasive ventilation (NIV) has been investigated as a strategy to wean critically ill adults from invasive ventilation and reduce ventilator-related... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Extubation to non-invasive ventilation (NIV) has been investigated as a strategy to wean critically ill adults from invasive ventilation and reduce ventilator-related complications.
METHODS
We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, proceedings of four conferences and bibliographies (to June 2020) for randomised and quasi-randomised trials that compared extubation with immediate application of NIV to continued invasive weaning in intubated adults and reported mortality (primary outcome) or other outcomes. Two reviewers independently screened citations, assessed trial quality and abstracted data.
RESULTS
We identified 28 trials, of moderate-to-good quality, involving 2066 patients, 44.6% with chronic obstructive pulmonary disease (COPD). Non-invasive weaning significantly reduced mortality (risk ratio (RR) 0.57, 95% CI 0.44 to 0.74; high quality), weaning failures (RR 0.59, 95% CI 0.43 to 0.81; high quality), pneumonia (RR 0.30, 95% CI 0.22 to 0.41; high quality), intensive care unit (ICU) (mean difference (MD) -4.62 days, 95% CI -5.91 to -3.34) and hospital stay (MD -6.29 days, 95% CI -8.90 to -3.68). Non-invasive weaning also significantly reduced the total duration of ventilation, duration of invasive ventilation and duration of ventilation related to weaning (MD -0.57, 95% CI -1.08 to -0.07) and tracheostomy rate. Mortality, pneumonia, reintubation and ICU stay were significantly lower in trials enrolling COPD (vs mixed) populations.
CONCLUSION
Non-invasive weaning significantly reduced mortality, pneumonia and the duration of ventilation related to weaning, particularly in patients with COPD. Beneficial effects are less clear (or more careful patient selection is required) in non-COPD patients.
PROSPERO REGISTRATION NUMBER
CRD42020201402.
Topics: Adult; Critical Illness; Humans; Intensive Care Units; Noninvasive Ventilation; Pulmonary Disease, Chronic Obstructive; Respiration, Artificial; Ventilator Weaning
PubMed: 34716282
DOI: 10.1136/thoraxjnl-2021-216993