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Revue Des Maladies Respiratoires Jan 2020Cocaine can be responsible for many psychiatric and/or somatic disorders. The aim of this systematic literature review of data was to expose relations between cocaine...
Cocaine can be responsible for many psychiatric and/or somatic disorders. The aim of this systematic literature review of data was to expose relations between cocaine use and pulmonary complications. Cocaine can be responsible for acute respiratory symptoms (cough, black sputum, hemoptysis, dyspnea, wheezing, chest pain) and for various pulmonary disorders including barotrauma (pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium), airway damage, asthma, bronchiolitis obliterans with organizing pneumonia, acute pulmonary edema, alveolar hemorrhage, alveolar pneumonia with carbonaceous material, bullous emphysema, acute eosinophilic pneumonia, pulmonary granulomatosis caused by talc or cellulose, interstitial pneumonitis and pulmonary fibrosis, vasculitis, pulmonary hypertension, pulmonary embolism and pulmonary infarction, mycotic pulmonary arterial aneurysms, septic emboli, aspiration pneumonia, community-acquired pneumonia, HIV-related opportunistic infections, latent tuberculosis infection, pulmonary tuberculosis, lung cancer and crack lung. Some of these complications are serious and may have a fatal outcome. Pulmonary function tests, thoracic tomodensitometry, bronchial fibroscopy with bronchoalveolar lavage and lung scintigraphy may be an aid to the diagnosis of these pulmonary compications. Cocaine use must be sought in case of respiratory symptoms in young persons.
Topics: Cocaine; Cocaine-Related Disorders; Drug Users; Humans; Lung Diseases
PubMed: 31883817
DOI: 10.1016/j.rmr.2019.11.641 -
Aerospace Medicine and Human Performance Feb 2019Barodontalgia, barometric pressure-induced dental pain, may jeopardize diving/flight safety. The aim of this systematic review was to investigate the rate of...
Barodontalgia, barometric pressure-induced dental pain, may jeopardize diving/flight safety. The aim of this systematic review was to investigate the rate of barodontalgia among military and civilian divers and aircrews based on previous reports. We analyzed the data of 4894 aircrew/divers reported in the literature. Barodontalgia rates (flight vs. diving, military vs. civilian, pressurized vs. non-pressurized aircrafts) were analyzed. The Chi-squared test was used to compare between groups. Of the 4894 individuals, 402 (8.2%) suffered from barodontalgia. Divers (9.8%) were more vulnerable than aircrews (5.8%). Barodontalgia experience rate was 5.4% and 6.5% in military and civilian aircrews, respectively, and 7.3% and 12.8% in military and civilian scuba divers, respectively. Barodontalgia was more common among aircrews of pressurized than non-pressurized aircrafts (7.3% vs. 3.2%, respectively). The greater amplitude of barometric pressure changes explains the higher rate of barodontalgia in divers than aircrew. The higher rate during pressurized flights is possibly because intracabin pressure in the pressurized cabin is still routinely higher than in nonpressurized aircrafts. Improved oral care and mandatory annual dental checkups may be the reason for the significantly lower rate of barodontalgia experienced among military aircrews and divers compared to their civilian counterparts. These results emphasize the essential role of atmospheric pressure change in the generation of pain during flight or diving and the importance of proper dental care.
Topics: Aerospace Medicine; Atmospheric Pressure; Barotrauma; Diving; Humans; Military Personnel; Pilots; Toothache
PubMed: 30670123
DOI: 10.3357/AMHP.5183.2019 -
Injury Jan 2014The objective of this study is to provide a systematic review on ocular injuries induced by glass bottles containing carbonated drinks in China, which emphasised the... (Review)
Review
BACKGROUND
The objective of this study is to provide a systematic review on ocular injuries induced by glass bottles containing carbonated drinks in China, which emphasised the injury circumstance and visual function loss.
METHODS
We performed a literature-based retrospective analysis using predetermined inclusion and exclusion criteria. Demographic characteristics of pressurised bottled drinks-related eye injuries were obtained and vision loss was calculated.
RESULTS
A total of 26 relevant articles were found suitable for investigation of causative agent and patient demographics, of which 19 articles could be used for calculating vision loss and injury circumstance. Victims were often pertinent workers (46.0%). Most of the trauma was serious and even devastating. Final visual acuity was >10/20 in 29.2%, with severe final vision loss (<10/200) in 30.8%. Visual acuity can improve significantly with treatment (P<0.05).
CONCLUSIONS
One in three ocular injuries from glass bottles containing carbonated drinks show severe vision loss. Relevant workers are most frequently injured, followed by inappropriate handlers or openers. Besides manufacturing standards being strictly implemented, many ocular traumas related to bottled carbonated drinks should be prevented through health education.
Topics: Blast Injuries; Carbonated Beverages; China; Eye Injuries; Glass; Humans; Pressure; Retrospective Studies
PubMed: 24148261
DOI: 10.1016/j.injury.2013.09.039 -
Undersea & Hyperbaric Medicine :... 2021Multiday hyperbaric exposure has been shown to reduce the incidence of decompression sickness (DCS) of compressed-air workers. This effect, termed acclimatization, has...
Multiday hyperbaric exposure has been shown to reduce the incidence of decompression sickness (DCS) of compressed-air workers. This effect, termed acclimatization, has been addressed in a number of studies, but no comprehensive review has been published. This systematic review reports the findings of a literature search. PubMed, Ovid Embase, The Cochrane Library and Rubicon Research Repository were searched for studies reporting DCS incidence, venous gas embolism (VGE) or subjective health reports after multiday hyperbaric exposure in man and experimental animals. Twenty-nine studies fulfilled inclusion criteria. Three epidemiological studies reported statistically significant acclimatization to DCS in compressed-air workers after multiday hyperbaric exposure. One experimental study observed less itching after standardized simulated dives. Two human experimental studies reported lower DCS incidence after multiday immersed diving. Acclimatization to DCS has been observed in six animal species. Multiday diving had less consistent effect on VGE after hyperbaric exposure in man. Four studies observed acclimatization while no statistically significant acclimatization was reported in the remaining eight studies. A questionnaire study did not report any change in self-perceived health after multiday diving. This systematic review has not identified any study suggesting a sensitizing effect of multiday diving, and there is a lack of data supporting benefit of a day off diving after a certain number of consecutive diving days. The results suggest that multiday hyperbaric exposure probably will have an acclimatizing effect and protects from DCS. The mechanisms causing acclimatization, extent of protection and optimal procedure for acclimatization has been insufficiently investigated.
Topics: Animals; Cats; Dogs; Humans; Rabbits; Rats; Acclimatization; Atmospheric Pressure; Decompression Sickness; Diagnostic Self Evaluation; Diving; Embolism, Air; Goats; Hyperbaric Oxygenation; Incidence; Occupational Diseases; Rats, Sprague-Dawley; Reference Values; Time Factors
PubMed: 33975403
DOI: 10.22462/03.04.2021.3 -
PloS One 2022To report current evidence regarding the effectiveness of hyperbaric oxygen therapy (HBOT) on the impairments presented by children with cerebral palsy (CP), and its... (Meta-Analysis)
Meta-Analysis
PURPOSE
To report current evidence regarding the effectiveness of hyperbaric oxygen therapy (HBOT) on the impairments presented by children with cerebral palsy (CP), and its safety.
MATERIALS AND METHODS
PUBMED, The Cochrane Library, Google Scholar, and the Undersea and Hyperbaric Medical Society database were searched by two reviewers. Methodological quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the modified Downs and Black (m-DB) evaluation tool for non RCTs. A meta-analysis was performed where applicable for RCTs.
RESULTS
Five RCTs were identified. Four had a high level of evidence. Seven other studies were observational studies of low quality. All RCTs used 100% O2, 1.5 to 1.75 ATA, as the treatment intervention. Pressurized air was the control intervention in 3 RCTs, and physical therapy in 2. In all but one RCTs, similar improvements were observed regarding motor and/or cognitive functions, in the HBOT and control groups. Adverse events were mostly of mild severity, the most common being middle ear barotrauma (up to 50% of children).
CONCLUSION
There is high-level evidence that HBOT is ineffective in improving motor and cognitive functions, in children with CP. There is moderate-level evidence that HBOT is associated with a higher rate of adverse events than pressurized air in children.
Topics: Cerebral Palsy; Child; Humans; Hyperbaric Oxygenation
PubMed: 36240157
DOI: 10.1371/journal.pone.0276126 -
JBI Database of Systematic Reviews and... May 2018To determine the effects of dexmedetomidine versus propofol on extubation time, intensive care unit (ICU) length of stay, total hospital length of stay and in-hospital...
Effectiveness of dexmedetomidine versus propofol on extubation times, length of stay and mortality rates in adult cardiac surgery patients: a systematic review and meta-analysis.
OBJECTIVE
To determine the effects of dexmedetomidine versus propofol on extubation time, intensive care unit (ICU) length of stay, total hospital length of stay and in-hospital mortality rates in cardiac surgery patients.
INTRODUCTION
Recovery from cardiovascular surgery involves weaning from mechanical ventilation. Mechanical ventilation decreases the work of breathing for patients by inhaling oxygen and exhaling carbon dioxide via a ventilator or breathing machine. Prolonged mechanical ventilation is associated with complications, such as pneumonia and lung injury, and increases the risk of morbidity and mortality. Major risk factors that contribute to lung injury are due to high tidal volumes and barotrauma. Cardiac surgery patients remain on the ventilator postoperatively due to the high dose opioid-based anesthesia and the initial vulnerable hemodynamic state. An important component of postoperative management following cardiac surgery is the use of sedation to reduce the stress response, facilitate assisted ventilation, and provide anxiolysis. Propofol and dexmedetomidine are two common sedative agents with differing pharmacological profiles used to provide comfort and minimize hemodynamic disturbances during this recovery phase. Choice of drug may have an impact on length of mechanical ventilation, length of stay and mortality.
INCLUSION CRITERIA
Participants included were ≥18 years, of any gender or ethnicity, undergoing valvular surgery, coronary artery bypass graft (CABG) surgery, or valvular surgery and CABG. Studies were excluded if participants received both dexmedetomidine and propofol concurrently as a primary sedative. Interventions were propofol compared to dexmedetomidine as continuous infusions for sedation after cardiac surgery. All variations of dosages and duration of both sedative agents were included. Outcomes of interest were: total time (hours) of mechanical ventilation after cardiac surgery, specifically from end of surgery to extubation; total length of stay (LOS) in the ICU (hours) following cardiac surgery, specifically from ICU admission to transfer to medical ward; total hospital LOS (hours) following cardiac surgery, from date of admission to date of discharge; and in-hospital mortality rates, from date of admission to date of discharge. Randomized controlled trials (RCTs), controlled trials, and prospective and retrospective cohort studies were considered for inclusion.
METHODS
A search was conducted in MEDLINE via PubMed, Embase, Trip Database, ProQuest Nursing and Allied Health Source Database, Web of Science, ProQuest Dissertations and Theses Global, and MedNar to locate both published and unpublished studies between January 1, 1999 and November 23, 2017. Two reviewers assessed the methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Quantitative data were extracted using the standardized data extraction tool from JBI SUMARI. Data were pooled using Comprehensive Meta-Analysis Software Version 3 (Biostat, NJ, USA). Mean differences (95% confidence interval [CI]) and effect size estimates were calculated for continuous outcomes. Meta-analysis using a random-effects model was performed for length of mechanical ventilation, ICU LOS, and hospital LOS. Results have been presented in narrative form when findings could not be pooled using meta-analysis. Standard GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) evidence assessment of outcomes has been reported.
RESULTS
A total of four studies were included in the review. Meta-analysis of three cohort studies revealed dexmedetomidine to be superior to propofol with an average reduction of 4.18 hours (95% CI -6.69 to -1.67, p = 0.001) on the extubation times, an average 9.89 hour (95% CI -18.6 to -1.19, p = 0.03) reduction in ICU LOS, and an average 37.9 hour (95% CI, -60.41 to -15.46, p = 0.00) reduction in overall hospital LOS. A RCT was excluded from pooling for meta-analysis, but its results were congruent with meta-analysis results. There was lack of sufficient data to perform meta-analysis on in-hospital mortality rates.
CONCLUSIONS
In postoperative cardiac surgery patients, dexmedetomidine is associated with a shorter time to extubation, shorter ICU LOS, and shorter hospital LOS in postoperative cardiac surgery patients compared to propofol. The quality of evidence for these findings however is low and no recommendations can be made to change current practice. There was insufficient evidence to determine significant differences in-hospital mortality rates. Sedation protocols still need to be formulated.There are significant gaps in the literature. Areas of further research include additional well-designed and appropriately powered RCTs with wide inclusion criteria to reflect this surgical population; quantitative, transparent, and standardized sedation, weaning, and extubation protocols; precise and standardized methods and measurements for interventions and outcomes, and short- and long-term morbidity and mortality follow-up.
Topics: Adult; Airway Extubation; Analgesics, Non-Narcotic; Anesthetics, Intravenous; Cardiac Surgical Procedures; Critical Care; Dexmedetomidine; Hospital Mortality; Humans; Intensive Care Units; Length of Stay; Propofol; Respiration, Artificial; Time Factors
PubMed: 29762314
DOI: 10.11124/JBISRIR-2017-003488 -
Anesthesiology May 2009Positive end expiratory pressure (PEEP) is an important component of therapy in patients with acute lung injury or acute respiratory distress syndrome. The independent... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Positive end expiratory pressure (PEEP) is an important component of therapy in patients with acute lung injury or acute respiratory distress syndrome. The independent effect of PEEP on mortality is currently unknown.
METHODS
A systematic review and meta-analysis of randomized controlled clinical trials comparing the use of higher and lower levels of PEEP.
RESULTS
Six trials with a total of 2,484 patients from 102 intensive care units and 9 countries met the eligibility criteria. In three trials, the effect of different levels of PEEP was compared in groups receiving comparable tidal volumes. Three trials accounted for more than 85% of total weighting in the meta-analyses. The pooled relative risk obtained from these three trials showed a trend towards improved mortality with high PEEP, even though the difference did not reach statistical significance: Pooled cumulative risk of 0.90 (95% CI 0.72-1.02, P = 0.077). The reduction in absolute risk of death was approximately 4%. There was no evidence of a significant increase in baro-trauma in patients receiving high PEEP, with a pooled risk of 0.95 (95% CI 0.62-1.45, P = 0.81).
CONCLUSION
High PEEP strategy may have a clinically relevant independent mortality benefit. Despite a possible increase in baro-trauma, the benefits far outweigh potential risks. Current evidence therefore favors the use of high PEEP as the preferred option when ventilating patients with severe acute respiratory distress syndrome. As the reduction in absolute risk of death is less than 5%, a future clinical trial aimed at demonstrating statistical significance is likely to pose considerable financial and ethical burdens.
Topics: Humans; Positive-Pressure Respiration; Randomized Controlled Trials as Topic; Respiratory Distress Syndrome
PubMed: 19352160
DOI: 10.1097/ALN.0b013e31819fae06 -
European Archives of... Feb 2022Tympanic membrane retraction (TMR) is a relatively common otological finding. However, no consensus on its management exists. We are looking especially for a treatment...
IMPORTANCE
Tympanic membrane retraction (TMR) is a relatively common otological finding. However, no consensus on its management exists. We are looking especially for a treatment strategy in the military population who are unable to attend frequent follow-up visits, and who experience relatively more barotrauma at great heights and depths and easily suffer from otitis externa from less hygienic circumstances.
OBJECTIVE
To assess and summarize the available evidence for the effectiveness of surgical interventions and watchful waiting policy in patients with a tympanic membrane retraction.
EVIDENCE REVIEW
The protocol for this systematic review was published at Prospero (207859). PubMed, Embase, and the Cochrane Database of Systematic Reviews were systematically searched from inception up to September 2020 for published and unpublished studies. We included randomized trials and observational studies that investigated surgical interventions (tympanoplasty, ventilation tube insertion) and wait-and-see policy. The primary outcomes of this study were clinical remission of the tympanic membrane retraction, tympanic membrane perforations and cholesteatoma development.
FINDINGS
In total, 27 studies were included, consisting of 1566 patients with TMRs. We included data from 2 randomized controlled trials (76 patients) and 25 observational studies (1490 patients). Seven studies (329 patients) investigated excision of the TMR with and without ventilation tube placement, 3 studies (207 patients) investigated the wait-and-see policy and 17 studies (1030 patients) investigated tympanoplasty for the treatment of TMRs.
CONCLUSIONS AND RELEVANCE
This study provides all the studies that have been published on the surgical management and wait-and-policy for tympanic membrane retractions. No high level of evidence comparative studies has been performed. The evidence for the management of tympanic membrane retractions is heterogenous and depends on many factors such as the patient population, location and severity of the TMR and presence of other ear pathologies (e.g., perforation, risk of cholesteatoma and serous otitis media).
Topics: Humans; Middle Ear Ventilation; Otitis Media with Effusion; Tympanic Membrane; Tympanoplasty
PubMed: 33689022
DOI: 10.1007/s00405-021-06719-3 -
Aerospace Medicine and Human Performance Feb 2017Flights to high altitude can lead to exposure and unique pathology not seen in normal commercial aviation. (Review)
Review
INTRODUCTION
Flights to high altitude can lead to exposure and unique pathology not seen in normal commercial aviation.
METHODS
This paper assesses the potential for point-of-care ultrasound to aid in management and disposition of injured crewmembers from a high altitude incident. This was accomplished through a systematic literature review regarding current diagnostic and therapeutic uses of ultrasound for injuries expected in high altitude free fall and parachuting.
RESULTS
While current research supports its utility in diagnostics, therapeutic procedures, and triage decisions, little research has been done regarding its utility in high altitude specific pathology, but its potential has been demonstrated.
DISCUSSION
An algorithm was created for use in high altitude missions, in the event of an emergency descent and traumatic landing for an unconscious and hypotensive pilot, to rule out most life threatening causes. Each endpoint includes disposition, allowing concise decision-making.Galdamez LA, Clark JB, Antonsen EL. Point-of-care ultrasound utility and potential for high altitude crew recovery missions. Aerosp Med Hum Perform. 2017; 88(2):128-136.
Topics: Aerospace Medicine; Altitude; Aviation; Barotrauma; Cardiac Tamponade; Clinical Decision-Making; Contusions; Decompression Sickness; Diaphragm; Emergency Medical Services; Fractures, Bone; Humans; Pericardial Effusion; Pleural Effusion; Pneumothorax; Point-of-Care Systems; Pulmonary Atelectasis; Pulmonary Edema; Surgery, Computer-Assisted; Ultrasonography
PubMed: 28095957
DOI: 10.3357/AMHP.4640.2017 -
Asian Cardiovascular & Thoracic Annals Feb 2022There are various reports of air leaks with coronavirus disease 2019 (COVID-19). We undertook a systematic review of all published case reports and series to analyse the...
INTRODUCTION
There are various reports of air leaks with coronavirus disease 2019 (COVID-19). We undertook a systematic review of all published case reports and series to analyse the types of air leaks in COVID-19 and their outcomes.
METHODS
The literature search from PubMed, Science Direct, and Google Scholar databases was performed from the start of the pandemic till 31 March 2021. The inclusion criteria were case reports or series on (1) laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, (2) with the individual patient details, and (3) reported diagnosis of one or more air leak syndrome (pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoperitoneum, pneumopericardium).
RESULTS
A total of 105 studies with 188 patients were included in the final analysis. The median age was 56.02 (SD 15.53) years, 80% males, 11% had previous respiratory disease, and 8% were smokers. Severe or critical COVID-19 was present in 50.6% of the patients. Pneumothorax (68%) was the most common type of air leak. Most patients (56.7%) required intervention with lower mortality (29.1% vs. 44.1%, p = 0.07) and intercostal drain (95.9%) was the preferred interventional management. More than half of the patients developed air leak on spontaneous breathing. The mortality was significantly higher in patients who developed air leak with positive pressure ventilation (49%, p < 0.001) and required escalation of respiratory support (39%, p = 0.006).
CONCLUSION
Air leak in COVID-19 can occur spontaneously without positive pressure ventilation, higher transpulmonary pressures, and other risk factors like previous respiratory disease or smoking. The mortality is significantly higher if associated with positive pressure ventilation and escalation of respiratory support.
Topics: COVID-19; Female; Humans; Male; Mediastinal Emphysema; Middle Aged; Pneumothorax; SARS-CoV-2; Treatment Outcome
PubMed: 34247490
DOI: 10.1177/02184923211031134