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JAMA Network Open Mar 2023High-dose docosahexaenoic acid (DHA), a long-chain polyunsaturated fatty acid, may affect the risk of bronchopulmonary dysplasia (BPD). However, high-level summative... (Meta-Analysis)
Meta-Analysis
Association Between Enteral Supplementation With High-Dose Docosahexaenoic Acid and Risk of Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review and Meta-analysis.
IMPORTANCE
High-dose docosahexaenoic acid (DHA), a long-chain polyunsaturated fatty acid, may affect the risk of bronchopulmonary dysplasia (BPD). However, high-level summative evidence supporting such clinical association in very preterm infants is lacking.
OBJECTIVE
To examine the association between enteral supplementation with high-dose DHA during the neonatal period and the risk of BPD in preterm infants born at less than 29 weeks' gestation.
DATA SOURCES
PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, medRxiv, and ClinicalTrials.gov were searched from inception to August 1, 2022, for eligible articles with no language restrictions.
STUDY SELECTION
Randomized clinical trials (RCTs) were eligible for inclusion (1) if their interventions involved direct administration of a minimum DHA supplementation of 40 mg/kg/d or breast milk or formula feeding of at least 0.4% of total fatty acids, and (2) if they reported data on either BPD, death, BPD severity, or a combined outcome of BPD and death.
DATA EXTRACTION AND SYNTHESIS
Two investigators completed independent review of titles and abstracts, full text screening, data extraction, and quality assessment using the Cochrane Risk of Bias 2.0. Risk ratios (RRs) with 95% CIs were pooled using random-effect meta-analyses.
MAIN OUTCOMES AND MEASURES
Primary outcome was BPD using trial-specific definitions, which was further stratified for RCTs that used a more stringent BPD definition based on systematic pulse oximetry assessment at 36 weeks' postmenstrual age. Other outcomes were BPD, death, BPD severity, or combined BPD and death.
RESULTS
Among the 2760 studies screened, 4 RCTs were included, which involved 2304 infants (1223 boys [53.1%]; mean [SD] gestational age, 26.5 [1.6] weeks). Enteral supplementation with high-dose DHA was associated with neither BPD (4 studies [n = 2186 infants]; RR, 1.07 [95% CI, 0.86-1.34]; P = .53; I2 = 72%) nor BPD or death (4 studies [n = 2299 infants]; RR, 1.04 [95% CI, 0.91-1.18]; P = .59; I2 = 61%). However, an inverse association with BPD was found in RCTs that used a more stringent BPD definition (2 studies [n = 1686 infants]; RR, 1.20 [95% CI, 1.01-1.42]; P = .04; I2 = 48%). Additionally, DHA was inversely associated with moderate-to-severe BPD (3 studies [n = 1892 infants]; RR, 1.16 [95% CI, 1.04-1.29]; P = .008; I2 = 0%).
CONCLUSIONS AND RELEVANCE
Results of this study showed that enteral supplementation with high-dose DHA in the neonatal period was not associated overall with BPD, but an inverse association was found in the included RCTs that used a more stringent BPD definition. These findings suggest that high-dose DHA supplementation should not be recommended to prevent BPD in very preterm infants.
Topics: Infant, Newborn; Infant; Male; Female; Humans; Adult; Docosahexaenoic Acids; Bronchopulmonary Dysplasia; Infant, Premature; Gestational Age; Infant, Premature, Diseases; Fetal Growth Retardation; Dietary Supplements
PubMed: 36943265
DOI: 10.1001/jamanetworkopen.2023.3934 -
The Cochrane Database of Systematic... Dec 2010Bronchiolitis is an acute, viral lower respiratory tract infection affecting infants and often treated with bronchodilators. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Bronchiolitis is an acute, viral lower respiratory tract infection affecting infants and often treated with bronchodilators.
OBJECTIVES
To assess the effects of bronchodilators on clinical outcomes in infants with acute bronchiolitis.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1) which contains the Acute Respiratory Infections Group's Specialized Register, MEDLINE (1966 to March week 2 2010) and EMBASE (2003 to March 2010).
SELECTION CRITERIA
Randomized controlled trials (RCTs) comparing bronchodilators (other than epinephrine) with placebo for bronchiolitis.
DATA COLLECTION AND ANALYSIS
Two authors assessed trial quality and extracted data. Unpublished data were obtained from trial authors.
MAIN RESULTS
We included 28 trials (1912 infants) with bronchiolitis. In 10 inpatient and 10 outpatient studies, oxygen saturation did not improve with bronchodilators (mean difference (MD) -0.45, 95% confidence interval (CI) -0.96 to 0.05, n = 1182). Outpatient bronchodilator treatment did not reduce the rate of hospitalization (12% in bronchodilator group versus 16% in placebo, odds ratio (OR) 0.78, 95% CI 0.47 to 1.29, n = 650). Inpatient bronchodilator treatment did not reduce the duration of hospitalization (MD 0.06, 95% CI -0.27 to 0.39, n = 349). In seven inpatient and eight outpatient studies, average clinical score decreased slightly with bronchodilators (standardized mean difference (SMD) -0.37, 95% CI -0.62 to -0.13, n = 1006).Oximetry and clinical score outcomes showed significant heterogeneity. Including only studies at low risk of bias significantly reduced heterogeneity measures for oximetry (I(2) statistic = 17%) and average clinical score (I(2) statistic = 26%), while having little impact on the overall effect size of oximetry (MD -0.38, 95% CI -0.75 to 0.00, P = 0.05) and average clinical score (SMD -0.26, 95% CI -0.44 to -0.08, P = 0.005).Effect estimates for outpatients were slightly larger than for inpatients for oximetry (outpatients MD -0.57, 95% CI -1.13 to 0.00 versus inpatients MD -0.29, 95% CI -1.10 to 0.51) and average clinical score (outpatients SMD -0.49, 95% CI -0.86 to -0.11 versus inpatients SMD -0.20, 95% CI -0.43 to 0.03). Adverse effects included tachycardia and tremors.
AUTHORS' CONCLUSIONS
Bronchodilators do not improve oxygen saturation, do not reduce hospital admission after outpatient treatment, do not shorten the duration of hospitalization and do not reduce the time to resolution of illness at home. The small improvements in clinical scores for outpatients must be weighed against the costs and adverse effects of bronchodilators.
Topics: Acute Disease; Ambulatory Care; Bronchiolitis; Bronchodilator Agents; Hospitalization; Humans; Infant; Randomized Controlled Trials as Topic
PubMed: 21154348
DOI: 10.1002/14651858.CD001266.pub2 -
Journal of Clinical Monitoring and... Feb 2022The objective of this systematic review and meta-analysis was to analyze the effectiveness of contactless vital sign monitors that utilize a consumer-friendly camera... (Meta-Analysis)
Meta-Analysis Review
The objective of this systematic review and meta-analysis was to analyze the effectiveness of contactless vital sign monitors that utilize a consumer-friendly camera versus medical grade instruments. A multiple database search was conducted from inception to September 2020. Inclusion criteria were as follows: studies that used a consumer-grade camera (smartphone/webcam) to examine contactless vital signs in adults; evaluated the non-contact device against a reference medical device; and used the participants' face for measurement. Twenty-six studies were included in the review of which 16 were included in Pearson's correlation and 14 studies were included in the Bland-Altman meta-analysis. Twenty-two studies measured heart rate (HR) (92%), three measured blood pressure (BP) (12%), and respiratory rate (RR) (12%). No study examined blood oxygen saturation (SpO). Most studies had a small sample size (≤ 30 participants) and were performed in a laboratory setting. Our meta-analysis found that consumer-grade contactless vital sign monitors were accurate in comparison to a medical device in measuring HR. Current contactless monitors have limitations such as motion, poor lighting, and lack of automatic face tracking. Currently available consumer-friendly contactless monitors measure HR accurately compared to standard medical devices. More studies are needed to assess the accuracy of contactless BP and RR monitors. Implementation of contactless vital sign monitors for clinical use will require validation in a larger population, in a clinical setting, and expanded to encompass other vital signs including BP, RR, and SpO.
Topics: Adult; Heart Rate; Humans; Monitoring, Physiologic; Oximetry; Respiratory Rate; Vital Signs
PubMed: 34240262
DOI: 10.1007/s10877-021-00734-9 -
Journal of Global Health Sep 2023Pulse oximetry has been used in medical care for decades. Its use quickly became standard of care in high resource settings, with delayed widespread availability and use...
BACKGROUND
Pulse oximetry has been used in medical care for decades. Its use quickly became standard of care in high resource settings, with delayed widespread availability and use in lower resource settings. Pulse oximetry training initiatives have been ongoing for years, but a map of the literature describing such initiatives among health care workers in low- and middle-income countries (LMICs) has not previously been conducted. Additionally, the coronavirus disease 2019 (COVID-19) pandemic further highlighted the inequitable distribution of pulse oximetry use and training. We aimed to characterise the landscape of pulse oximetry training for health care workers in LMICs prior to the COVID-19 pandemic as described in the literature.
METHODS
We systematically searched six databases to identify studies reporting pulse oximetry training among health care workers, broadly defined, in LMICs prior to the COVID-19 pandemic. Two reviewers independently assessed titles and abstracts and relevant full texts for eligibility. Data were charted by one author and reviewed for accuracy by a second. We synthesised the results using a narrative synthesis.
RESULTS
A total of 7423 studies were identified and 182 screened in full. A total of 55 training initiatives in 42 countries met inclusion criteria, as described in 66 studies since some included studies reported on different aspects of the same training initiative. Five overarching reasons for conducting pulse oximetry training were identified: 1) anaesthesia and perioperative care, 2) respiratory support programme expansion, 3) perinatal assessment and monitoring, 4) assessment and monitoring of children and 5) assessment and monitoring of adults. Educational programmes varied in their purpose with respect to the types of patients being targeted, the health care workers being instructed, and the depth of pulse oximetry specific training.
CONCLUSIONS
Pulse oximetry training initiatives have been ongoing for decades for a variety of purposes, utilising a multitude of approaches to equip health care workers with tools to improve patient care. It is important that these initiatives continue as pulse oximetry availability and knowledge gaps remain. Neither pulse oximetry provision nor training alone is enough to bolster patient care, but sustainable solutions for both must be considered to meet the needs of both health care workers and patients.
Topics: Adult; Child; Female; Pregnancy; Humans; Developing Countries; Pandemics; COVID-19; Educational Status; Health Personnel
PubMed: 37736848
DOI: 10.7189/jogh.13.04074 -
Physiotherapy Dec 2009To investigate the efficacy and safety of the technique of instillation of normal saline prior to suction of airways in intubated patients. (Review)
Review
OBJECTIVE
To investigate the efficacy and safety of the technique of instillation of normal saline prior to suction of airways in intubated patients.
DATA SOURCES
Databases searched included: MEDLINE, CINAHL, EMBASE, Cochrane Controlled Trials Register and Full text clinicians' health journals @ Ovid from the earliest time to March 2009. Citation tracking of relevant primary and review articles.
REVIEW METHODS
All randomised controlled trials, crossover trials, quasi- and full systematic reviews were screened. From 65 articles screened, 17 articles (two quasi-systematic reviews and 15 empirical studies) met the eligibility criteria and were included for data extraction. The outcomes in the reviewed studies included oxygenation, lung mechanics, sputum yield, dyspnoea, tube patency and ventilator-associated pneumonia. Effect sizes and 95% confidence intervals were calculated.
RESULTS
Studies were mainly of low methodological quality due to factors such as lack of assessor blinding and within-group-only statistics. Overall, there was a positive effect favouring the use of saline to increase sputum yield (d=0.50, 95% confidence interval 0.10 to 0.90). Due to heterogeneity of methodology, it was not possible to perform meta-analyses on haemodynamics, oxygenation, tube patency and ventilator-associated pneumonia. Overall, while a decrease was found in oxygen saturation measured by pulse oximetry (SpO(2)) following instillation of normal saline compared with no saline, this was of limited clinical significance.
CONCLUSIONS
The results of this review reflect the poor quality of available articles on instillation of normal saline prior to suction of artificial airways. There is little evidence of benefit but also minimal evidence of safety risks. Controlled trials of better quality and more clinically relevant outcomes need to be performed before this technique is either accepted or rejected.
Topics: Clinical Trials as Topic; Humans; Instillation, Drug; Intubation, Intratracheal; Respiration, Artificial; Sodium Chloride; Suction
PubMed: 19892088
DOI: 10.1016/j.physio.2009.06.002 -
Respiratory Care Sep 2023The effect of application of fingernail polish on S measurement remains unclear. We conducted this systematic review to ascertain the impact of fingernail polish on S... (Review)
Review
BACKGROUND
The effect of application of fingernail polish on S measurement remains unclear. We conducted this systematic review to ascertain the impact of fingernail polish on S measurement.
METHODS
We queried PubMed, Embase, and CINAHL databases for publications indexed through December 2022. We included studies providing paired S data from fingertips without and after nail polish application or reporting the number of subjects whose S could not be measured due to fingernail polish. We used random effects modeling to summarize standardized mean differences (SMDs) and corresponding 95% CI for different nail polish colors from comparative studies.
RESULTS
We retrieved 122 studies and included 21 publications, mostly performed on healthy volunteers. Of these, 17 (81.0%) studies had a low risk of bias. We summarized mean SMD for 10 nail polish colors (black, blue, brown, green, orange, pink, purple, red, white, and yellow) from 25 paired data sets on S across 20 studies. We found small (likely clinically insignificant) but statistically significant differences in mean S when fingers were coated with black, blue, brown, or purple nail polish (SMD -0.57, -0.47, -0.33, and -0.25, respectively; 95% CI -0.86 to -0.29, -0.84 to -0.10, -0.59 to -0.07, and -0.48 to -0.02, respectively). Only one of 4 studies reported a high proportion of unsuccessful oximeter readings from fingers painted with black (88.0%) or brown (36.0%) nail polish.
CONCLUSIONS
Although fingernail polish of some colors can marginally reduce S reading or occasionally impede S measurement, the variability is clinically insignificant.
Topics: Humans; Color; Cosmetics; Nails; Oximetry; Oxygen
PubMed: 37185113
DOI: 10.4187/respcare.10399 -
Resuscitation Plus Sep 2024To examine speed and accuracy of newborn heart rate measurement by various assessment methods employed at birth. (Review)
Review
AIM
To examine speed and accuracy of newborn heart rate measurement by various assessment methods employed at birth.
METHODS
A search of Medline, SCOPUS, CINAHL and Cochrane was conducted between January 1, 1946, to until August 16, 2023. (CRD 42021283364) Study selection was based on predetermined criteria. Reviewers independently extracted data, appraised risk of bias and assessed certainty of evidence.
RESULTS
Pulse oximetry is slower and less precise than ECG for heart rate assessment. Both auscultation and palpation are imprecise for heart rate assessment. Other devices such as digital stethoscope, Doppler ultrasound, an ECG device using dry electrodes incorporated in a belt, photoplethysmography and electromyography are studied in small numbers of newborns and data are not available for extremely preterm or bradycardic newborns receiving resuscitation. Digital stethoscope is fast and accurate. Doppler ultrasound and dry electrode ECG in a belt are fast, accurate and precise when compared to conventional ECG with gel adhesive electrodes.
LIMITATIONS
Certainty of evidence was low or very low for most comparisons.
CONCLUSION
If resources permit, ECG should be used for fast and accurate heart rate assessment at birth. Pulse oximetry and auscultation may be reasonable alternatives but have limitations. Digital stethoscope, doppler ultrasound and dry electrode ECG show promise but need further study.
PubMed: 38912532
DOI: 10.1016/j.resplu.2024.100668 -
Clinical Oral Investigations Jul 2022To assess whether wearing complete dentures during sleep influences the cardiorespiratory parameters of patients with obstructive sleep apnea (OSA). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess whether wearing complete dentures during sleep influences the cardiorespiratory parameters of patients with obstructive sleep apnea (OSA).
MATERIALS AND METHODS
A systematic review was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to determine whether wearing complete dentures during sleep influences the cardiorespiratory parameters of patients with OSA. An electronic search was performed in four databases, PubMed/MEDLINE, Cochrane Library, Web of Science, and SCOPUS, and in the gray literature (TRIALS) until November 2021. This review included clinical trials, randomized clinical trials, and studies in which patients using conventional complete dentures were diagnosed with OSA using polysomnography and the cardiorespiratory parameters were measured using oximetry or polysomnography during sleep.
RESULTS
In total, 788 references were found in the database, and 12 articles were selected for full reading. Six articles were selected for qualitative and quantitative analyses after applying the inclusion and exclusion criteria and reading the full article. The meta-analysis showed that mean oxygen saturation (SpO) increased with the use of complete dentures (p = 0.001), but the other parameters showed no significant differences between those wearing and not wearing dentures during sleep.
CONCLUSIONS
The mean SpO reduced in patients wearing complete dentures, but the other cardiorespiratory parameters evaluated were not affected.
CLINICAL RELEVANCE
This study indicates a possible influence of the use of complete dentures on the mean SpO during sleep. The use of complete denture could aid other treatments in improving respiratory and sleep quality.
Topics: Denture, Complete; Humans; Mouth, Edentulous; Polysomnography; Sleep; Sleep Apnea, Obstructive
PubMed: 35616727
DOI: 10.1007/s00784-022-04517-7 -
Academic Emergency Medicine : Official... Aug 2016Tissue oximetry using near-infrared spectroscopy (NIRS) is a noninvasive monitor of cerebral oxygenation. This new technology has been used during cardiac arrest (CA)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tissue oximetry using near-infrared spectroscopy (NIRS) is a noninvasive monitor of cerebral oxygenation. This new technology has been used during cardiac arrest (CA) because of its ability to give measures in low-blood-flow situations. The aim of this study was to assess the evidence regarding the association between the types of NIRS measurements (mean, initial, and highest values) and resuscitation outcomes (return of spontaneous circulation [ROSC], survival to discharge, and good neurologic outcome) in patients undergoing cardiopulmonary resuscitation.
METHODS
This review was registered (Prospero CRD42015017380) and is reported as per the PRISMA guidelines. Medline, Embase, and CENTRAL were searched. All studies, except case reports and case series of fewer than five patients, reporting on adults that had NIRS monitoring during CA were eligible for inclusion. Two reviewers assessed the quality of the included articles and extracted the data. The outcome effect was standardized using standardized mean difference (SMD).
RESULTS
Twenty nonrandomized observational studies (15 articles and five conference abstracts) were included in this review, for a total of 2,436 patients. We found a stronger association between ROSC and mean NIRS values (SMD = 1.33; 95% confidence interval [CI] = 0.92 to 1.74) than between ROSC and initial NIRS measurements (SMD = 0.51; 95% CI = 0.23 to 0.78). There was too much heterogeneity among the highest NIRS measurements group to perform meta-analysis. Only two of the 75 patients who experienced ROSC had a mean NIRS saturation under 30%. Patients who survived to discharge and who had good neurologic outcome displayed superior combined initial and mean NIRS values than their counterparts (SMD = 1.63; 95% CI = 1.34 to 1.92; and SMD = 2.12; 95% CI = 1.14 to 3.10).
CONCLUSIONS
Patients with good resuscitation outcomes have significantly higher NIRS saturations during resuscitation than their counterparts. The types of NIRS measurements during resuscitation influenced the association between ROSC and NIRS saturation. Prolonged failure to obtain a NIRS saturation higher than 30% may be included in a multimodal approach to the decision of terminating resuscitation efforts (Class IIb, Level of Evidence C-Limited Data).
Topics: Adult; Cardiopulmonary Resuscitation; Female; Heart Arrest; Humans; Monitoring, Physiologic; Oximetry; Patient Discharge; Reference Standards; Spectroscopy, Near-Infrared
PubMed: 27028004
DOI: 10.1111/acem.12980 -
Journal of Perianesthesia Nursing :... Apr 2022The objective of this review was to evaluate the effectiveness of capnography monitoring versus standard monitoring of pulse oximetry in detecting respiratory adverse... (Review)
Review
PURPOSE
The objective of this review was to evaluate the effectiveness of capnography monitoring versus standard monitoring of pulse oximetry in detecting respiratory adverse events in nonintubated pediatric and adult postanesthesia care unit (PACU) patients.
DESIGN
Experimental, quasi-experimental, and observational studies examining pulse oximetry and capnography in adult and pediatric patients in the PACU were included in this systematic review.
METHODS
An initial search of MEDLINE and CINAHL, PubMed, Web of Science, Prospero, Google Scholar, and Cochrane was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy in July 2019. Reference lists of studies included at critical appraisal stage were hand-searched. Studies published in English from 1978 onward were included.
FINDINGS
Meta-analysis was not possible due to variation in outcome measurements; therefore, results are presented in narrative form. Four studies were included in the review: 1 randomized controlled trial (RCT) and 3 observational cross-sectional studies. The RCT was considered of moderate to high quality, and the observational cross-sectional studies were of high quality. The main findings of this review suggest that there is limited high-quality evidence that capnography improves detection of respiratory adverse events in the PACU versus pulse oximetry.
CONCLUSIONS
The lack of RCTs and varied outcomes measures in the 4 studies reviewed meant that meta-analysis was not possible. Early detection of respiratory adverse events afforded by the addition of PETCO to SpO in the PACU was seen in these studies. More research is needed to determine if widespread implementation of capnography in addition to pulse oximetry would reduce severity of respiratory related adverse events in the PACU through more timely identification.
Topics: Adult; Capnography; Child; Cross-Sectional Studies; Hand; Humans; Monitoring, Physiologic; Oximetry
PubMed: 34974968
DOI: 10.1016/j.jopan.2021.03.013