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Cureus Jul 2022Bevacizumab is a monoclonal anti-vascular endothelial growth factor (VEGF) antibody that binds to and makes all of the VEGF isoforms inactive, and thus prevents... (Review)
Review
Bevacizumab is a monoclonal anti-vascular endothelial growth factor (VEGF) antibody that binds to and makes all of the VEGF isoforms inactive, and thus prevents angiogenesis, development, and the spread of the tumor. The most reported side effects after administering bevacizumab include bleeding, high blood pressure, heart failure, proteinuria, thrombosis, and gastrointestinal perforation. Pneumothorax has rarely been reported as a complication of bevacizumab, but with an unclear mechanism. This article aims to explore the occurrence of pneumothorax as a side effect after using bevacizumab through a systematic review of current case reports published on the topic. A literature search was conducted using PubMed, Google Scholar, ScienceDirect, and Directory of Open Access through the utilization of appropriate keywords, and case reports were selected based on predefined inclusion and exclusion criteria. Our results encompass five case reports that were further evaluated for demographic, clinical, and treatment parameters. This systematic review concludes that pneumothorax can occur after bevacizumab-containing chemotherapy although this side effect is relatively rare. Awareness regarding this possible side effect can assist clinicians during their practice in considering pneumothorax as a possible differential diagnosis when encountering patients presenting with pulmonary symptoms after starting bevacizumab-containing chemotherapy; hence, timely diagnosis and treatment can save a life.
PubMed: 36043019
DOI: 10.7759/cureus.27338 -
Annals of Medicine and Surgery (2012) Jan 2022An ever-increasing number of studies have reported an increased incidence of spontaneous pulmonary barotrauma such as pneumothorax, pneumomediastinum, and subcutaneous... (Review)
Review
BACKGROUND
An ever-increasing number of studies have reported an increased incidence of spontaneous pulmonary barotrauma such as pneumothorax, pneumomediastinum, and subcutaneous emphysema in patients with COVID-19. We conducted this systematic review and meta-analysis to assess the value and significance of the available data.
METHODS
A thorough systematic search was conducted to identify studies of barotrauma in hospitalized patients with COVID-19. Data analysis of case reports was done using a statistical package for the social sciences (SPSS) version 22, and meta-analysis was performed using CMA-3.
RESULTS
We identified a total of 4488 studies after thorough database searching.118 case reports and series, and 15 observational studies were included in the qualitative analysis. Fifteen studies were included in the quantitative analysis. The observational studies reported barotrauma in 4.2% (2.4-7.3%) among hospitalized patients; 15.6% (11-21.8%) among critically ill patients; and 18.4% (13-25.3%) in patients receiving invasive mechanical ventilation, showing a linear relationship of barotrauma with the severity of the disease. In addition, barotrauma was associated with a longer length of hospital stay, more extended ICU stay, and higher in-hospital mortality. Also, a slightly higher odds of barotrauma was seen in COVID-19 ARDS compared with non-COVID-19 ARDS.
CONCLUSION
COVID-19 pneumonia is associated with a higher incidence of barotrauma. It presents unique challenges for invasive and non-invasive ventilation management. Further studies are required to unravel the underlying pathophysiology and develop safer management strategies.
PubMed: 35003730
DOI: 10.1016/j.amsu.2021.103221 -
Chest Mar 2012A pneumothorax is a potentially life-threatening condition. Although CT scan is the reference standard for diagnosis, chest radiographs are commonly used to rule out the... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
A pneumothorax is a potentially life-threatening condition. Although CT scan is the reference standard for diagnosis, chest radiographs are commonly used to rule out the diagnosis. We compared the test characteristics of ultrasonography and supine chest radiography in adult patients clinically suspected of having a pneumothorax, using CT scan or release of air on chest tube placement as reference standard.
METHODS
We searched for English literature in MEDLINE and EMBASE and performed hand searches. Two independent investigators used standardized forms to review articles for inclusion, quality (QUADAS tool), and data extraction. We calculated κ agreement for study selection and evaluated clinical and quality homogeneity before meta-analysis.
RESULTS
We reviewed 570 articles and selected 21 for full review (κ, 0.89); eight articles (total of 1,048 patients) met all inclusion criteria (κ, 0.81). All studies but one used the ultrasonographic signs of lung sliding and comet tail to rule out pneumothorax. Chest radiography data were available for 864 of 1,048 patients evaluated with ultrasonography. Ultrasonography was 90.9% sensitive (95% CI, 86.5-93.9) and 98.2% specific (95% CI, 97.0-99.0) for the detection of pneumothorax. Chest radiography was 50.2% sensitive (95% CI, 43.5-57.0) and 99.4% specific (95% CI, 98.3-99.8).
CONCLUSIONS
Performance of ultrasonography for the detection of pneumothorax is excellent and is superior to supine chest radiography. Considering the rapid access to bedside ultrasonography and the excellent performance of this simple test, this study supports the routine use of ultrasonography for the detection of pneumothorax.
Topics: Humans; Pneumothorax; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography
PubMed: 21868468
DOI: 10.1378/chest.11-0131 -
Injury Mar 2018To assess the accuracy of the chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and haemothorax in adults. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the accuracy of the chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and haemothorax in adults.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
PubMed, EMBASE, Scopus, Web of Science and LILACS (up to 2016) were systematically searched for prospective studies on the diagnostic accuracy of ultrasonography for pneumothorax and haemothorax in adult trauma patients. The references of other systematic reviews and the included studies were checked for further articles. The characteristics and results of the studies were extracted using a standardised form, and their methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Primary analysis was performed considering each hemithorax as an independent unit, while secondary analysis considered each patient. The global diagnostic accuracy of the chest ultrasonography was estimated using the Rutter-Gatsonis hierarchical summary ROC method. Moreover, Reitsma's bivariate model was used to estimate the sensitivity, specificity, positive likelihood ratio (LR + ) and negative likelihood ratio (LR-) of each sonographic sign. This review was previously registered (PROSPERO CRD42016048085).
RESULTS
Nineteen studies were included in the review, 17 assessing pneumothorax and 5 assessing haemothorax. The reference standard was always chest tomography, alone or in parallel with chest radiography and observation of the chest tube. The overall methodological quality of the studies was low. The diagnostic accuracy of chest ultrasonography had an area under the curve (AUC) of 0.979 for pneumothorax (Fig). The absence of lung sliding and comet-tail artefacts was the most reported sonographic sign of pneumothorax, with a sensitivity of 0.81 (95% confidence interval [95%CI], 0.71-0.88), specificity of 0.98 (95%CI, 0.97-0.99), LR+ of 67.9 (95%CI, 26.3-148) and LR- of 0.18 (95%CI, 0.11-0.29). An echo-poor or anechoic area in the pleural space was the only sonographic sign for haemothorax, with a sensitivity of 0.60 (95%CI, 0.31-0.86), specificity of 0.98 (95%CI, 0.94-0.99), LR+ of 37.5 (95%CI, 5.26-207.5), LR- of 0.40 (95%CI, 0.17-0.72) and AUC of 0.953.
CONCLUSION
Notwithstanding the limitations of the included studies, this systematic review and meta-analysis suggested that chest ultrasonography is an accurate tool for the diagnostic assessment of traumatic pneumothorax and haemothorax in adults.
Topics: Emergency Service, Hospital; Hemothorax; Humans; Pneumothorax; Prospective Studies; Reproducibility of Results; Thoracic Injuries; Ultrasonography
PubMed: 29433802
DOI: 10.1016/j.injury.2018.01.033 -
BMJ Clinical Evidence Jan 2011The incidence of spontaneous pneumothorax is 24/100,000 a year in men and 9.9/100,000 a year in women in England and Wales. The major contributing factor is smoking,... (Review)
Review
INTRODUCTION
The incidence of spontaneous pneumothorax is 24/100,000 a year in men and 9.9/100,000 a year in women in England and Wales. The major contributing factor is smoking, which increases the likelihood by 22 times in men, and by 8 times in women. While death from spontaneous pneumothorax is rare, rates of recurrence are high, with one study of men in the USA finding a total recurrence rate of 35%.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in people presenting with spontaneous pneumothorax? What are the effects of interventions to prevent recurrence in people with previous spontaneous pneumothorax? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 17 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: chest-tube drainage (alone or plus suction), chest tubes (small, standard sizes, one-way valves), needle aspiration, and pleurodesis.
Topics: Chest Tubes; Drainage; Humans; Pleurodesis; Pneumothorax; Prospective Studies; Recurrence; Suction; Treatment Outcome
PubMed: 21477390
DOI: No ID Found -
Annals of Palliative Medicine Nov 2021Vascular punctures are widely used in clinical applications; however, clinical trials have identified complications and poor prognosis for patients undergoing common... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Vascular punctures are widely used in clinical applications; however, clinical trials have identified complications and poor prognosis for patients undergoing common peripheral vein puncture as compared to ultrasound-guided peripheral venipuncture and catheterization. Ultrasound-guided peripheral venipuncture and catheterization is accurate, simple, has fewer associated complications, and will gradually take the place of common peripheral vein puncture.
METHODS
To study the safety of ultrasound-guided peripheral venous catheterization, a meta-analysis was conducted of relevant articles dating from establishment date of the database (such as PubMed, MEDLINE and EMBASE) to March 2021, with the search keywords being peripheral venipuncture, ultrasound guidance, vascular injury rate, and hematoma formation rate. A total of 8 trials were used to determine accuracy indicators, which included puncture failure rate, arterial injury rate, hematoma formation rate, pneumothorax incidence rate, and hemothorax incidence rate.
RESULTS
There were statistically significant differences between the two methods for peripheral venipuncture and catheterization in terms of puncture failure rate [odds ratio (OR) =0.08; 95% CI: 0.04-0.16; P<0.00001], incidence of vascular injury (OR =0.15; 95% CI: 0.07-0.32; P<0.00001), probability of hematoma formation during the puncture process (OR =0.24; 95% CI: 0.08-0.69; P=0.008), and probability of pneumothorax during puncture (OR =0.10; 95% CI: 0.02-0.55; P=0.008).
DISCUSSION
Eight articles were included for meta-analysis. Ultrasound-guided peripheral venipuncture and catheterization is a commonly used puncture method for patients needing rapid fluid infusion with pressure or a pressure pump, repeated transfusion of blood product, or multiple daily venous blood drawing test. The results were very clear, and the puncture failure rate and other complications of ultrasound-guided peripheral venipuncture catheterization were low.
Topics: Catheterization, Central Venous; Clinical Trials as Topic; Humans; Incidence; Phlebotomy; Ultrasonography; Ultrasonography, Interventional
PubMed: 34872297
DOI: 10.21037/apm-21-3163 -
The Cochrane Database of Systematic... May 2023Nasal high flow (nHF) therapy provides heated, humidified air and oxygen via two small nasal prongs, at gas flows of more than 1 litre/minute (L/min), typically 2 L/min... (Review)
Review
BACKGROUND
Nasal high flow (nHF) therapy provides heated, humidified air and oxygen via two small nasal prongs, at gas flows of more than 1 litre/minute (L/min), typically 2 L/min to 8 L/min. nHF is commonly used for non-invasive respiratory support in preterm neonates. It may be used in this population for primary respiratory support (avoiding, or prior to the use of mechanical ventilation via an endotracheal tube) for prophylaxis or treatment of respiratory distress syndrome (RDS). This is an update of a review first published in 2011 and updated in 2016.
OBJECTIVES
To evaluate the benefits and harms of nHF for primary respiratory support in preterm infants compared to other forms of non-invasive respiratory support.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date March 2022.
SELECTION CRITERIA
We included randomised or quasi-randomised trials comparing nHF with other forms of non-invasive respiratory support for preterm infants born less than 37 weeks' gestation with respiratory distress soon after birth.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane Neonatal methods. Our primary outcomes were 1. death (before hospital discharge) or bronchopulmonary dysplasia (BPD), 2. death (before hospital discharge), 3. BPD, 4. treatment failure within 72 hours of trial entry and 5. mechanical ventilation via an endotracheal tube within 72 hours of trial entry. Our secondary outcomes were 6. respiratory support, 7. complications and 8. neurosensory outcomes. We used GRADE to assess the certainty of evidence.
MAIN RESULTS
We included 13 studies (2540 infants) in this updated review. There are nine studies awaiting classification and 13 ongoing studies. The included studies differed in the comparator treatment (continuous positive airway pressure (CPAP) or nasal intermittent positive pressure ventilation (NIPPV)), the devices for delivering nHF and the gas flows used. Some studies allowed the use of 'rescue' CPAP in the event of nHF treatment failure, prior to any mechanical ventilation, and some allowed surfactant administration via the INSURE (INtubation, SURfactant, Extubation) technique without this being deemed treatment failure. The studies included very few extremely preterm infants less than 28 weeks' gestation. Several studies had unclear or high risk of bias in one or more domains. Nasal high flow compared with continuous positive airway pressure for primary respiratory support in preterm infants Eleven studies compared nHF with CPAP for primary respiratory support in preterm infants. When compared with CPAP, nHF may result in little to no difference in the combined outcome of death or BPD (risk ratio (RR) 1.09, 95% confidence interval (CI) 0.74 to 1.60; risk difference (RD) 0, 95% CI -0.02 to 0.02; 7 studies, 1830 infants; low-certainty evidence). Compared with CPAP, nHF may result in little to no difference in the risk of death (RR 0.78, 95% CI 0.44 to 1.39; 9 studies, 2009 infants; low-certainty evidence), or BPD (RR 1.14, 95% CI 0.74 to 1.76; 8 studies, 1917 infants; low-certainty evidence). nHF likely results in an increase in treatment failure within 72 hours of trial entry (RR 1.70, 95% CI 1.41 to 2.06; RD 0.09, 95% CI 0.06 to 0.12; number needed to treat for an additional harmful outcome (NNTH) 11, 95% CI 8 to 17; 9 studies, 2042 infants; moderate-certainty evidence). However, nHF likely does not increase the rate of mechanical ventilation (RR 1.04, 95% CI 0.82 to 1.31; 9 studies, 2042 infants; moderate-certainty evidence). nHF likely results in a reduction in pneumothorax (RR 0.66, 95% CI 0.40 to 1.08; 10 studies, 2094 infants; moderate-certainty evidence) and nasal trauma (RR 0.49, 95% CI 0.36 to 0.68; RD -0.06, 95% CI -0.09 to -0.04; 7 studies, 1595 infants; moderate-certainty evidence). Nasal high flow compared with nasal intermittent positive pressure ventilation for primary respiratory support in preterm infants Four studies compared nHF with NIPPV for primary respiratory support in preterm infants. When compared with NIPPV, nHF may result in little to no difference in the combined outcome of death or BPD, but the evidence is very uncertain (RR 0.64, 95% CI 0.30 to 1.37; RD -0.05, 95% CI -0.14 to 0.04; 2 studies, 182 infants; very low-certainty evidence). nHF may result in little to no difference in the risk of death (RR 0.78, 95% CI 0.36 to 1.69; RD -0.02, 95% CI -0.10 to 0.05; 3 studies, 254 infants; low-certainty evidence). nHF likely results in little to no difference in the incidence of treatment failure within 72 hours of trial entry compared with NIPPV (RR 1.27, 95% CI 0.90 to 1.79; 4 studies, 343 infants; moderate-certainty evidence), or mechanical ventilation within 72 hours of trial entry (RR 0.91, 95% CI 0.62 to 1.33; 4 studies, 343 infants; moderate-certainty evidence). nHF likely results in a reduction in nasal trauma, compared with NIPPV (RR 0.21, 95% CI 0.09 to 0.47; RD -0.17, 95% CI -0.24 to -0.10; 3 studies, 272 infants; moderate-certainty evidence). nHF likely results in little to no difference in the rate of pneumothorax (RR 0.78, 95% CI 0.40 to 1.53; 4 studies, 344 infants; moderate-certainty evidence). Nasal high flow compared with ambient oxygen We found no studies examining this comparison. Nasal high flow compared with low flow nasal cannulae We found no studies examining this comparison.
AUTHORS' CONCLUSIONS
The use of nHF for primary respiratory support in preterm infants of 28 weeks' gestation or greater may result in little to no difference in death or BPD, compared with CPAP or NIPPV. nHF likely results in an increase in treatment failure within 72 hours of trial entry compared with CPAP; however, it likely does not increase the rate of mechanical ventilation. Compared with CPAP, nHF use likely results in less nasal trauma and likely a reduction in pneumothorax. As few extremely preterm infants less than 28 weeks' gestation were enrolled in the included trials, evidence is lacking for the use of nHF for primary respiratory support in this population.
Topics: Humans; Infant, Newborn; Bronchopulmonary Dysplasia; Infant, Extremely Premature; Oxygen; Pneumothorax; Respiration, Artificial; Surface-Active Agents
PubMed: 37144837
DOI: 10.1002/14651858.CD006405.pub4 -
Annals of Thoracic and Cardiovascular... Dec 2022The best treatment strategy for primary spontaneous pneumothorax is controversial and varies widely in practice. (Meta-Analysis)
Meta-Analysis
PURPOSE
The best treatment strategy for primary spontaneous pneumothorax is controversial and varies widely in practice.
METHODS
Literatures were searched from databases till 24 August 2021. A Bayesian network meta-analysis was conducted to compare the outcomes of various treatments with the following endpoints: recurrence rate, postoperative chest tube duration, postoperative air leakage duration, length of hospital stay, and complications rate.
RESULTS
In all, 7210 patients of 20 randomized controlled trials and 17 cohort studies were included. Surgery had a significantly lower recurrence rate compared to other treatments. Besides, bullectomy (BT) combined with chemical pleurodesis (CP), mechanical pleurodesis, or staple line coverage (SLC) can reduce the recurrence rate compared to BT alone, but none of them were statistically significant. In terms of reducing chest tube duration, BT with tubular Neoveil outperformed BT + pleural abrasion (mean difference [MD], 95% confidence interval [CI]: -2.5 [-4.63, -0.35]) and BT + apical pleurectomy (MD, 95% CI: -2.72 [-5.16, -0.27]).
CONCLUSIONS
Surgical methods were superior to manual aspiration (MA), chest tube drainage (CTD), and conservative treatment in terms of recurrence reduction. There was no significant difference between MA and CTD in reducing the recurrence rate. Among surgical methods, CP is more effective than mechanical pleurodesis and SLC among the additional procedures based on BT.
Topics: Humans; Pneumothorax; Network Meta-Analysis; Bayes Theorem; Treatment Outcome; Recurrence; Pleurodesis; Thoracic Surgery, Video-Assisted
PubMed: 36002271
DOI: 10.5761/atcs.oa.22-00113 -
European Respiratory Review : An... Mar 2022Tracheobronchial injury is a heterogeneous entity comprising multiple rare and potentially life-threatening scenarios. We performed a systematic literature review... (Review)
Review
Tracheobronchial injury is a heterogeneous entity comprising multiple rare and potentially life-threatening scenarios. We performed a systematic literature review focusing on post-intubation tracheal injuries (PiTIs) and post-traumatic tracheobronchial injuries (PTTBIs).PiTIs are often longitudinal lacerations of the middle third of the membranous trachea. Subcutaneous emphysema of the face and trunk following tracheal intubation should immediately trigger the diagnosis. Diagnosis may be suspected on the chest computed tomography (CT) and should be confirmed by bronchoscopic examination. Conservative management is encouraged for a spontaneously breathing or stable patient on noninvasive ventilation. Surgical repair is mandatory when mechanical ventilation is required and if bridging of the injury is impossible.PTTBIs are often associated with other severe injuries. Patients often present with massive subcutaneous emphysema and intractable pneumothorax. Diagnosis may be suspected on the chest CT and should be confirmed by bronchoscopic examination. Early surgical repair is indicated. In selected patients, conservative management can be considered.
Topics: Bronchi; Humans; Intubation, Intratracheal; Noninvasive Ventilation; Tomography, X-Ray Computed; Trachea
PubMed: 35082126
DOI: 10.1183/16000617.0126-2021 -
Environmental Pollution (Barking, Essex... Aug 2021A relationship between the occurrence of spontaneous pneumothorax (SP) and meteorological factors has been observed but with contradictory results. The objectives of... (Meta-Analysis)
Meta-Analysis
A relationship between the occurrence of spontaneous pneumothorax (SP) and meteorological factors has been observed but with contradictory results. The objectives of this systematic review was to synthesis the current body of evidence to the relationships between the occurrence of SP and environmental determinants such as meteorological factors and air pollutants. We conducted a systematic search of MEDLINE, Scopus, Cochrane Library and gray literature from inception up to 31st December 2020, to find published scientific research articles based on the following eligibility criteria: original studies and population-based articles describing the relationship between meteorological factors or air pollutants and the occurrence of SP. For the meta-analysis, studies involving a quantitative analysis of the exposure variable (atmospheric pressure, temperature, humidity and wind speed) and the impact of the occurrence of SP with comparable methodology were selected. General characteristics and methodological information for each study were assessed. The quality was evaluated according to the Newcastle-Ottawa Scale. Fourty four and 13 studies were respectively included in the qualitative and quantitative analyses. The variability of the study design with moderate quality and the different measurements of the exposure variables highlight the contrasting results. The results of the meta-analyses are in favor of a higher temperature observed in the day with SP than in the days without SP (maximum: MD 0.25 (-0.08, 0.58) p = 0.14; I = 26%, p = 0.21; mean: MD 0.22 (-0.15, 0.59) p = 0.24; I = 45%, p = 0.07). The small number of studies focused on air pollution did not allow us to conclude to determine the potential impact of exposure to air pollutants on the occurrence of SP. Meteorological conditions seem to be related to SP occurrence, especially increased temperature.
Topics: Air Pollutants; Air Pollution; Humans; Meteorological Concepts; Meteorology; Pneumothorax
PubMed: 33892373
DOI: 10.1016/j.envpol.2021.117089