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Hemodialysis International.... Jan 2023We conducted a systematic review of studies investigating lock solutions for use in non-tunneled hemodialysis catheters.
BACKGROUND
We conducted a systematic review of studies investigating lock solutions for use in non-tunneled hemodialysis catheters.
METHODS
We searched PubMed and Cochrane databases from inception to June 11, 2021. Study inclusion criteria were: randomized trial or observational study, adults (>18 years), with acute kidney injury (AKI); and temporary non-tunneled catheters. We recorded bleeding events, catheter dysfunction and complications.
RESULTS
Of 649 studies identified, 6 were included (4 randomized, 1 non-randomized trial, 1 retrospective cohort study; sample sizes 78-1496 patients). Citrate was compared to heparin in 4 studies, to saline in 1, and ethanol versus saline in 1. Event-free survival of non-tunneled catheters did not differ between groups. Catheter-related infections and adverse events were less frequent with citrate locks, but reached statistical significance in only two studies.
CONCLUSION
Existing data are too heterogeneous to enable recommending one type of catheter lock over any other for non-tunneled hemodialysis catheters.
Topics: Adult; Humans; Retrospective Studies; Central Venous Catheters; Renal Dialysis; Catheterization; Heparin; Catheter-Related Infections; Citric Acid; Citrates; Catheters, Indwelling; Observational Studies as Topic
PubMed: 36203330
DOI: 10.1111/hdi.13047 -
BMC Musculoskeletal Disorders Jun 2023Total knee arthroplasty (TKA) in patients with osteoarthritis (OA) are considered to be a successful procedure, but with little being known about outcomes in patients... (Meta-Analysis)
Meta-Analysis
PURPOSE
Total knee arthroplasty (TKA) in patients with osteoarthritis (OA) are considered to be a successful procedure, but with little being known about outcomes in patients with rheumatoid arthritis (RA). The aim of this study was to compare the outcomes of TKA in patients with RA versus OA.
METHODS
Data were obtained from PubMed, Cochrane Library, EBSCO and Scopus for all available studies comparing the outcomes of THA in RA and OA patients (From January 1, 2000 to October 15, 2022). Outcomes of interest included infection, revision, venous thromboembolism (VTE), mortality, periprosthetic fractures, prosthetic loosening, length of stay, and satisfaction. Two reviewers independently assessed each study for quality and extracted data. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS).
RESULTS
Twenty-four articles with a total 8,033,554 patients were included in this review. The results found strong evidence for increased risk of overall infection (OR = 1.61, 95% CI, 1.24-2.07; P = 0.0003), deep infection (OR = 2.06, 95% CI, 1.37-3.09; P = 0.0005), VTE (OR = 0.76, 95% CI, 0.61-0.93; P = 0.008), pulmonary embolism (PE) (OR = 0.84, 95% CI, 0.78-0.90; P<0.00001), periprosthetic fractures (OR = 1.87, 95% CI, 1.60-2.17; P<0.00001); and reasonable evidence for increased risk of deep venous thrombosis (DVT) (OR = 0.74, 95% CI, 0.54-0.99; P = 0.05), and length of stay (OR = 0.07, 95% CI, 0.01-0.14; P = 0.03) after TKA in patients with RA versus OA. There were no significant differences in superficial site infection (OR = 0.84,95% CI, 0.47-1.52; P = 0.57), revision (OR = 1.33,95% CI, 0.79-2.23; P = 0.28), mortality (OR = 1.16,95% CI, 0.87-1.55; P = 0.32), and prosthetic loosening (OR = 1.75, 95% CI, 0.56-5.48; P = 0.34) between the groups.
CONCLUSION
Our study demonstrated that patients with RA have a higher risk of postoperative infection, VTE, periprosthetic fracture, and lengths of stay, but did not increase revision rate, prosthetic loosening and mortality compared to patients with OA following TKA. In conclusion, despite RA increased incidence of postoperative complications, TKA should continue to be presented as an effective surgical procedure for patients whose conditions are intractable to conservative and medical management of RA.
Topics: Humans; Arthroplasty, Replacement, Knee; Periprosthetic Fractures; Venous Thromboembolism; Arthritis, Rheumatoid; Osteoarthritis; Postoperative Complications
PubMed: 37312069
DOI: 10.1186/s12891-023-06601-9 -
World Neurosurgery Nov 2018Complications arising from cerebral venous occlusion/sacrifice during neurosurgical procedures have received comparatively less attention in the neurosurgical...
BACKGROUND
Complications arising from cerebral venous occlusion/sacrifice during neurosurgical procedures have received comparatively less attention in the neurosurgical literature. Consequently, cerebral venous complications are not given due recognition, even though most practicing neurosurgeons would agree that they are not uncommon. We present a review of complications arising from venous sacrifice/occlusion during neurosurgery and discuss strategies described in the literature to prevent such occurrences.
METHODS
We conducted a systematic review of the literature to provide a synopsis of the current evidence regarding cerebral venous injury after a neurosurgical procedure. The objectives of this review were to assess the incidence of venous injuries after a neurosurgical procedure with their clinical outcome and to evaluate current strategies and technical advances for their prevention. Complications related to dural venous sinuses were not considered in this review.
RESULTS
Twenty-six relevant articles were identified and reviewed. Complications from cerebral venous occlusion/sacrifice are being increasingly recognized, and venous preservation strategies are being promoted in the neurosurgical literature. Based on our review of literature, the incidence of venous injury can range from 2.6% to 30%. We discuss the pathophysiology after venous injury and factors affecting outcome after cerebral venous injury. An overview of surgical techniques described to prevent or manage venous injury during neurosurgical procedures is presented.
CONCLUSIONS
The unpredictable response of the brain to venous injury causes catastrophic complications in a few patients. To avoid these complications, meticulous venous preservation should be a goal in all neurosurgical procedures. Increased recognition of cerebral venous complications over the last 2 decades has resulted in the increasing recognition among neurosurgeons that venous preservation is an essential tenet of neurosurgery.
Topics: Brain Edema; Brain Infarction; Cerebral Veins; Cerebrovascular Disorders; Humans; Neurosurgical Procedures; Organ Sparing Treatments; Postoperative Complications; Tomography, X-Ray Computed; Vascular Surgical Procedures
PubMed: 30509451
DOI: 10.1016/j.wneu.2018.06.231 -
Child's Nervous System : ChNS :... Feb 2020Posttraumatic craniocervical vascular injuries in pediatric traumatic brain injury (TBI) are rare, and children-specific, evidence-based standards on screening and... (Review)
Review
INTRODUCTION
Posttraumatic craniocervical vascular injuries in pediatric traumatic brain injury (TBI) are rare, and children-specific, evidence-based standards on screening and therapy of posttraumatic carotid-cavernous fistula (CCF), craniocervical artery dissections (CCAD), traumatic aneurysms (TA), and posttraumatic sinus venous thrombosis (SVT) is lacking. The aim of this review is to summarize the data on epidemiology, clinical presentation, and treatment of these traumatic lesions in a systematic manner.
METHODS
We performed a systematic PubMed search for records of CCF, CCAD, TA, and SVT related to pediatric TBI published until June 2019.
RESULTS
After screening 2439 records, 42 were included in the quantitative analysis. Incidences for CCAD in blunt TBI were 0.21% (range 0.02-6.82%). 11.7% (range 1.69-15.58%) of pediatric aneurysms were found to be traumatic of origin, whereas 38.2% (range 36.84-40%) of all pediatric SVT were due to blunt TBI. For all of the posttraumatic cerebrovascular pathologies, we found a clear male predominance with 68.75% in CCF, 63.4% in CCAD, 60% in TA, and 58.33% in SVT. Clinical presentation did not differ from the adult population with exception of young child. While there is only recommendation for the therapy of CCAD and SVT in the pediatric population, no such recommendation exists for the treatment of CCF's and TA's, and data from randomized controlled trials is lacking.
CONCLUSION
While these results show that posttraumatic CCF, CCAD, TA, and SVT are rarely encountered in children, misdiagnosis may have potentially drastic consequences due to a longer lifetime burden in the pediatric population. Awareness, early recognition, and prompt initiation of the appropriate therapy are essential to avoid morbidity and mortality. Further studies should focus on the development of clinical and radiological screening criteria of posttraumatic vascular lesions in children.
Topics: Aortic Dissection; Brain Injuries; Carotid-Cavernous Sinus Fistula; Child; Computed Tomography Angiography; Exophthalmos; Humans; Magnetic Resonance Imaging; Male
PubMed: 31901968
DOI: 10.1007/s00381-019-04482-9 -
Pediatric Nephrology (Berlin, Germany) May 2021There are similarities in hemodialysis (HD) between adults and children and also unique pediatric aspects. In this systematic review, we evaluated the existing HD...
BACKGROUND
There are similarities in hemodialysis (HD) between adults and children and also unique pediatric aspects. In this systematic review, we evaluated the existing HD literature, including vascular access, indications, parameters, and outcomes as a reflection on real-life HD practices.
METHODS
Medline, Embase, CINAHL, Web of Science, and Cochrane Library were systematically searched for literature on HD in children (1-20 years). Two reviewers independently assessed the literature and data on indications; vascular access, outcomes, and specific parameters for HD were extracted.
RESULTS
Fifty-four studies (8751 patients) were included in this review. Studies were stratified into age groups 1-5, 6-12, and 13-20 years based on median/mean age reported in the study, as well as era of publication (1990-2000, 2001-2010, and 2011-2019). Across all age groups, both arteriovenous fistulas and central venous catheters were utilized for vascular access. Congenital abnormalities and glomerulopathy were the most common HD indications. HD parameters including HD session duration, dialysate and blood flow rates, urea reduction ratio, and ultrafiltration were characterized for each age group, as well as common complications including catheter dysfunction and intradialytic hypotension. Median mortality rates were 23.3% (3.3), 7.6% (14.5), and 2.0% (3.0) in ages 1-5, 6-12, and 13-20 years, respectively. Median transplantation rates were 41.6% (38.3), 52.0% (32.0), and 21% (25.6) in ages 1-5, 6-12, and 13-20, respectively.
CONCLUSION
This comprehensive systematic review summarizes available literature on HD in children and young adults, including best vascular access, indications, technical aspects, and outcomes, and reflects on HD practices over the last three decades.
Topics: Central Venous Catheters; Child; Dialysis Solutions; Humans; Hypotension; Infant; Kidney Diseases; Kidney Failure, Chronic; Renal Dialysis; Young Adult
PubMed: 33188608
DOI: 10.1007/s00467-020-04821-y -
World Neurosurgery Oct 2020Dural venous sinus thrombosis (DVST) is an increasingly recognized complication of blunt traumatic brain injury (TBI) and skull fractures. However, data concerning... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dural venous sinus thrombosis (DVST) is an increasingly recognized complication of blunt traumatic brain injury (TBI) and skull fractures. However, data concerning epidemiology and clinical significance of DVST are unclear. Determining the disease burden in patients with TBI is an important first step to guide future studies assessing the natural course of traumatic DVST or the effects of its treatment. Therefore, we performed to our knowledge the first systematic review and meta-analysis evaluating the prevalence of DVST in patients with TBI and skull fractures.
METHODS
MEDLINE and Embase databases were systematically searched for relevant studies published up to March 2018. All studies that assessed the prevalence of DVST among patients with TBI who underwent a vascular imaging study were included. The primary outcome was the presence or absence of DVST on imaging. A random-effects meta-analysis was used to pool studies.
RESULTS
Our systematic review yielded 638 articles, and 13 articles met inclusion criteria. In patients with skull fractures adjacent to a venous sinus, the prevalence was 26.2% (95% confidence interval = 19.4%-34.4%). This elevated risk was similar between adult (pooled estimate 23.8%; 95% CI = 16.2%-33.5%) and pediatric (pooled estimate 31.3%; 95% CI = 19.1%-46.9%) populations.
CONCLUSIONS
We found an unexpectedly high and consistent frequency of DVST among patients with skull fractures regardless of age group or severity of brain injury. These findings are important and highlight the need for further understanding the natural history of DVST and providing better guidelines on its management.
Topics: Brain Injuries, Traumatic; Head Injuries, Closed; Humans; Prevalence; Sinus Thrombosis, Intracranial; Skull Fractures
PubMed: 32615287
DOI: 10.1016/j.wneu.2020.06.117 -
Foot and Ankle Surgery : Official... Feb 2018Our aim was to determine the evidence for thromboprophylaxis for prevention of symptomatic venous thromboembolism (VTE) in adults with foot or ankle trauma treated with... (Meta-Analysis)
Meta-Analysis Review
Does thromboprophylaxis reduce symptomatic venous thromboembolism in patients with below knee cast treatment for foot and ankle trauma? A systematic review and meta-analysis.
BACKGROUND
Our aim was to determine the evidence for thromboprophylaxis for prevention of symptomatic venous thromboembolism (VTE) in adults with foot or ankle trauma treated with below knee cast or splint. Our secondary aim was to report major bleeding events.
METHODS
MEDLINE and EMBASE databases were searched for randomized controlled trials from inception to 1st June 2015.
RESULTS
Seven studies were included. All focused on low molecular weight heparin (LMWH). None found a statistically significant symptomatic DVT reduction individually. At meta-analysis LMWH was protective against symptomatic DVT (OR 0.29, 95% CI 0.09-0.95). Symptomatic pulmonary embolism affected 3/692 (0.43%). None were fatal. 86 patients required LMWH thromboprophylaxis to prevent one symptomatic DVT event. The overall incidence of major bleeding was 1 in 886 (0.11%).
CONCLUSIONS
Low molecular weight heparin reduces the incidence of symptomatic VTE in adult patients with foot or ankle trauma treated with below knee cast or splint.
Topics: Ankle Injuries; Anticoagulants; Casts, Surgical; Foot Injuries; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; Primary Prevention; Splints; Venous Thromboembolism
PubMed: 29413769
DOI: 10.1016/j.fas.2016.06.005 -
The International Journal of Lower... Dec 2016A systematic review and meta-analyses of nutritional supplementation to treat chronic lower extremity wounds was done in order to test the premise that impaired... (Meta-Analysis)
Meta-Analysis Review
A systematic review and meta-analyses of nutritional supplementation to treat chronic lower extremity wounds was done in order to test the premise that impaired nutrition is implicated in healing. The databases of Ovid MEDLINE, Ovid EMBASE, Cochrane Library, and EBSCO CINAHL (1972-October 2014) were searched systematically. Only randomized controlled trials in adults with chronic lower extremity wounds were included. Both topical and systemic routes of supplementing nutrition were considered. The primary outcome was wound healing. Study characteristics, outcomes, and risk of bias were extracted by trained researchers and confirmed by the principal investigator. Twenty-three of 278 (8.3%) retrieved articles met the inclusion criteria and were selected. Most of the studies were of unclear or low risk. Overall, nutritional supplementation was favorable (risk ratio [RR] = 1.44, 95% confidence interval [CI] = 1.25-1.66). The systemic route was marginally better than the topical one (RR = 1.51, 95% CI = 1.36-1.67; RR = 1.14, 95% CI = 0.96-1.36, respectively). For venous ulcers, the data showed nutritional supplementation to be significantly beneficial compared to placebo (RR = 1.44, 95% CI = 1.31-1.59). Similar data were found for diabetic foot and sickle cell ulcers (RR = 1.17, 95% CI = 0.93-1.47; RR = 1.56, 95% CI = 0.94-2.60, respectively). These data permit the inferences that nutritional supplementation in the populations studied showed significant benefits in the healing of venous ulcers and tendency (nonsignificant trends) in the healing of diabetic and sickle cell ulcers.
Topics: Humans; Lower Extremity; Nutritional Support; Wound Healing; Wounds and Injuries
PubMed: 27810941
DOI: 10.1177/1534734616674624 -
Critical Care Explorations May 2021To compare different modalities of renal replacement therapy in critically ill adults with acute kidney injury. (Review)
Review
OBJECTIVES
To compare different modalities of renal replacement therapy in critically ill adults with acute kidney injury.
DATA SOURCES
We searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to 25 May, 2020. We included randomized controlled trials comparing the efficacy and safety of different renal replacement therapy modalities in critically ill patients with acute kidney injury.
STUDY SELECTION
Ten reviewers (working in pairs) independently screened studies for eligibility, extracted data, and assessed risk of bias.
DATA EXTRACTION
We performed random-effects frequentist network meta-analyses and used the Grading of Recommendations, Assessment, Development, and Evaluation approach to assess certainty of evidence. The primary analysis was a four-node analysis: continuous renal replacement therapy, intermittent hemodialysis, slow efficiency extended dialysis, and peritoneal dialysis. The secondary analysis subdivided these four nodes into nine nodes including continuous veno-venous hemofiltration, continuous veno-venous hemodialysis, continuous veno-venous hemodiafiltration, continuous arterio-venous hemodiafiltration, intermittent hemodialysis, intermittent hemodialysis with hemofiltration, slow efficiency extended dialysis, slow efficiency extended dialysis with hemofiltration, and peritoneal dialysis. We set the minimal important difference threshold for mortality as 2.5% (relative difference, 0.04).
DATA SYNTHESIS
Thirty randomized controlled trials ( = 3,774 patients) proved eligible. There may be no difference in mortality between continuous renal replacement therapy and intermittent hemodialysis (relative risk, 1.04; 95% CI, 0.93-1.18; low certainty), whereas continuous renal replacement therapy demonstrated a possible increase in mortality compared with slow efficiency extended dialysis (relative risk, 1.06; 95% CI, 0.85-1.33; low certainty) and peritoneal dialysis (relative risk, 1.16; 95% CI, 0.92-1.49; low certainty). Continuous renal replacement therapy may increase renal recovery compared with intermittent hemodialysis (relative risk, 1.15; 95% CI, 0.91-1.45; low certainty), whereas both continuous renal replacement therapy and intermittent hemodialysis may be worse for renal recovery compared with slow efficiency extended dialysis and peritoneal dialysis (low certainty). Peritoneal dialysis was probably associated with the shortest duration of renal support and length of ICU stay compared with other interventions (low certainty for most comparisons). Slow efficiency extended dialysis may be associated with shortest length of hospital stay (low or moderate certainty for all comparisons) and days of mechanical ventilation (low certainty for all comparisons) compared with other interventions. There was no difference between continuous renal replacement therapy and intermittent hemodialysis in terms of hypotension (relative risk, 0.92; 95% CI, 0.72-1.16; moderate certainty) or other complications of therapy, but an increased risk of hypotension and bleeding was seen with both modalities compared with peritoneal dialysis (low or moderate certainty). Complications of slow efficiency extended dialysis were not sufficiently reported to inform comparisons.
CONCLUSIONS
The results of this network meta-analysis suggest there is no difference in mortality between continuous renal replacement therapy and intermittent hemodialysis although continuous renal replacement therapy may increases renal recovery compared with intermittent hemodialysis. Slow efficiency extended dialysis with hemofiltration may be the most effective intervention at reducing mortality. Peritoneal dialysis is associated with good efficacy, and the least number of complications however may not be practical in all settings. Importantly, all conclusions are based on very low to moderate certainty evidence, limited by imprecision. At the very least, ICU clinicians should feel comfortable that the differences between continuous renal replacement therapy, intermittent hemodialysis, slow efficiency extended dialysis, and, where clinically appropriate, peritoneal dialysis are likely small, and any of these modalities is a reasonable option to employ in critically ill patients.
PubMed: 34079944
DOI: 10.1097/CCE.0000000000000399 -
World Neurosurgery Aug 2023A cerebrospinal fluid (CSF) venous fistula (CVF) is an aberrant connection between the subarachnoid space and a vein resulting in CSF loss. The presentation and... (Review)
Review
OBJECTIVE
A cerebrospinal fluid (CSF) venous fistula (CVF) is an aberrant connection between the subarachnoid space and a vein resulting in CSF loss. The presentation and management of CVF with cognitive decline is incompletely understood.
METHODS
A systematic review was completed following the PRISMA guidelines. Articles that included at least 1 case of imaging-confirmed CVF with details on patient treatment were included. A separate review of cases of patients with spontaneous intracranial hypotension (SIH) with frontotemporal dementia (FTD) or dementia symptoms was also completed.
RESULTS
Ten CVF articles (69 patients; average age, 51.5 years) and 5 SIH with FTD or dementia articles (n = 41; average age, 55.9 years) were identified. Only 1 patients with CVF with cognitive abnormalities was identified. The most common symptom was headache in both reviews. Brain sag was identified in all patients, whereas CSF leak was identified in only 2 patients with SIH with FTD or dementia (4.9%). An epidural blood or fibrin glue patch was used in all patients with CVF and in 33 patients with SIH with FTD or dementia. Fifty-five patients with CVF (79.7%) and 27 patients with SIH with FTD or dementia (65.9%) had surgery.
CONCLUSIONS
The 2 cases and literature reviews show the difficulty in diagnosis and treatment of CVF with cognitive decline. Novel imaging techniques should be used in patients with cognitive decline in whom a CSF leak is suspected. Transvenous embolization or surgery should be considered before patching for treatment of CVF-induced brain sag and resulting dementia.
Topics: Humans; Middle Aged; Frontotemporal Dementia; Cerebrospinal Fluid Leak; Intracranial Hypotension; Cognitive Dysfunction; Fistula; Magnetic Resonance Imaging
PubMed: 36934870
DOI: 10.1016/j.wneu.2023.03.056