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Frontiers in Oncology 2022In recent years, an increasing number of thoracic surgeons have attempted to apply no routine chest tube drainage (NT) strategy after thoracoscopic lung resection....
Comparison of perioperative outcomes with or without routine chest tube drainage after video-assisted thoracoscopic pulmonary resection: A systematic review and meta-analysis.
BACKGROUND
In recent years, an increasing number of thoracic surgeons have attempted to apply no routine chest tube drainage (NT) strategy after thoracoscopic lung resection. However, the safety and feasibility of not routinely placing a chest tube after lung resection remain controversial. This study aimed to investigate the effect of NT strategy after thoracoscopic pulmonary resection on perioperative outcomes.
METHODS
A comprehensive literature search of PubMed, Embase, and the Cochrane Library databases until 3 January 2022 was performed to identify the studies that implemented NT strategy after thoracoscopic pulmonary resection. Perioperative outcomes were extracted by 2 reviewers independently and then synthesized using a random-effects model. Risk ratio (RR) and standardized mean difference (SMD) with 95% confidence interval (CI) served as the summary statistics for meta-analysis. Subgroup analysis and sensitivity analysis were subsequently performed.
RESULTS
A total of 12 studies with 1,381 patients were included. The meta-analysis indicated that patients in the NT group had a significantly reduced postoperative length of stay (LOS) (SMD = -0.91; 95% CI: -1.20 to -0.61; P < 0.001) and pain score on postoperative day (POD) 1 (SMD = -0.95; 95% CI: -1.54 to -0.36; P = 0.002), POD 2 (SMD = -0.37; 95% CI: -0.63 to -0.11; P = 0.005), and POD 3 (SMD = -0.39; 95% CI: -0.71 to -0.06; P = 0.02). Further subgroup analysis showed that the difference of postoperative LOS became statistically insignificant in the lobectomy or segmentectomy subgroup (SMD = -0.30; 95% CI: -0.91 to 0.32; P = 0.34). Although the risk of pneumothorax was significantly higher in the NT group (RR = 1.75; 95% CI: 1.14-2.68; P = 0.01), the reintervention rates were comparable between groups (RR = 1.04; 95% CI: 0.48-2.25; P = 0.92). No significant difference was found in pleural effusion, subcutaneous emphysema, operation time, pain score on POD 7, and wound healing satisfactory (all P > 0.05). The sensitivity analysis suggested that the results of the meta-analysis were stabilized.
CONCLUSIONS
This meta-analysis suggested that NT strategy is safe and feasible for selected patients scheduled for video-assisted thoracoscopic pulmonary resection.
SYSTEMATIC REVIEW REGISTRATION
https://inplasy.com/inplasy-2022-4-0026, identifier INPLASY202240026.
PubMed: 36003771
DOI: 10.3389/fonc.2022.915020 -
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 -
International Wound Journal Feb 2023We performed a meta-analysis to evaluate the effect of chronic obstructive pulmonary disease on surgical site wound infection, and other postoperative problems after... (Meta-Analysis)
Meta-Analysis
Surgical site wound infection, and other postoperative problems after coronary artery bypass grafting in subjects with chronic obstructive pulmonary disease: A meta-analysis.
We performed a meta-analysis to evaluate the effect of chronic obstructive pulmonary disease on surgical site wound infection, and other postoperative problems after coronary artery bypass grafting. A systematic literature search up to April 2022 was performed and 37 444 subjects with coronary artery bypass grafting at the baseline of the studies; 4320 of them were with the chronic obstructive pulmonary disease, and 33 124 were without chronic obstructive pulmonary disease. Odds ratio (OR), and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the effect of chronic obstructive pulmonary disease on surgical site wound infection, and other postoperative problems after coronary artery bypass grafting using the dichotomous, and contentious methods with a random or fixed-effect model. The chronic obstructive pulmonary disease subjects had a significantly higher surgical site wound infection (OR, 1.27; 95% CI, 1.01-1.60, P = 0.04), respiratory failure (OR, 1.84; 95% CI, 1.55-2.18, P < 0.001), mortality (OR, 1.61; 95% CI, 1.37-1.89, P < 0.001), pneumonia (OR, 2.30; 95% CI, 1.97-2.68, P < 0.001), pleural effusion (OR, 1.78; 95% CI, 1.12-2.83, P = 0.02), stroke (OR, 1.99; 95% CI, 1.17-3.36, P = 0.01), and length of intensive care unit stay (MD, 0.73; 95% CI, 0.19-1.26, P = 0.008) after coronary artery bypass grafting compared with subjects without chronic obstructive pulmonary disease. However, chronic obstructive pulmonary disease subjects did not show any significant difference in length of hospital stay (MD, 0.83; 95% CI, -0.01 to 1.67, P = 0.05), and pneumothorax (OR, 1.59; 95% CI, 0.98-2.59, P = 0.06) after coronary artery bypass grafting compared with subjects without chronic obstructive pulmonary disease. The chronic obstructive pulmonary disease subjects had a significantly higher surgical site wound infection, respiratory failure, mortality, pneumonia, pleural effusion, stroke, and length of intensive care unit stay, and no significant difference in length of hospital stay, and pneumothorax after coronary artery bypass grafting compared with subjects without chronic obstructive pulmonary disease. The analysis of outcomes should be with caution because of the low sample size of 1 out of 11 studies in the meta-analysis and a low number of studies in certain comparisons.
Topics: Humans; Coronary Artery Bypass; Coronary Artery Disease; Pleural Effusion; Pneumothorax; Postoperative Complications; Pulmonary Disease, Chronic Obstructive; Respiratory Insufficiency; Stroke; Surgical Wound Infection; Treatment Outcome
PubMed: 35801278
DOI: 10.1111/iwj.13877 -
The Cochrane Database of Systematic... Jun 2022Acute respiratory distress syndrome (ARDS) represents the most severe course of COVID-19 (caused by the SARS-CoV-2 virus), usually resulting in a prolonged stay in an... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acute respiratory distress syndrome (ARDS) represents the most severe course of COVID-19 (caused by the SARS-CoV-2 virus), usually resulting in a prolonged stay in an intensive care unit (ICU) and high mortality rates. Despite the fact that most affected individuals need invasive mechanical ventilation (IMV), evidence on specific ventilation strategies for ARDS caused by COVID-19 is scarce. Spontaneous breathing during IMV is part of a therapeutic concept comprising light levels of sedation and the avoidance of neuromuscular blocking agents (NMBA). This approach is potentially associated with both advantages (e.g. a preserved diaphragmatic motility and an optimised ventilation-perfusion ratio of the ventilated lung), as well as risks (e.g. a higher rate of ventilator-induced lung injury or a worsening of pulmonary oedema due to increases in transpulmonary pressure). As a consequence, spontaneous breathing in people with COVID-19-ARDS who are receiving IMV is subject to an ongoing debate amongst intensivists.
OBJECTIVES
To assess the benefits and harms of early spontaneous breathing activity in invasively ventilated people with COVID-19 with ARDS compared to ventilation strategies that avoid spontaneous breathing.
SEARCH METHODS
We searched the Cochrane COVID-19 Study Register (which includes CENTRAL, PubMed, Embase, Clinical Trials.gov WHO ICTRP, and medRxiv) and the WHO COVID-19 Global literature on coronavirus disease to identify completed and ongoing studies from their inception to 2 March 2022.
SELECTION CRITERIA
Eligible study designs comprised randomised controlled trials (RCTs) that evaluated spontaneous breathing in participants with COVID-19-related ARDS compared to ventilation strategies that avoided spontaneous breathing (e.g. using NMBA or deep sedation levels). Additionally, we considered controlled before-after studies, interrupted time series with comparison group, prospective cohort studies and retrospective cohort studies. For these non-RCT studies, we considered a minimum total number of 50 participants to be compared as necessary for inclusion. Prioritised outcomes were all-cause mortality, clinical improvement or worsening, quality of life, rate of (serious) adverse events and rate of pneumothorax. Additional outcomes were need for tracheostomy, duration of ICU length of stay and duration of hospitalisation.
DATA COLLECTION AND ANALYSIS
We followed the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions. Two review authors independently screened all studies at the title/abstract and full-text screening stage. We also planned to conduct data extraction and risk of bias assessment in duplicate. We planned to conduct meta-analysis for each prioritised outcome, as well as subgroup analyses of mortality regarding severity of oxygenation impairment and duration of ARDS. In addition, we planned to perform sensitivity analyses for studies at high risk of bias, studies using NMBA in addition to deep sedation level to avoid spontaneous breathing and a comparison of preprints versus peer-reviewed articles. We planned to assess the certainty of evidence using the GRADE approach.
MAIN RESULTS
We identified no eligible studies for this review.
AUTHORS' CONCLUSIONS
We found no direct evidence on whether early spontaneous breathing in SARS-CoV-2-induced ARDS is beneficial or detrimental to this particular group of patients. RCTs comparing early spontaneous breathing with ventilatory strategies not allowing for spontaneous breathing in SARS-CoV-2-induced ARDS are necessary to determine its value within the treatment of severely ill people with COVID-19. Additionally, studies should aim to clarify whether treatment effects differ between people with SARS-CoV-2-induced ARDS and people with non-SARS-CoV-2-induced ARDS.
Topics: COVID-19; Humans; Neuromuscular Blocking Agents; Respiration, Artificial; Respiratory Distress Syndrome; SARS-CoV-2; Systematic Reviews as Topic
PubMed: 35767435
DOI: 10.1002/14651858.CD015077 -
Journal of Bronchology & Interventional... Jul 2022Pharmacologic therapeutics for advanced emphysema have limited benefit. Bronchoscopic lung volume reduction with endobronchial valves (EBVs) have reported improvements... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pharmacologic therapeutics for advanced emphysema have limited benefit. Bronchoscopic lung volume reduction with endobronchial valves (EBVs) have reported improvements in lung function, breathlessness, and quality of life through randomized clinical trials, with less morbidity as comparted to Surgical Lung volume Reduction. We here present a Meta-analysis and systematic review of bronchoscopic lung volume reduction in advanced chronic obstructive lung disease patients.
METHODS
PubMed (NLM), Embase (Elsevier), and Web of Science (Clarivate Analytics) search was conducted using a combination of keywords and subject headings. The search was confined to the last 15 years and was completed on October 23, 2020. Only placebo-controlled randomized control trials of emphysema patients with EBV were included. Quality assessment was done by 2 independent reviewers.
RESULTS
Nine studies were included for the meta-analysis with a total number of 1383 patients of whom 888 received EBV and 495 standard of care (SOC) medications. Our Metanalysis show statistically significant improvement in forced expiratory volume in first second, percentage forced expiratory volume in first second, St. George's respiratory questionnaire, and 6-minute walk distance in EBV group compared with SOC. Residual volume had statistically significant reduction after EBV placement compared with SOC. These differences continued to be present during short-term (<=6 mo) and long-term follow-up (>=6 mo). These improvements were even higher when the EBV patients'. Collateral ventilation was negative/fissure was intact (CV-/FI >90%). The rate of hemoptysis and pneumothorax was higher in the EBV group compared with SOC, however, did not lead to increased fatal outcomes.
CONCLUSION
In conclusion, EBV has favorable effects on patients' outcomes in patients who have heterogeneous emphysema particularly with no collateral ventilation.
Topics: Bronchoscopy; Emphysema; Forced Expiratory Volume; Humans; Pneumonectomy; Pulmonary Emphysema; Quality of Life; Treatment Outcome
PubMed: 35698281
DOI: 10.1097/LBR.0000000000000872 -
Heart Failure Reviews Jan 2023A subgroup of patients with noncompaction cardiomyopathy (NCCM) is at increased risk of ventricular arrhythmias and sudden cardiac death (SCD). In selected patients with... (Meta-Analysis)
Meta-Analysis Review
A subgroup of patients with noncompaction cardiomyopathy (NCCM) is at increased risk of ventricular arrhythmias and sudden cardiac death (SCD). In selected patients with NCCM, implantable cardioverter-defibrillator (ICD) therapy could be advantageous for preventing SCD. Currently, there is no complete overview of outcome and complications after ICD therapy in patients with NCCM. This study sought to present an overview using pooled data of currently available studies. Embase, MEDLINE, Web of Science, and Cochrane databases were searched and returned 915 studies. After a thorough examination, 12 studies on outcome and complications after ICD therapy in patients with NCCM were included. There were 275 patients (mean age 38.6 years; 47% women) with NCCM and ICD implantation. Most of the patients received an ICD for primary prevention (66%). Pooled analysis demonstrates that the appropriate ICD intervention rate was 11.95 per 100 person-years and the inappropriate ICD intervention rate was 4.8 per 100 person-years. The cardiac mortality rate was 2.37 per 100 person-years. ICD-related complications occurred in 10% of the patients, including lead malfunction and revision (4%), lead displacement (3%), infection (2%), and pneumothorax (2%). Patients with NCCM who are at increased risk of SCD may significantly benefit from ICD therapy, with a high appropriate ICD therapy rate of 11.95 per 100 person-years and a low cardiac mortality rate of 2.37 per 100 person-years. Inappropriate therapy rate of 4.8 per 100 person-years and ICD-related complications were not infrequent and may lead to patient morbidity.
Topics: Humans; Female; Adult; Male; Defibrillators, Implantable; Cardiomyopathies; Arrhythmias, Cardiac; Death, Sudden, Cardiac; Treatment Outcome; Risk Factors
PubMed: 35689132
DOI: 10.1007/s10741-022-10250-w -
Children (Basel, Switzerland) Apr 2022In neonates with meconium aspiration syndrome (MAS), continuous positive airway pressure (CPAP) may be more beneficial compared to endotracheal intubation (ETI). We... (Review)
Review
BACKGROUND
In neonates with meconium aspiration syndrome (MAS), continuous positive airway pressure (CPAP) may be more beneficial compared to endotracheal intubation (ETI). We evaluated the efficacy of CPAP in neonates with MAS.
METHODS
Four engines were used to search randomized clinical trials (RCTs). We used relative risk (RR) and mean difference (MD) with 95% confidence intervals (95%CI) to assess the effect on dichotomous and continuous outcomes, respectively. In addition, we used the Paule-Mandel (PM) random effects model due to the anticipated lack of events.
RESULTS
Three RCTs were included ( = 432). No significant difference was found in mortality (RR = 0.82; 95%CI = 0.54-1.25; I = 71%; = 0.36), need for ventilation (RR = 0.49; 95%CI = 0.15-1.56; I = 71%; = 0.57), and incidence of pneumothorax (RR = 1.24; 95%CI = 0.30-5.12; I = 0%; = 0.77) in the CPAP group compared to the ETI group. Regarding secondary outcomes, compared to the ETI group, no significant differences were found in APGAR at one minute (MD = -1.01; 95%CI -2.97 to 0.94; I = 98%; = 0.31), APGAR at 5 min (MD = -1.00; 95%CI = -2.96 to 0.95; I = 99%; = 0.32), days of hospitalization (MD = -0.52; 95%CI = -1.46 to 0.42; I = 94%; = 0.28), and cord pH (MD = 0.003; 95%CI = -0.01 to 0.02; I = 0%; = 0.79).
CONCLUSIONS
In patients with MAS, there is no significant effect of CPAP use compared to ETI on primary, specifically on mortality, need for ventilation, the incidence of pneumothorax, and secondary outcomes.
PubMed: 35626765
DOI: 10.3390/children9050589 -
Pakistan Journal of Medical Sciences 2022COVID-19 patients develop Life-threatening complications like pneumomediastinum/pneumothorax and emphysema which might experience prolonged hospital stays and additional... (Review)
Review
OBJECTIVES
COVID-19 patients develop Life-threatening complications like pneumomediastinum/pneumothorax and emphysema which might experience prolonged hospital stays and additional costs might be imposed on the patient and the health system. The clinical features and outcomes of mechanically ventilated patients with COVID-19 infection who develop a pneumothorax, pneumomediastinum and subcutaneous emphysema has not been rigorously described or compared to those who do not develop these complications. So a systematic review of studies conducted on this subject was carried out to better manage these complications by investigating the underlying factors in COVID-19 patients.
METHODS
The search was conducted between early January and late December 2020 in databases including PubMed, Scopus, ProQuest, Embase, Cochrane Library, and Web of Science, using the following keywords and their combinations: COVID-19 Complication, Pneumothorax, Pneumomediastinum, Pneumopericardium, and Subcutaneous Emphysema. The extracted studies were screened separately by two researchers based on the PRISMA statement. After eliminating the duplicate studies, the title, abstract, and full text of the remaining studies were reviewed. Disagreements in the screening and selection of the studies were resolved by consensus or through a third-party opinion.
RESULTS
A total of 793 articles were retrieved through the literature search, and 99 studies conducted on a total of 139 patients were finally included The patient mortality was found to have a significant relationship with positive pressure ventilation (P=0.0001). There was no significant relationship between the patients' death and chest tube insertion (P=0.2) or between the interval of time from the onset of symptoms to the diagnosis of pneumothorax (P=0.7). The mean age was higher in the deceased cases, and the mean difference observed was statistically significant (P=0.001).
CONCLUSION
With the expansion of our clinical understanding of COVID-19, recognition of the uncommon complications of COVID-19 especially pneumothorax is crucial. Although in our review we couldn't find a causal relationship between COVID-19 and pneumothorax or association between pneumothorax and death, as it is limited by many variables such as included studies' design, or incomplete outcome data especially more information about the associated risk factors, we recommend performing more well-designed studies to describe the pneumothoraxes' incidence, risk factors, and outcomes in COVID-19 patients.
PubMed: 35480506
DOI: 10.12669/pjms.38.3.5529 -
International Journal of Environmental... Apr 2022Spontaneous pneumomediastinum (SPM) during pregnancy or labor is a rare event. We presented a case report and a systematic review of the literature to provide... (Review)
Review
BACKGROUND
Spontaneous pneumomediastinum (SPM) during pregnancy or labor is a rare event. We presented a case report and a systematic review of the literature to provide comprehensive symptoms, treatments, and complications analysis in the pregnant population affected by SPM.
METHODS
We conducted a comprehensive search of four databases for published papers in all languages from the beginning to 1 September 2021; Results: We included 76 papers with a total of 80 patients. A total of 76% patients were young primiparous, with a median age of 24 ± 5.4 years. The median gestational age was 40 ± 2.4 weeks, with a median duration of labor of 7.4 ± 4.2 h. In 86%, the ethnic origin was not specified. SPM develops in 55% of cases during the second stage of labor. Subcutaneous swelling and subcutaneous emphysema were present in 91.4%. Chest pain and dyspnea were present in 51.4% and 50% of the patients, respectively. We found that 32.9% patients had crepitus, and less common symptoms were dysphonia and tachycardia (14.3% and 14.3%, respectively). Oxygen and bronchodilators were used in 37.7% of the cases. Analgesics or sedatives were administered in 27.1%. Conservative management or the observation was performed in 21.4% and 28.6%, respectively. Antibiotics treatment was offered in 14.3%, whereas invasive procedures such as chest-tube drainage were used in just 5.7% of patients. There were no complications documented in most SPM (70.0%). We found that 16.7% of the SPM developed a pneumothorax and 5% developed a pneumopericardium.; Conclusions: In pregnancy, SPM occurs as subcutaneous swelling or emphysema during the second stage of labor. The treatment is usually conservative, with oxygen and bronchodilators and a low sequela rate. A universal consensus on therapy of spontaneous pneumomediastinum in pregnancy is necessary to reduce the risk of complications.
Topics: Adolescent; Adult; Bronchodilator Agents; Child, Preschool; Delivery, Obstetric; Female; Humans; Mediastinal Emphysema; Oxygen; Pregnancy; Subcutaneous Emphysema; Syndrome; Young Adult
PubMed: 35457486
DOI: 10.3390/ijerph19084618 -
Medical Ultrasonography Mar 2023To assess chest ultrasound (US) diagnostic accuracy in pneumothorax diagnosing. (Meta-Analysis)
Meta-Analysis Review
AIM
To assess chest ultrasound (US) diagnostic accuracy in pneumothorax diagnosing.
MATERIAL AND METHODS
Prospec-tive studies related to the US pneumothorax diagnostic accuracy in trauma patients were extensively searched from 2000 up to November 2020. The studies features and findings were gathered using a standardised form and the methodological quality of the investigations was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).
RESULTS
Twelve articles were finally chosen for quantitative analysis. The overall sensitivity of US scan in pneumothorax diagnosis was 89% (95%CI 86-91%). Specificity was 96% (95%CI 95-97%). The diagnostic odds ratio was 193.94 (59.009-637.40) at 95%CI, thus demonstrating high chest US accuracy in pneumothorax diagnosis.
CONCLUSION
Despite the limitations of the included studies, this systematic review and meta-analysis concluded that chest US is a reliable method for diagnosing pneu-mothorax in traumatized patients.
Topics: Humans; Pneumothorax; Sensitivity and Specificity; Thoracic Injuries; Ultrasonography; Wounds, Nonpenetrating
PubMed: 35437526
DOI: 10.11152/mu-3309