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Journal of Thoracic Disease Dec 2017The characteristic and outcomes of lung cancer patients with combined pulmonary fibrosis and emphysema (CPFE) have long been assessed, but results were controversial....
BACKGROUND
The characteristic and outcomes of lung cancer patients with combined pulmonary fibrosis and emphysema (CPFE) have long been assessed, but results were controversial. Therefore, we performed a meta-analysis to assess the clinical features and prognosis of lung cancer patients with CPFE.
METHODS
The databases PubMed, Embase, and Web of Science (updated to October 1, 2017) were searched for eligible studies. Pooled odds ratios (ORs), weighted mean differences (WMD) or hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used to evaluate the clinicopathological characteristics, the short-term outcome after operation and long-term survival of lung cancer patients with CPFE compared with lung cancer patients without CPFE (fibrosis, emphysema, and normal).
RESULTS
Thirty original studies with 8,050 patients were included in this meta-analysis. The pooled results indicated that lung cancer patients with CPFE were associated with higher age (MD =3.39; 95% CI: 2.12-4.67, P<0.001), male (OR =8.46; 95% CI: 6.36-11.26, P<0.001), ex- or current smoker (OR =39.65; 95% CI: 15.64-100.5, P<0.001), longer smoking history (MD =15.56; 95% CI: 3.73-27.39, P=0.01), lower DLCO% (MD =-13.82; 95% CI: -21.4 to -6.24, P<0.001), squamous cell carcinoma histology (OR =3.55; 95% CI: 2.49-5.05, P<0.001), the lower lobes (OR =1.92; 95% CI: 1.52-2.43, P<0.001), advanced pathological stage (OR =1.55; 95% CI: 1.22-1.96, P<0.001). Lung cancer patients with CPFE had higher 30-day mortality (OR =4.72, 95% CI: 2.06-10.85, P<0.001), 90-day mortality (OR =5.33; 95% CI: 1.39-20.42, P=0.01), and incidence of postoperative complications (OR =5.25, 95% CI: 2.38-11.57, P<0.001). In addition, the lung cancer patients with CPFE had a poorer OS (HR =2.006, 95% CI: 1.347-2.986, P=0.001) than lung cancer patients without CPFE.
CONCLUSIONS
This meta-analysis demonstrated that lung cancer patients with CPFE have more aggressive clinical characteristic and a poor prognosis, suggesting that lung cancer patients with CPFE should be early detected, treated reasonably and be taken good care of.
PubMed: 29312742
DOI: 10.21037/jtd.2017.12.72 -
International Journal of Chronic... 2017Alpha-1 antitrypsin deficiency (AATD) is a rare genetic condition predisposing individuals to chronic obstructive pulmonary disease (COPD). The treatment is generally... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Alpha-1 antitrypsin deficiency (AATD) is a rare genetic condition predisposing individuals to chronic obstructive pulmonary disease (COPD). The treatment is generally extrapolated from COPD unrelated to AATD; however, most COPD trials exclude AATD patients; thus, this study sought to systematically review AATD-specific literature to assist evidence-based patient management.
METHODS
Standard review methodology was used with meta-analysis and narrative synthesis (PROSPERO-CRD42015019354). Eligible studies were those of any treatment used in severe AATD. Randomized controlled trials (RCTs) were the primary focus; however, case series and uncontrolled studies were eligible. All studies had ≥10 participants receiving treatment or usual care, with baseline and follow-up data (>3 months). Risk of bias was assessed appropriately according to study methodology.
RESULTS
In all, 7,296 studies were retrieved from searches; 52 trials with 5,632 participants met the inclusion criteria, of which 26 studies involved alpha-1 antitrypsin augmentation and 17 concerned surgical treatments (largely transplantation). Studies were grouped into four management themes: COPD medical, COPD surgical, AATD specific, and other treatments. Computed tomography (CT) density, forced expiratory volume in 1 s, diffusing capacity of the lungs for carbon monoxide, health status, and exacerbation rates were frequently used as outcomes. Meta-analyses were only possible for RCTs of intravenous augmentation, which slowed progression of emphysema measured by CT density change, 0.79 g/L/year versus placebo (=0.002), and associated with a small increase in exacerbations 0.29/year (=0.02). Mortality following lung transplant was comparable between AATD- and non-AATD-related COPD. Surgical reduction of lung volume demonstrated inferior outcomes compared with non-AATD-related emphysema.
CONCLUSION
Intravenous augmentation remains the only disease-specific therapy in AATD and there is evidence that this slows decline in emphysema determined by CT density. There is paucity of data around other treatments in AATD. Treatments for usual COPD may not be as efficacious in AATD, and further studies may be required for this disease group.
Topics: Chi-Square Distribution; Disease Progression; Enzyme Replacement Therapy; Humans; Lung; Lung Transplantation; Observational Studies as Topic; Pneumonectomy; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Randomized Controlled Trials as Topic; Recovery of Function; Treatment Outcome; alpha 1-Antitrypsin; alpha 1-Antitrypsin Deficiency
PubMed: 28496314
DOI: 10.2147/COPD.S130440 -
The Cochrane Database of Systematic... Mar 2017Chronic obstructive pulmonary disease (COPD) (commonly referred to as chronic bronchitis and emphysema) is a chronic lung condition characterised by the inflammation of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic obstructive pulmonary disease (COPD) (commonly referred to as chronic bronchitis and emphysema) is a chronic lung condition characterised by the inflammation of airways and irreversible destruction of pulmonary tissue leading to progressively worsening dyspnoea. It is a leading international cause of disability and death in adults. Evidence suggests that there is an increased prevalence of anxiety disorders in people with COPD. The severity of anxiety has been shown to correlate with the severity of COPD, however anxiety can occur with all stages of COPD severity. Coexisting anxiety and COPD contribute to poor health outcomes in terms of exercise tolerance, quality of life and COPD exacerbations. The evidence for treatment of anxiety disorders in this population is limited, with a paucity of evidence to support the efficacy of medication-only treatments. It is therefore important to evaluate psychological therapies for the alleviation of these symptoms in people with COPD.
OBJECTIVES
To assess the effects of psychological therapies for the treatment of anxiety disorders in people with chronic obstructive pulmonary disease.
SEARCH METHODS
We searched the specialised registers of two Cochrane Review Groups: Cochrane Common Mental Disorders (CCMD) and Cochrane Airways (CAG) (to 14 August 2015). The specialised registers include reports of relevant randomised controlled trials from The Cochrane Library, MEDLINE, Embase, and PsycINFO. We carried out complementary searches on PsycINFO and CENTRAL to ensure no studies had been missed. We applied no date or language restrictions.
SELECTION CRITERIA
We considered all randomised controlled trials (RCTs), cluster-randomised trials and cross-over trials of psychological therapies for people (aged over 40 years) with COPD and coexisting anxiety disorders (as confirmed by recognised diagnostic criteria or a validated measurement scale), where this was compared with either no intervention or education only. We included studies in which the psychological therapy was delivered in combination with another intervention (co-intervention) only if there was a comparison group that received the co-intervention alone.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened citations to identify studies for inclusion and extracted data into a pilot-tested standardised template. We resolved any conflicts that arose through discussion. We contacted authors of included studies to obtain missing or raw data. We performed meta-analyses using the fixed-effect model and, if we found substantial heterogeneity, we reanalysed the data using the random-effects model.
MAIN RESULTS
We identified three prospective RCTs for inclusion in this review (319 participants available to assess the primary outcome of anxiety). The studies included people from the outpatient setting, with the majority of participants being male. All three studies assessed psychological therapy (cognitive behavioural therapy) plus co-intervention versus co-intervention alone. We assessed the quality of evidence contributing to all outcomes as low due to small sample sizes and substantial heterogeneity in the analyses. Two of the three studies had prespecified protocols available for comparison between prespecified methodology and outcomes reported within the final publications.We observed some evidence of improvement in anxiety over 3 to 12 months, as measured by the Beck Anxiety Inventory (range from 0 to 63 points), with psychological therapies performing better than the co-intervention comparator arm (mean difference (MD) -4.41 points, 95% confidence interval (CI) -8.28 to -0.53; P = 0.03). There was however, substantial heterogeneity between the studies (I = 62%), which limited the ability to draw reliable conclusions. No adverse events were reported.
AUTHORS' CONCLUSIONS
We found only low-quality evidence for the efficacy of psychological therapies among people with COPD with anxiety. Based on the small number of included studies identified and the low quality of the evidence, it is difficult to draw any meaningful and reliable conclusions. No adverse events or harms of psychotherapy intervention were reported.A limitation of this review is that all three included studies recruited participants with both anxiety and depression, not just anxiety, which may confound the results. We downgraded the quality of evidence in the 'Summary of findings' table primarily due to the small sample size of included trials. Larger RCTs evaluating psychological interventions with a minimum 12-month follow-up period are needed to assess long-term efficacy.
Topics: Anxiety Disorders; Bronchitis, Chronic; Emphysema; Exercise Tolerance; Female; Humans; Male; Psychotherapy; Pulmonary Disease, Chronic Obstructive; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 28322440
DOI: 10.1002/14651858.CD010673.pub2 -
Journal of Cancer Research and... Dec 2016Draining of the chest cavity with two chest tubes after pulmonary lobectomy is a common practice. The objective of this study was to evaluate whether using two tubes... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Draining of the chest cavity with two chest tubes after pulmonary lobectomy is a common practice. The objective of this study was to evaluate whether using two tubes after a pulmonary lobectomy is more effective than using a single tube.
PATIENTS AND METHODS
We performed a meta-analysis of five randomized studies that compared the single chest tube with double chest tube application after pulmonary lobectomy. The primary end-point was amount of drainage and duration of chest tube drainage. The secondary end-points were the patient's numbers of new drain insertion after operation, hospital stay after operation, the patient's numbers of subcutaneous emphysema after operation, the patient's numbers of residual pleural air space, pain score, the number of patients who need thoracentesis, and cost.
RESULTS
Five randomized controlled trials totaling 502 patients were included. Meta-analysis results are as follows: There were statistically significant differences in amount of drainage (risk ratio [RR] = -0.15; 95% confidence interval [CI] = -3.17, -0.12, P = 0. 03), duration of chest tube drainage (RR = -0.43; 95% CI = -0.57, -0.19, P = 0.02), pain score (P < 0.05). Compared with patients receiving the double chest tube group, there were no statistically significant differences between the two groups with regard to the patient's numbers of new drain insertion after operation.
CONCLUSION
Compared with the double chest tube, the single chest tube significantly decreases amount of drainage, duration of chest tube drainage, pain score, the number of patients who need thoracentesis, and cost. Although there is convincing evidence to confirm the results mentioned herein, they still need to be confirmed by large-sample, multicenter, randomized, controlled trials.
Topics: Chest Tubes; Drainage; Humans; Length of Stay; Odds Ratio; Pneumonectomy; Publication Bias; Randomized Controlled Trials as Topic; Retreatment; Treatment Outcome
PubMed: 28230045
DOI: 10.4103/0973-1482.200743 -
The Cochrane Database of Systematic... Dec 2016Chronic lung disease (CLD) occurs frequently in preterm infants. Bronchodilators have the potential effect of dilating small airways with muscle hypertrophy. Increased... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic lung disease (CLD) occurs frequently in preterm infants. Bronchodilators have the potential effect of dilating small airways with muscle hypertrophy. Increased compliance and tidal volume and decreased pulmonary resistance have been documented with the use of bronchodilators in infants with CLD. Therefore, bronchodilators might have a role in the prevention and treatment of CLD.
OBJECTIVES
To determine the effect of bronchodilators given as prophylaxis or as treatment for CLD on mortality and other complications of preterm birth in infants at risk for or identified as having CLD.
SEARCH METHODS
On 2016 March 7, we used the standard strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE (from 1966), Embase (from 1980) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1982). We searched clinical trials databases, conference proceedings and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. We applied no language restrictions.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials involving preterm infants were eligible for inclusion. Initiation of bronchodilator therapy for prevention of CLD had to occur within two weeks of birth. Treatment of patients with CLD had to be initiated before discharge from the neonatal unit. The intervention had to include administration of a bronchodilator by nebulisation, by metered dose inhaler (with or without a spacer device) or by intravenous or oral administration versus placebo or no intervention. Eligible studies had to include at least one of the following predefined clinical outcomes: mortality, CLD, number of days on oxygen, number of days on ventilator, patent ductus arteriosus (PDA), pulmonary interstitial emphysema (PIE), pneumothorax, intraventricular haemorrhage (IVH) of any grade, necrotising enterocolitis (NEC), sepsis and adverse effects of bronchodilators.
DATA COLLECTION AND ANALYSIS
We used the standard method described in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). Two review authors extracted and assessed all data provided by each study. We reported risk ratio (RR), risk difference (RD) and number needed to treat for an additional beneficial outcome (NNTB) with 95% confidence interval (CI) for dichotomous outcomes and mean difference (MD) for continuous data. We assessed the quality of the evidence by using the GRADE approach.
MAIN RESULTS
For this update, we identified one new randomised controlled trial investigating effects of bronchodilators in preterm infants. This study, which enrolled 73 infants but reported on 52 infants, examined prevention of CLD with the use of aminophylline. According to GRADE, the quality of the evidence was very low. One previously included study enrolled 173 infants to look at prevention of CLD with the use of salbutamol. According to GRADE, the quality of the evidence was moderate. We found no eligible trial that studied the use of bronchodilator therapy for treatment of individuals with CLD. Prophylaxis with salbutamol led to no statistically significant differences in mortality (RR 1.08, 95% CI 0.50 to 2.31; RD 0.01, 95% CI -0.09 to 0.11) nor in CLD (RR 1.03, 95% CI 0.78 to 1.37; RD 0.02, 95% CI -0.13 to 0.17). Results showed no statistically significant differences in other complications associated with CLD nor in preterm birth. Investigators in this study did not comment on side effects due to salbutamol. Prophylaxis with aminophylline led to a significant reduction in CLD at 28 days of life (RR 0.18, 95% CI 0.04 to 0.74; RD -0.35, 95% CI -0.56 to -0.13; NNTB 3, 95% CI 2 to 8) and no significant difference in mortality (RR 3.0, 95% CI 0.33 to 26.99; RD 0.08, 95% CI -0.07 to 0.22), along with a significantly shorter dependency on supplementary oxygen in the aminophylline group compared with the no treatment group (MD -17.75 days, 95% CI -27.56 to -7.94). Tests for heterogeneity were not applicable for any of the analyses, as each meta-analysis included only one study.
AUTHORS' CONCLUSIONS
Data are insufficient for reliable assessment of the use of salbutamol for prevention of CLD. One trial of poor quality reported a reduction in the incidence of CLD and shorter duration of supplementary oxygen with prophylactic aminophylline, but these results must be interpreted with caution. Additional clinical trials are necessary to assess the role of bronchodilator agents in prophylaxis or treatment of CLD. Researchers studying the effects of bronchodilators in preterm infants should include relevant clinical outcomes in addition to pulmonary mechanical outcomes. We identified no trials that studied the use of bronchodilator therapy for treatment of CLD.
Topics: Albuterol; Aminophylline; Beclomethasone; Bronchodilator Agents; Chronic Disease; Drug Therapy, Combination; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lung Diseases; Randomized Controlled Trials as Topic
PubMed: 27960245
DOI: 10.1002/14651858.CD003214.pub3 -
BMC Pulmonary Medicine Nov 2016The incidence and prevalence of chronic kidney disease (CKD) continue to rise worldwide. Increasing age, diabetes, hypertension, and cigarette smoking are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The incidence and prevalence of chronic kidney disease (CKD) continue to rise worldwide. Increasing age, diabetes, hypertension, and cigarette smoking are well-recognized risk factors for CKD. Chronic obstructive pulmonary disease (COPD) is characterized by chronic airway inflammation leading to airway obstruction and parenchymal lung destruction. Due to some of the common pathogenic mechanisms, COPD has been associated with increased prevalence of CKD.
METHODS
Systematic review of medical literature reporting the incidence and prevalence of CKD in patients with COPD using the Cochrane Collaboration Methodology, and conduct meta-analysis to study the cumulative effect of the eligible studies. We searched Medline via Ovid, PubMed, EMBASE and ISI Web of Science databases from 1950 through May, 2016. We included prospective and retrospective observational studies that reported the prevalence of CKD in patients with COPD.
RESULTS
Our search resulted in 19 eligible studies of which 9 have been included in the meta-analysis. The definition of CKD was uniform across all the studies included in analysis. COPD was found to be associated with CKD in the included epidemiological studies conducted in many countries. Our meta-analysis showed that COPD was found to be associated with a significantly increased prevalence of CKD (Odds Ratio [OR] = 2.20; 95% Confidence Interval [CI] 1.83, 2.65).
STUDY LIMITATIONS
Studies included are observational studies. However, given the nature of our research question there is no possibility to perform a randomized control trial.
CONCLUSIONS
Patients with COPD have increased odds of developing CKD. Future research should investigate the pathophysiological mechanism behind this association, which may lead to better outcomes.
Topics: Humans; Incidence; Odds Ratio; Prevalence; Pulmonary Disease, Chronic Obstructive; Renal Insufficiency, Chronic; Risk Factors
PubMed: 27881110
DOI: 10.1186/s12890-016-0315-0 -
The Cochrane Database of Systematic... Oct 2016Lung volume reduction surgery (LVRS) performed to treat patients with severe diffuse emphysema was reintroduced in the nineties. Lung volume reduction surgery aims to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Lung volume reduction surgery (LVRS) performed to treat patients with severe diffuse emphysema was reintroduced in the nineties. Lung volume reduction surgery aims to resect damaged emphysematous lung tissue, thereby increasing elastic properties of the lung. This treatment is hypothesised to improve long-term daily functioning and quality of life, although it may be costly and may be associated with risks of morbidity and mortality. Ten years have passed since the last version of this review was prepared, prompting us to perform an update.
OBJECTIVES
The objective of this review was to gather all available evidence from randomised controlled trials comparing the effectiveness of lung volume reduction surgery (LVRS) versus non-surgical standard therapy in improving health outcomes for patients with severe diffuse emphysema. Secondary objectives included determining which subgroup of patients benefit from LVRS and for which patients LVRS is contraindicated, to establish the postoperative complications of LVRS and its morbidity and mortality, to determine which surgical approaches for LVRS are most effective and to calculate the cost-effectiveness of LVRS.
SEARCH METHODS
We identified RCTs by using the Cochrane Airways Group Chronic Obstructive Pulmonary Disease (COPD) register, in addition to the online clinical trials registers. Searches are current to April 2016.
SELECTION CRITERIA
We included RCTs that studied the safety and efficacy of LVRS in participants with diffuse emphysema. We excluded studies that investigated giant or bullous emphysema.
DATA COLLECTION AND ANALYSIS
Two independent review authors assessed trials for inclusion and extracted data. When possible, we combined data from more than one study in a meta-analysis using RevMan 5 software.
MAIN RESULTS
We identified two new studies (89 participants) in this updated review. A total of 11 studies (1760 participants) met the entry criteria of the review, one of which accounted for 68% of recruited participants. The quality of evidence ranged from low to moderate owing to an unclear risk of bias across many studies, lack of blinding and low participant numbers for some outcomes. Eight of the studies compared LVRS versus standard medical care, one compared two closure techniques (stapling vs laser ablation), one looked at the effect of buttressing the staple line on the effectiveness of LVRS and one compared traditional 'resectional' LVRS with a non-resectional surgical approach. Participants completed a mandatory course of pulmonary rehabilitation/physical training before the procedure commenced. Short-term mortality was higher for LVRS (odds ratio (OR) 6.16, 95% confidence interval (CI) 3.22 to 11.79; 1489 participants; five studies; moderate-quality evidence) than for control, but long-term mortality favoured LVRS (OR 0.76, 95% CI 0.61 to 0.95; 1280 participants; two studies; moderate-quality evidence). Participants identified post hoc as being at high risk of death from surgery were those with particularly impaired lung function, poor diffusing capacity and/or homogenous emphysema. Participants with upper lobe-predominant emphysema and low baseline exercise capacity showed the most favourable outcomes related to mortality, as investigators reported no significant differences in early mortality between participants treated with LVRS and those in the control group (OR 0.87, 95% CI 0.23 to 3.29; 290 participants; one study), as well as significantly lower mortality at the end of follow-up for LVRS compared with control (OR 0.45, 95% CI 0.26 to 0.78; 290 participants; one study). Trials in this review furthermore provided evidence of low to moderate quality showing that improvements in lung function parameters other than forced expiratory volume in one second (FEV), quality of life and exercise capacity were more likely with LVRS than with usual follow-up. Adverse events were more common with LVRS than with control, specifically the occurrence of (persistent) air leaks, pulmonary morbidity (e.g. pneumonia) and cardiovascular morbidity. Although LVRS leads to an increase in quality-adjusted life-years (QALYs), the procedure is relatively costly overall.
AUTHORS' CONCLUSIONS
Lung volume reduction surgery, an effective treatment for selected patients with severe emphysema, may lead to better health status and lung function outcomes, specifically for patients who have upper lobe-predominant emphysema with low exercise capacity, but the procedure is associated with risks of early mortality and adverse events.
Topics: Adult; Humans; Laser Therapy; Lung; Pneumonectomy; Pulmonary Emphysema; Randomized Controlled Trials as Topic; Surgical Stapling; Sutures
PubMed: 27739074
DOI: 10.1002/14651858.CD001001.pub3 -
Respiratory Care Nov 2016This systematic review focuses on respiratory effects of inhalational marijuana. The systematic review of the literature was conducted using a comparative method between... (Review)
Review
This systematic review focuses on respiratory effects of inhalational marijuana. The systematic review of the literature was conducted using a comparative method between 2 researchers. Abstracts were reviewed for inclusion of respiratory effects related to inhalational marijuana. Relevant abstracts were collected, and full text articles were retrieved for review. Articles were removed if they did not contain burning marijuana; were animal studies; or were editorials, systematic reviews, commentaries, non-English language, or non-respiratory-related articles. Forty-eight articles were collected and categorized by respiratory effects. In particular, lung cancer, bullous emphysema/COPD, and other respiratory symptoms were the primary categories. Articles were noted by study population country, sample size, age distribution, and findings that were pertinent to respiratory health. The research indicates that there is a risk of lung cancer from inhalational marijuana as well as an association between inhalational marijuana and spontaneous pneumothorax, bullous emphysema, or COPD. A variety of symptoms have been reported by inhalational marijuana smokers, including wheezing, shortness of breath, altered pulmonary function tests, cough, phlegm production, bronchodilation, and other symptoms. It is important to stay current with research findings to educate patients on this smoking behavior.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cough; Dyspnea; Female; Humans; Lung; Lung Neoplasms; Male; Marijuana Smoking; Middle Aged; Pneumothorax; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Respiratory Function Tests; Respiratory Sounds; Young Adult
PubMed: 27507173
DOI: 10.4187/respcare.04846 -
PloS One 2016Patients with combined pulmonary fibrosis and emphysema (CPFE) have been suggested to have an increased risk of lung cancer. We conducted a systematic review of all... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Patients with combined pulmonary fibrosis and emphysema (CPFE) have been suggested to have an increased risk of lung cancer. We conducted a systematic review of all published data and performed a meta-analysis to define the characteristics of lung cancer that develops in CPFE.
METHOD
We searched Pubmed, Embase, and Cochrane to find original articles about lung cancer and CPFE published prior to September 2015. All titles/abstracts were reviewed by two radiologists to identify articles that used predefined selection criteria. Summary estimates were generated using a random-effect model and odds ratios (ORs) to develop squamous cell carcinoma (SqCC) were calculated. Kaplan-Meier survival curves were obtained for the survival of patients with CPFE and non-CPFE.
RESULTS
Nine original articles that assessed 620 patients were included in this review. In the pooled data, patients were older age (70.4 years), almost all were heavy smokers (53.5 pack years), and males were predominant (92.6%). SqCC was the most common type (42.3%), followed by adenocarcinoma (34.4%). Compared with lung cancer population with an otherwise normal lung, the OR to develop SqCC in CPFE was 9.06 (95% CI, 6.08-13.5). The ORs in CPFE compared with lung cancers that developed in lungs with fibrosis or emphysema were also higher. The median survival for CPFE patients with lung cancer (19.5 months) was significantly shorter than in non-CPFE (53.1 months).
CONCLUSIONS
Lung cancer in CPFE, most commonly SqCC, presents in elderly heavy smokers with a male predominance. The median survival for CPFE patients with lung cancer is 19.5 months.
Topics: Aged; Emphysema; Female; Humans; Lung Neoplasms; Male; Pulmonary Fibrosis
PubMed: 27618692
DOI: 10.1371/journal.pone.0161437 -
The Cochrane Database of Systematic... Sep 2016During synchronised mechanical ventilation, positive airway pressure and spontaneous inspiration coincide. If synchronous ventilation is provoked, adequate gas exchange... (Review)
Review
BACKGROUND
During synchronised mechanical ventilation, positive airway pressure and spontaneous inspiration coincide. If synchronous ventilation is provoked, adequate gas exchange should be achieved at lower peak airway pressures, potentially reducing baro/volutrauma, air leak and bronchopulmonary dysplasia. Synchronous ventilation can potentially be achieved by manipulation of rate and inspiratory time during conventional ventilation and employment of patient-triggered ventilation.
OBJECTIVES
To compare the efficacy of:(i) synchronised mechanical ventilation, delivered as high-frequency positive pressure ventilation (HFPPV) or patient-triggered ventilation (assist control ventilation (ACV) and synchronous intermittent mandatory ventilation (SIMV)), with conventional ventilation or high-frequency oscillation (HFO);(ii) different types of triggered ventilation (ACV, SIMV, pressure-regulated volume control ventilation (PRVCV), SIMV with pressure support (PS) and pressure support ventilation (PSV)).
SEARCH METHODS
We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 5), MEDLINE via PubMed (1966 to June 5 2016), EMBASE (1980 to June 5 2016), and CINAHL (1982 to June 5 2016). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.
SELECTION CRITERIA
Randomised or quasi-randomised clinical trials comparing synchronised ventilation delivered as HFPPV to CMV, or ACV/SIMV to CMV or HFO in neonates. Randomised trials comparing different triggered ventilation modes (ACV, SIMV, SIMV plus PS, PRVCV and PSV) in neonates.
DATA COLLECTION AND ANALYSIS
Data were collected regarding clinical outcomes including mortality, air leaks (pneumothorax or pulmonary interstitial emphysema (PIE)), severe intraventricular haemorrhage (grades 3 and 4), bronchopulmonary dysplasia (BPD) (oxygen dependency beyond 28 days), moderate/severe BPD (oxygen/respiratory support dependency beyond 36 weeks' postmenstrual age (PMA) and duration of weaning/ventilation.Eight comparisons were made: (i) HFPPV versus CMV; (ii) ACV/SIMV versus CMV; (iii) SIMV or SIMV + PS versus HFO; iv) ACV versus SIMV; (v) SIMV plus PS versus SIMV; vi) SIMV versus PRVCV; vii) SIMV vs PSV; viii) ACV versus PSV. Data analysis was conducted using relative risk for categorical outcomes, mean difference for outcomes measured on a continuous scale.
MAIN RESULTS
Twenty-two studies are included in this review. The meta-analysis demonstrates that HFPPV compared to CMV was associated with a reduction in the risk of air leak (typical relative risk (RR) for pneumothorax was 0.69, 95% confidence interval (CI) 0.51 to 0.93). ACV/SIMV compared to CMV was associated with a shorter duration of ventilation (mean difference (MD) -38.3 hours, 95% CI -53.90 to -22.69). SIMV or SIMV + PS was associated with a greater risk of moderate/severe BPD compared to HFO (RR 1.33, 95% CI 1.07 to 1.65) and a longer duration of mechanical ventilation compared to HFO (MD 1.89 days, 95% CI 1.04 to 2.74).ACV compared to SIMV was associated with a trend to a shorter duration of weaning (MD -42.38 hours, 95% CI -94.35 to 9.60). Neither HFPPV nor triggered ventilation was associated with a significant reduction in the incidence of BPD. There was a non-significant trend towards a lower mortality rate using HFPPV versus CMV and a non-significant trend towards a higher mortality rate using triggered ventilation versus CMV. No disadvantage of HFPPV or triggered ventilation was noted regarding other outcomes.
AUTHORS' CONCLUSIONS
Compared to conventional ventilation, benefit is demonstrated for both HFPPV and triggered ventilation with regard to a reduction in air leak and a shorter duration of ventilation, respectively. In none of the trials was complex respiratory monitoring undertaken and thus it is not possible to conclude that the mechanism of producing those benefits is by provocation of synchronised ventilation. Triggered ventilation in the form of SIMV ± PS resulted in a greater risk of BPD and duration of ventilation compared to HFO. Optimisation of trigger and ventilator design with respect to respiratory diagnosis is encouraged before embarking on further trials. It is essential that newer forms of triggered ventilation are tested in randomised trials that are adequately powered to assess long-term outcomes before they are incorporated into routine clinical practice.
PubMed: 27581993
DOI: 10.1002/14651858.CD000456.pub5