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Neurosurgical Review Jul 2023Neurogenic pulmonary edema (NPE) is a life-threatening and severe complication in patients with spontaneous subarachnoid hemorrhage (SAH). The prevalence of NPE varies... (Meta-Analysis)
Meta-Analysis Review
Neurogenic pulmonary edema (NPE) is a life-threatening and severe complication in patients with spontaneous subarachnoid hemorrhage (SAH). The prevalence of NPE varies significantly across studies due to differences in case definitions, study populations, and methodologies. Therefore, a precise estimation of the prevalence and risk factors related to NPE in patients with spontaneous SAH is important for clinical decision-makers, policy providers, and researchers. We conducted a systematic search of the PubMed/Medline, Embase, Web of Science, Scopus, and Cochrane Library databases from their inception to January 2023. Thirteen studies were included in the meta-analysis, with a total of 3,429 SAH patients. The pooled global prevalence of NPE was estimated to be 13%. Out of the eight studies (n = 1095, 56%) that reported the number of in-hospital mortalities of NPE among patients with SAH, the pooled proportion of in-hospital deaths was 47%. Risk factors associated with NPE after spontaneous SAH included female gender, WFNS class, APACHE II score ≥ 20, IL-6 > 40 pg/mL, Hunt and Hess grade ≥ 3, elevated troponin I, elevated white blood cell count, and electrocardiographic abnormalities. Multiple studies showed a strong positive correlation between the WFNS class and NPE. In conclusion, NPE has a moderate prevalence but a high in-hospital mortality rate in patients with SAH. We identified multiple risk factors that can help identify high-risk groups of NPE in individuals with SAH. Early prediction of the onset of NPE is crucial for timely prevention and early intervention.
Topics: Humans; Female; Pulmonary Edema; Subarachnoid Hemorrhage; Hospital Mortality; Prevalence; Databases, Factual
PubMed: 37432487
DOI: 10.1007/s10143-023-02081-6 -
Journal of the American Heart... Jul 2023Background To study the prevalence and types of hypertension-mediated organ damage and the prognosis of patients presenting to the emergency department (ED) with... (Meta-Analysis)
Meta-Analysis
Background To study the prevalence and types of hypertension-mediated organ damage and the prognosis of patients presenting to the emergency department (ED) with hypertensive emergencies. Methods and Results PubMed was queried from inception through November 30, 2021. Studies were included if they reported the prevalence or prognosis of hypertensive emergencies in patients presenting to the ED. Studies reporting data on hypertensive emergencies in other departments were excluded. The extracted data were arcsine transformed and pooled using a random-effects model. Fifteen studies (n=4370 patients) were included. Pooled analysis demonstrates that the prevalence of hypertensive emergencies was 0.5% (95% CI, 0.40%-0.70%) in all patients presenting to ED and 35.9% (95% CI, 26.7%-45.5%) among patients presenting in ED with hypertensive crisis. Ischemic stroke (28.1% [95% CI, 18.7%-38.6%]) was the most prevalent hypertension-mediated organ damage, followed by pulmonary edema/acute heart failure (24.1% [95% CI, 19.0%-29.7%]), hemorrhagic stroke (14.6% [95% CI, 9.9%-20.0%]), acute coronary syndrome (10.8% [95% CI, 7.3%-14.8%]), renal failure (8.0% [95% CI, 2.9%-15.5%]), subarachnoid hemorrhage (6.9% [95% CI, 3.9%-10.7%]), encephalopathy (6.1% [95% CI, 1.9%-12.4%]), and the least prevalent was aortic dissection (1.8% [95% CI, 1.1%-2.8%]). Prevalence of in-hospital mortality among patients with hypertensive emergency was 9.9% (95% CI, 1.4%-24.6%). Conclusions Our findings demonstrate a pattern of hypertension-mediated organ damage primarily affecting the brain and heart, substantial cardiovascular renal morbidity and mortality, as well as subsequent hospitalization in patients with hypertensive emergencies presenting to the ED.
Topics: Humans; Emergencies; Hypertension; Hospitalization; Heart Failure; Subarachnoid Hemorrhage; Emergency Service, Hospital
PubMed: 37421281
DOI: 10.1161/JAHA.122.029355 -
American Journal of Obstetrics &... Sep 2023This study aimed to review the diagnostic criteria for mirror syndrome and describe its clinical presentation. (Review)
Review
OBJECTIVE
This study aimed to review the diagnostic criteria for mirror syndrome and describe its clinical presentation.
DATA SOURCES
Databases from PubMed, Scopus, Cochrane Library, ClinicalTrials.gov, and CINAHL were inquired for case series containing ≥2 cases of mirror syndrome from inception to February 2022.
STUDY ELIGIBILITY CRITERIA
Studies were included if they reported ≥2 cases of mirror syndrome and included case reports, case series, cohort studies, and case-control studies.
STUDY APPRAISAL AND SYNTHESIS METHODS
The studies' quality and risk of bias were independently assessed. Data were tabulated using Microsoft Excel and summarized using narrative review and descriptive statistics. This systematic review was conducted according to the Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement. All eligible references were assessed. Screening of records and data extraction were independently performed, and a third author resolved disagreements.
RESULTS
Of 13 citations, 12 studies (n=82) reported diagnostic criteria for mirror syndrome: maternal edema (11/12), fetal hydrops (9/12), placental edema (6/12), placentomegaly (5/12), and preeclampsia (2/12); 12 studies (n=82) described the clinical presentation of mirror syndrome as maternal edema (62.2%), hypoalbuminemia (54.9%), anemia (39.0%), and new-onset hypertension (39.0%); 4 studies (n=36) reported that hemodilution was present in all patients; 8 studies (n=36) reported the etiology of fetal hydrops, with the most common being structural cardiac malformations (19.4%), alpha thalassemia (19.4%), Rh isoimmunization (13.9%), and nonimmune hydrops fetalis (13.9%); and 6 studies (n=47) reported maternal complications, 89.4% of which were major: postpartum hemorrhage (44.7%), hemorrhage requiring blood transfusion (19.1%), intensive care unit admission (12.8%), heart failure (10.6%), pulmonary edema (8.5%), and renal dysfunction (8.5%). In 39 cases, the reported fetal outcomes were stillbirth (66.6%) and neonatal or infant death (25.6%). The overall survival rate among continued pregnancies was 7.7%.
CONCLUSION
The diagnostic criteria of mirror syndrome differed considerably among studies. Mirror syndrome clinical presentation overlapped with preeclampsia. Only 4 studies discussed hemodilution. Significant maternal morbidity and fetal mortality were associated with mirror syndrome. Further research is warranted to elucidate the pathogenesis of mirror syndrome to better guide clinicians in identifying and managing the condition.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Edema; Hydrops Fetalis; Placenta; Pre-Eclampsia; Syndrome; Systematic Reviews as Topic
PubMed: 37385374
DOI: 10.1016/j.ajogmf.2023.101067 -
Alternative Therapies in Health and... Sep 2023For patients with acute heart failure (AHF), the methods of clinical diagnosis of pulmonary edema mainly include clinical symptoms, laboratory results, and an imaging... (Meta-Analysis)
Meta-Analysis
CONTEXT
For patients with acute heart failure (AHF), the methods of clinical diagnosis of pulmonary edema mainly include clinical symptoms, laboratory results, and an imaging examination. The common diagnostic methods, such as chest X-rays and computerized tomography (CT) scanning, haven't been completely satisfactory.
OBJECTIVE
The study intended to systematically, quantitatively, and comprehensively evaluate the value of a lung (pulmonary) ultrasound, performed at a patient's bedside, in the diagnosis of acute heart failure (AHF), to provide an objective basis for its clinical application and further research.
DESIGN
The research team searched PubMed, Excerpta Medica Database (EMBASE), ScienceDirect, Cochrane Library, China Journal Full-text Database (CNKI), VIP Full-text Database, Wanfang Database, and China Biomedical Literature Database (CBM) for relevant literature, from January 2010 to the present, about the use of a lung ultrasound for diagnosis of AHF patients. The team used keywords to search literature: ultrasound, AHF diagnosis, cardiogenic pulmonary edema, ultrasonic examination, AHF diagnosis, and cardiogenic pulmonary edema. The research team then conducted a meta-analysis of the collected data according to the Cochrane Handbook 5.3 with RevMan 5.3 statistical software.
SETTING
The study took place at Jinan.
OUTCOME MEASURES
The research team: (1) evaluated the quality of the included studies; (2) examined the accuracy of a lung ultrasound in the diagnosis of AHF compared to computerized tomography (CT) as well as to the conventional ultrasonic cardiogram (echocardiogram) that a cardiologist performs; (3) determined the sensitivity, specificity, and predictive value of lung ultrasound using data from two of the included studies; (4) evaluated the data by drawing funnel charts; and (5) examined the publication bias of the included studies.
RESULTS
The research team selected six controlled clinical studies, with 345 data samples, for the meta-analysis. The team performed heterogeneity tests for the included research data. For the first test, the team compared the accuracy of lung ultrasound and CT in diagnosing AHF and found obvious heterogeneity, with χ2 = 11.40, df = 3, P = .010, and I2 = 74%. Based on an analysis using a random effects model, the team found no significant differences between the two methods in the diagnosis of AHF (P = .35). For the second test, the team compared the accuracy of lung ultrasound and an ultrasonic cardiogram in diagnosing AHF and found that the data didn't differ significantly, with χ2 = 0.08, df = 1, P = .78, I2 = 0%. Based on an analysis using a fixed effects model, the team found that the accuracy of the lung ultrasound in diagnosing AHF was significantly higher than that of ultrasonic cardiogram (P = .01). In the two studies, the sensitivity and specificity were high. The majority of the funnel charts were symmetrical, but a few were asymmetrical, suggesting a publication bias, which the heterogeneity in the studies and the limited number of examined examples may explain.
CONCLUSIONS
Lung ultrasound is of great value in the diagnosis of AHF. It's highly efficient, has prospects for broad clinical application, and is worth popularizing, benefiting patients. Scholars need to verify the current study's findings in follow-up studies and in more high-quality case-control trials.
Topics: Humans; Pulmonary Edema; Echocardiography; Lung; Ultrasonography; Heart Failure
PubMed: 37347689
DOI: No ID Found -
The American Journal of the Medical... Aug 2023Three percent hypertonic saline (3% HTS) is used to treat several critical conditions such as severe and symptomatic hyponatremia and increased intracranial pressure. It... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Three percent hypertonic saline (3% HTS) is used to treat several critical conditions such as severe and symptomatic hyponatremia and increased intracranial pressure. It has been traditionally administered through a central venous catheter (CVC). The avoidance of peripheral intravenous infusion of 3% HTS stems theoretically from the concern about the ability of the peripheral veins to tolerate hyperosmolar infusions. The aim of this systematic review and meta-analysis is to assess the rate of complications associated with the infusion of 3% HTS using peripheral intravenous access.
METHODS
We conducted a systematic review and meta-analysis to assess the rate of complications related to the peripheral infusion of 3% HTS. We searched several databases for available studies that met the criteria until February 24th, 2022. We included ten studies conducted across three countries examining the incidence of infiltration, phlebitis, venous thrombosis, erythema, and edema. The overall event rate was calculated and transformed using the Freeman-Tukey arcsine method and pooled using the DerSimonian and Laird random-effects model. I was used to evaluate heterogeneity. Selected items from Newcastle-Ottawa Scale were used to assess the risk of bias in each included study.
RESULTS
A total of 1200 patients were reported to have received peripheral infusion of 3% HTS. The analysis showed that peripherally administered 3% HTS has a low rate of complications. The overall incidence of each of the complications was as follows: infiltration 3.3%, (95% C.I. = 1.8-5.1%), phlebitis 6.2% (95% C.I. = 1.1-14.3%), erythema 2.3% (95% C.I. = 0.3-5.4%), edema 1.8% (95% C.I. = 0.0-6.2%), and venous thrombosis 1% (95% C.I. = 0.0-4.8%). There was one incident of venous thrombosis preceded by infiltration resulting from peripheral infusion of 3% HTS.
CONCLUSIONS
Peripheral administration of 3% HTS is considered a safe and possibly preferred option as it carries a low risk of complications and is a less invasive procedure compared to CVC.
Topics: Humans; Infusions, Intravenous; Saline Solution, Hypertonic; Phlebitis; Edema; Erythema
PubMed: 37192695
DOI: 10.1016/j.amjms.2023.04.025