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Intensive Care Medicine May 2022Hypercapnia is frequent during mechanical ventilation for acute respiratory distress syndrome (ARDS), but its effects on morbidity and mortality are still controversial.... (Meta-Analysis)
Meta-Analysis
PURPOSE
Hypercapnia is frequent during mechanical ventilation for acute respiratory distress syndrome (ARDS), but its effects on morbidity and mortality are still controversial. We conducted a systematic review and meta-analysis to explore clinical consequences of acute hypercapnia in adult patients ventilated for ARDS.
METHODS
We searched Medline, Embase, and the Cochrane Library via the OVID platform for studies published from 1946 to 2021. "Permissive hypercapnia" defined hypercapnia in studies where the group with hypercapnia was ventilated with a protective ventilation (PV) strategy (lower V targeting 6 ml/kg predicted body weight) while the group without hypercapnia was managed with a non-protective ventilation (NPV); "imposed hypercapnia" defined hypercapnia in studies where hypercapnic and non-hypercapnic patients were managed with a similar ventilation strategy.
RESULTS
Twenty-nine studies (10,101 patients) were included. Permissive hypercapnia, imposed hypercapnia under PV, and imposed hypercapnia under NPV were reported in 8, 21 and 1 study, respectively. Studies testing permissive hypercapnia reported lower mortality in hypercapnic patients receiving PV as compared to non-hypercapnic patients receiving NPV: OR = 0.26, 95% CI [0.07-0.89]. By contrast, studies reporting imposed hypercapnia under PV reported increased mortality in hypercapnic patients receiving PV as compared to non-hypercapnic patients also receiving PV: OR = 1.54, 95% CI [1.15-2.07]. There was a significant interaction between the mechanism of hypercapnia and the effect on mortality.
CONCLUSIONS
Clinical effects of hypercapnia are conflicting depending on its mechanism. Permissive hypercapnia was associated with improved mortality contrary to imposed hypercapnia under PV, suggesting a major role of PV strategy on the outcome.
Topics: Adult; Humans; Hypercapnia; Respiration; Respiration, Artificial; Respiratory Distress Syndrome
PubMed: 35294565
DOI: 10.1007/s00134-022-06640-1 -
JAMA Cardiology Mar 2022The outcome and interpretation of noninferiority trials depend on the magnitude of the noninferiority margin and whether a relative or absolute noninferiority margin is... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
The outcome and interpretation of noninferiority trials depend on the magnitude of the noninferiority margin and whether a relative or absolute noninferiority margin is used and may be affected by imprecision in event rate estimation.
OBJECTIVE
To assess the consequence of imprecise event rate estimations on interpretation of peer-reviewed randomized clinical trials.
DATA SOURCES
PubMed/MEDLINE was searched for articles published between January 1, 2015, and April 30, 2021.
STUDY SELECTION
Noninferiority randomized clinical trials of coronary stents published in selected journals with clinical events as the primary end point.
DATA EXTRACTION AND SYNTHESIS
Two reviewers (M.S. and F.V.) independently extracted data on trial characteristics, noninferiority assumptions, primary end point clinical outcomes, and study conclusions. Overestimation or underestimation of the control event rate was evaluated by dividing the assumed control event rate by the observed control event rate. For noninferiority end points with absolute margins, the assumed corresponding relative margin was defined as the ratio of the absolute margin and the assumed event rate, and the observed corresponding relative margin as the ratio between the absolute margin and the observed event rate in the control arm. Noninferiority comparisons with absolute margins were reanalyzed using the assumed corresponding relative margin and the Farrington-Manning score test for relative risk.
MAIN OUTCOMES AND MEASURES
Overestimation or underestimation, assumed and observed corresponding relative margins, and relative reanalysis of the primary end points of trials with absolute margins.
RESULTS
A total of 106 989 patients from 58 trials were included. The event rate in the control arms was overestimated by a median (IQR) of 28% (2%-74%). Most noninferiority trials used absolute rather than relative margins (55 of 58 trials [94.8%]). Owing to overestimation, absolute noninferiority margins became more permissive than originally assumed (median [IQR] of observed relative noninferiority margin, 1.62 [1.50-1.80] vs assumed relative noninferiority margin, 1.47 [1.39-1.55]; P < .001). Among trial comparisons that met noninferiority with an absolute noninferiority margin, 17 of 50 trials (34.0%) would not have met noninferiority with a corresponding assumed relative noninferiority margin.
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, assumed event rates were often overestimated in noninferiority coronary stent trials. Because most of these trials use absolute margins to define noninferiority, such overestimation results in excessively permissive relative noninferiority margins.
Topics: Clinical Protocols; Humans; Stents
PubMed: 35107583
DOI: 10.1001/jamacardio.2021.5724 -
JAMA Network Open Jan 2022Oxygen supplementation is a cornerstone treatment in pediatric critical care. Accumulating evidence suggests that overzealous use of oxygen, leading to hyperoxia, is... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Oxygen supplementation is a cornerstone treatment in pediatric critical care. Accumulating evidence suggests that overzealous use of oxygen, leading to hyperoxia, is associated with worse outcomes compared with patients with normoxia.
OBJECTIVES
To evaluate the association of arterial hyperoxia with clinical outcome in critically ill children among studies using varied definitions of hyperoxia.
DATA SOURCES
A systematic search of EMBASE, MEDLINE, Cochrane Library, and ClinicalTrials.gov from inception to February 1, 2021, was conducted.
STUDY SELECTION
Clinical trials or observational studies of children admitted to the pediatric intensive care unit that examined hyperoxia, by any definition, and described at least 1 outcome of interest. No language restrictions were applied.
DATA EXTRACTION AND SYNTHESIS
The Meta-analysis of Observational Studies in Epidemiology guideline and Newcastle-Ottawa Scale for study quality assessment were used. The review process was performed independently by 2 reviewers. Data were pooled with a random-effects model.
MAIN OUTCOMES AND MEASURES
The primary outcome was 28-day mortality; this time was converted to mortality at the longest follow-up owing to insufficient studies reporting the initial primary outcome. Secondary outcomes included length of stay, ventilator-related outcomes, extracorporeal organ support, and functional performance.
RESULTS
In this systematic review, 16 studies (27 555 patients) were included. All, except 1 randomized clinical pilot trial, were observational cohort studies. Study populations included were post-cardiac arrest (n = 6), traumatic brain injury (n = 1), extracorporeal membrane oxygenation (n = 2), and general critical care (n = 7). Definitions and assessment of hyperoxia differed among included studies. Partial pressure of arterial oxygen was most frequently used to define hyperoxia and mainly by categorical cutoff. In total, 11 studies (23 204 patients) were pooled for meta-analysis. Hyperoxia, by any definition, showed an odds ratio of 1.59 (95% CI, 1.00-2.51; after Hartung-Knapp adjustment, 95% CI, 1.05-2.38) for mortality with substantial between-study heterogeneity (I2 = 92%). This association was also found in less heterogeneous subsets. A signal of harm was observed at higher thresholds of arterial oxygen levels when grouped by definition of hyperoxia. Secondary outcomes were inadequate for meta-analysis.
CONCLUSIONS AND RELEVANCE
These results suggest that, despite methodologic limitations of the studies, hyperoxia is associated with mortality in critically ill children. This finding identifies the further need for prospective observational studies and importance to address the clinical implications of hyperoxia in critically ill children.
Topics: Adolescent; Child; Child, Preschool; Critical Illness; Hospitalization; Humans; Hyperoxia; Infant; Infant, Newborn; Intensive Care Units, Pediatric; Oxygen; Oxygen Inhalation Therapy
PubMed: 34985516
DOI: 10.1001/jamanetworkopen.2021.42105 -
The International Journal on Drug Policy Jan 2022A range of societal changes have created positive and encouraging environments for women's alcohol use. Within this context, in Western countries there is evidence of... (Review)
Review
BACKGROUND
A range of societal changes have created positive and encouraging environments for women's alcohol use. Within this context, in Western countries there is evidence of rising rates of alcohol consumption and related harms among midlife and older women. It is timely and important to explore the role of alcohol in the lives of midlife women to better understand observed data trends and to develop cohort specific policy responses. Focussing on Western countries and those with similar mixed market systems for alcohol regulation, this review aimed to identify 1) how women at midlife make sense of and account for their consumption of alcohol; 2) factors that play a role; and 3) the trends in theoretical underpinnings of qualitative research that explores women's drinking at midlife.
METHODS
A meta-study approach was undertaken. The review process involved extracting and analysing the data findings of eligible research, as well as reviewing the contextual factors and theoretical framing that actively shape research and findings.
RESULTS
Social meanings of alcohol were interwoven with alcohol's psycho-active qualities to create strong localised embodied experiences of pleasure, sociability, and respite from complicated lives and stressful circumstances in midlife women. Drinking was shaped by multiple and diverse aspects of social identity, such as sexuality, family status, membership of social and cultural groups, and associated responsibilities, underpinned by the social and material realities of their lives, societal and policy discourses around drinking, and how they physically experienced alcohol in the short and longer term.
CONCLUSION
For harm reduction strategies to be successful, further research effort should be undertaken to understand alcohol's diverse meanings and functions in women's lives and the individual, material, and socio-cultural factors that feed into these understandings. As well as broad policies that reduce overall consumption and "de-normalise" drinking in society, policy-makers could usefully work with cohorts of women to develop interventions that address the functional role of alcohol in their lives, as well as policies that address permissive regulatory environments and the overall social and economic position of women.
Topics: Aged; Alcohol Drinking; Data Collection; Female; Harm Reduction; Humans; Pleasure; Qualitative Research; Social Behavior
PubMed: 34653766
DOI: 10.1016/j.drugpo.2021.103453 -
Archives of Orthopaedic and Trauma... Nov 2022This article is a systematic review of the literature on elderly aged 80 and over with an ankle fracture. Low energy trauma fractures are a major public health burden in... (Review)
Review
INTRODUCTION
This article is a systematic review of the literature on elderly aged 80 and over with an ankle fracture. Low energy trauma fractures are a major public health burden in developed countries that have aged populations. Ankle fractures are the third most common fractures after hip and wrist fractures. The purpose of this review is to provide an overview of the treatments and the used outcome factors.
METHODS
PubMed, Embase, Cochrane Library, and CINAHL were searched to retrieve relevant studies. Studies published in English or Dutch concerning the treatment of ankle fractures in patients aged 80 and over were included.
RESULTS
Initially 2054 studies were found in the databases. After removing duplicate entries, 1182 remained. Finally, after screening six studies were included, of which three cohorts studies and three case series. Six different treatments were identified and described; ORIF, transarticular Steinmann pin, plaster cast with or without weight-bearing, Gallagher nail and the TCC nail. Furthermore, 32 outcome factors were identified.
DISCUSSION
The various studies show that practitioners are careful with early weight-bearing. However, if we look closely to the results and other literature, this seems not necessary and it could potentially be of great value to implement early weight-bearing in the treatment. Furthermore, quality of life seems underreported in this research field.
CONCLUSIONS
ORIF with plaster cast and permissive weight-bearing should be considered for this population since it seems to be a safe possibility for a majority of the relatively healthy patients aged 80 and over. In cases where surgery is contra-indicated and a plaster cast is the choice of treatment, early weight-bearing seems to have a positive influence on the outcome in the very old patient.
Topics: Aged; Aged, 80 and over; Ankle Fractures; Ankle Joint; Casts, Surgical; Female; Humans; Male; Quality of Life; Treatment Outcome
PubMed: 34546421
DOI: 10.1007/s00402-021-04161-y -
Psychological Reports Apr 2023The concept 'parenting styles' has been widely examined to understand the etiology of narcissism for decades. This study aimed to systematically review the empirical... (Review)
Review
The concept 'parenting styles' has been widely examined to understand the etiology of narcissism for decades. This study aimed to systematically review the empirical research literature regarding the association between perceived parenting styles and narcissism. In this study, Ebscohost, Wiley Online Library, Taylor&Francis, Springer Link, PubMed, PsycNet, ScienceDirect, and Google Scholar databases were searched using identified keywords. An extensive database search resulted in 75 identified publications. Of these, 60 were scrutinized, and in the end, ten studies were included in the review for data synthesis. To reach a common conceptualization on the parenting styles, the results were evaluated based on Baumrind's typology. As a result of this systematic review, we can conclude that there is a relationship between narcissism and parenting styles. In particular, perceived permissive parenting was positively correlated with narcissism. However, the relationship between narcissism and other parenting styles is more complex. Therefore, more high-quality empirical studies are needed to investigate the relationship between parenting and narcissism.
Topics: Humans; Young Adult; Parenting; Narcissism; Authoritarianism
PubMed: 34404305
DOI: 10.1177/00332941211041010 -
Pediatric Research Apr 2022There is no consensus on the optimal pCO levels in the newborn. We reviewed the effects of hypercapnia and hypocapnia and existing carbon dioxide thresholds in neonates.... (Review)
Review
There is no consensus on the optimal pCO levels in the newborn. We reviewed the effects of hypercapnia and hypocapnia and existing carbon dioxide thresholds in neonates. A systematic review was conducted in accordance with the PRISMA statement and MOOSE guidelines. Two hundred and ninety-nine studies were screened and 37 studies included. Covidence online software was employed to streamline relevant articles. Hypocapnia was associated with predominantly neurological side effects while hypercapnia was linked with neurological, respiratory and gastrointestinal outcomes and Retinpathy of prematurity (ROP). Permissive hypercapnia did not decrease periventricular leukomalacia (PVL), ROP, hydrocephalus or air leaks. As safe pCO ranges were not explicitly concluded in the studies chosen, it was indirectly extrapolated with reference to pCO levels that were found to increase the risk of neonatal disease. Although PaCO ranges were reported from 2.6 to 8.7 kPa (19.5-64.3 mmHg) in both term and preterm infants, there are little data on the safety of these ranges. For permissive hypercapnia, parameters described for bronchopulmonary dysplasia (BPD; PaCO 6.0-7.3 kPa: 45.0-54.8 mmHg) and congenital diaphragmatic hernia (CDH; PaCO ≤ 8.7 kPa: ≤65.3 mmHg) were identified. Contradictory findings on the effectiveness of permissive hypercapnia highlight the need for further data on appropriate CO parameters and correlation with outcomes. IMPACT: There is no consensus on the optimal pCO levels in the newborn. There is no consensus on the effectiveness of permissive hypercapnia in neonates. A safe range of pCO of 5-7 kPa was inferred following systematic review.
Topics: Carbon Dioxide; Humans; Hypercapnia; Hypocapnia; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Respiration, Artificial
PubMed: 34230621
DOI: 10.1038/s41390-021-01473-y -
Chest Jan 2022Clinicians use several measures to ascertain whether individual patients will tolerate liberation from mechanical ventilation, including the rapid shallow breathing... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Clinicians use several measures to ascertain whether individual patients will tolerate liberation from mechanical ventilation, including the rapid shallow breathing index (RSBI).
RESEARCH QUESTION
Given varied use of different thresholds, patient populations, and measurement characteristics, how well does RSBI predict successful extubation?
STUDY DESIGN AND METHODS
We searched six databases from inception through September 2019 and selected studies reporting the accuracy of RSBI in the prediction of successful extubation. We extracted study data and assessed quality independently and in duplicate.
RESULTS
We included 48 studies involving RSBI measurements of 10,946 patients. Pooled sensitivity for RSBI of < 105 in predicting extubation success was moderate (0.83 [95% CI, 0.78-0.87], moderate certainty), whereas specificity was poor (0.58 [95% CI, 0.49-0.66], moderate certainty) with diagnostic ORs (DORs) of 5.91 (95% CI, 4.09-8.52). RSBI thresholds of < 80 or 80 to 105 yielded similar sensitivity, specificity, and DOR. These findings were consistent across multiple subgroup analyses reflecting different patient characteristics and operational differences in RSBI measurement.
INTERPRETATION
As a stand-alone test, the RSBI has moderate sensitivity and poor specificity for predicting extubation success. Future research should evaluate its role as a permissive criterion to undergo a spontaneous breathing trial (SBT) for patients who are at intermediate pretest probability of passing an SBT.
TRIAL REGISTRY
PROSPERO; No.: CRD42020149196; URL: www.crd.york.ac.uk/prospero/.
Topics: Airway Extubation; Clinical Decision Rules; Clinical Decision-Making; Humans; Respiration, Artificial; Respiratory Rate; Tidal Volume; Ventilator Weaning
PubMed: 34181953
DOI: 10.1016/j.chest.2021.06.030 -
The Journal of Surgical Research Jun 2021Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become a standard adjunct for the management of life-threatening truncal hemorrhage, but the...
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become a standard adjunct for the management of life-threatening truncal hemorrhage, but the technique is limited by the sequalae of ischemia distal to occlusion. Partial REBOA addresses this limitation, and the recent Food and Drug Administration approval of a device designed to enable partial REBOA will broaden its application. We conducted a systematic review of the available animal and clinical literature on the methods, impacts, and outcomes associated with partial REBOA as a technique to enable targeted proximal perfusion and limit distal ischemic injury. We hypothesize that a systematic review of the published animal and human literature on partial REBOA will provide actionable insight for the use of partial REBOA in the context of future wider clinical implementation of this technique.
METHODS
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines, we conducted a search of the available literature which used partial inflation of a REBOA balloon catheter. Findings from 22 large animal studies and 14 clinical studies met inclusion criteria.
RESULTS
Animal and clinical results support the benefits of partial REBOA including extending the resuscitative window extended safe occlusion time, improved survival, reduced proximal hypertension, and reduced resuscitation requirements. Clinical studies provide practical physiologic targets for partial REBOA including a period of total occlusion followed by gradual balloon deflation to achieve a target proximal pressure and/or target distal pressure.
CONCLUSIONS
Partial REBOA has several benefits which have been observed in animal and clinical studies, most notably reduced ischemic insult to tissues distal to occlusion and improved outcomes compared with total occlusion. Practical clinical protocols are available for the implementation of partial REBOA in cases of life-threatening torso hemorrhage.
Topics: Animals; Aorta; Balloon Occlusion; Endovascular Procedures; Humans; Resuscitation; Shock, Hemorrhagic
PubMed: 33561721
DOI: 10.1016/j.jss.2020.12.054 -
Systematic Reviews Dec 2020Young people's use of pornography and participation in sexting are commonly viewed as harmful behaviours. This paper reports findings from a 'review of reviews', which...
BACKGROUND
Young people's use of pornography and participation in sexting are commonly viewed as harmful behaviours. This paper reports findings from a 'review of reviews', which aimed to systematically identify and synthesise the evidence on pornography and sexting amongst young people. Here, we focus specifically on the evidence relating to young people's use of pornography; involvement in sexting; and their beliefs, attitudes, behaviours and wellbeing to better understand potential harms and benefits, and identify where future research is required.
METHODS
We searched five health and social science databases; searches for grey literature were also performed. Review quality was assessed and findings synthesised narratively.
RESULTS
Eleven reviews of quantitative and/or qualitative studies were included. A relationship was identified between pornography use and more permissive sexual attitudes. An association between pornography use and stronger gender-stereotypical sexual beliefs was also reported, but not consistently. Similarly, inconsistent evidence of an association between pornography use and sexting and sexual behaviour was identified. Pornography use has been associated with various forms of sexual violence, aggression and harassment, but the relationship appears complex. Girls, in particular, may experience coercion and pressure to engage in sexting and suffer more negative consequences than boys if sexts become public. Positive aspects to sexting were reported, particularly in relation to young people's personal relationships.
CONCLUSIONS
We identified evidence from reviews of varying quality that linked pornography use and sexting amongst young people to specific beliefs, attitudes and behaviours. However, evidence was often inconsistent and mostly derived from observational studies using a cross-sectional design, which precludes establishing any causal relationship. Other methodological limitations and evidence gaps were identified. More rigorous quantitative studies and greater use of qualitative methods are required.
Topics: Adolescent; Attitude; Child; Coercion; Cross-Sectional Studies; Erotica; Female; Humans; Male; Review Literature as Topic; Sexual Behavior; Text Messaging
PubMed: 33280603
DOI: 10.1186/s13643-020-01541-0