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BMJ Open Jul 2023To compare the effectiveness and safety of percutaneous catheter drainage (PCD) against percutaneous needle aspiration (PNA) for liver abscess. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To compare the effectiveness and safety of percutaneous catheter drainage (PCD) against percutaneous needle aspiration (PNA) for liver abscess.
DESIGN
Systematic review, meta-analysis and trial sequential analysis.
DATA SOURCES
PubMed, Web of Science, Cochrane Library, Embase, Airiti Library and ClinicalTrials.gov were searched from their inception up to 16 March 2022.
ELIGIBILITY CRITERIA
Randomised controlled trials that compared PCD to PNA for liver abscess were considered eligible, without restriction on language.
DATA EXTRACTION AND SYNTHESIS
Primary outcome was treatment success rate. Depending on heterogeneity, either a fixed-effects model or a random-effects model was used to derive overall estimates. Review Manager V.5.3 software was used for meta-analysis. Trial sequential analysis was performed using the Trial Sequential Analysis software. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system.
RESULTS
Ten trials totalling 1287 individuals were included. Pooled analysis revealed that PCD, when compared with PNA, enhanced treatment success rate (risk ratio 1.16, 95% CI 1.07 to 1.25). Trial sequential analysis demonstrated this robust finding with required information size attained. For large abscesses, subgroup analysis favoured PCD (test of subgroup difference, p<0.001). In comparison to PNA, pooled analysis indicated a significant benefit of PCD on time to achieve clinical improvement or complete clinical relief (mean differences (MD) -2.53 days; 95% CI -3.54 to -1.52) in six studies with 1000 patients; time to achieve a 50% reduction in abscess size (MD -2.49 days; 95% CI -3.59 to -1.38) in five studies with 772 patients; and duration of intravenous antibiotic use (MD -4.04 days, 95% CI -5.99 to -2.10) in four studies with 763 patients. In-hospital mortality and complications were not different.
CONCLUSION
In patients with liver abscess, ultrasound-guided PCD raises the treatment success rate by 136 in 1000 patients, improves clinical outcomes by 3 days and reduces the need for intravenous antibiotics by 4 days.
PROSPERO REGISTRATION NUMBER
CRD42022316540.
Topics: Humans; Drainage; Suction; Liver Abscess; Biopsy, Needle; Anti-Bacterial Agents; Catheters
PubMed: 37518084
DOI: 10.1136/bmjopen-2023-072736 -
European Urology Focus Jan 2024Controversy exists regarding the therapeutic benefit of suction use during percutaneous nephrolithotripsy (PCNL). (Review)
Review
CONTEXT
Controversy exists regarding the therapeutic benefit of suction use during percutaneous nephrolithotripsy (PCNL).
OBJECTIVE
To review and highlight the options available in the use of suction for PCNL, and to discuss their strengths and limitations.
EVIDENCE ACQUISITION
A systematic literature search was performed using Scopus, EMBASE, and PubMed. Thirty four studies were included. There was one ex vivo study. Among clinical studies, 24 used a vacuum/suctioning sheath and nine a handpiece suction device/direct-in-scope suction. The suction technique was employed in standard, mini-PCNL, supermini-PCNL, and enhanced supermini‑PCNL techniques.
EVIDENCE SYNTHESIS
Handpiece suction devices demonstrated better safety and efficiency in treating large stones than nonsuction PCNL and in a much shorter time. Trilogy and ShockPulse-SE were equally effective, safe, and versatile for standard PCNL and mini-PCNL. The heavier handpiece makes Trilogy less ergonomically friendly. Laser suction handpiece devices can potentiate laser lithotripsy by allowing for better laser control with simultaneous suction of small fragments and dust. Integrated suction-based sheaths are available in reusable and disposable forms for mini-PCNL only. Mini-PCNL with suction reported superior outcomes for operative time and stone-free rate to mini-PCNL. This also helped minimize infectious complications by a combination of intrarenal pressure reduction and faster aspiration of irrigation fluid reducing the risk of sepsis, enhance intraoperative vision, and improve lithotripsy efficiency, which makes it a very attractive evolution for PCNL.
CONCLUSIONS
Suction devices in PCNL are reforming the way PCNL is being done. Adding suction to mini-PCNL reduces infectious complications and improves the stone-free rate. Our review shows that despite the limited evidence, suction techniques appear to improve PCNL outcomes.
PATIENT SUMMARY
In this review, we looked at the intra- and perioperative outcomes of percutaneous nephrolithotripsy (PCNL) with the addition of suction. With better stone fragmentation and fewer postoperative infections, this technology is very useful particularly for mini-PCNL.
Topics: Humans; Kidney Calculi; Suction; Lithotripsy; Lithotripsy, Laser; Postoperative Complications
PubMed: 37442721
DOI: 10.1016/j.euf.2023.06.010 -
PloS One 2023The benefits of routine gastric suctioning or lavage in neonates remain uncertain, despite the common practice worldwide. To investigate the potential advantages and... (Meta-Analysis)
Meta-Analysis
The benefits of routine gastric suctioning or lavage in neonates remain uncertain, despite the common practice worldwide. To investigate the potential advantages and harms, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the effects of these procedures in healthy or meconium-stained neonates at birth. We systematically searched PubMed, Scopus, Embase, Ovid, and the Cochrane Library databases from inception to February 9, 2023. We included only RCTs assessing the outcomes of gastric suction or lavage in neonates at birth. We calculated risk ratio (RR) and weighted mean differences with 95% confidence intervals (CIs) using a random-effects model. The primary outcomes were gastrointestinal symptoms including vomiting, retching, feeding intolerance, and secondary aspiration. The secondary outcomes included time to initiation of breastfeeding and potential adverse procedure-related events. Twelve RCTs with a total of 4,122 neonates were analyzed. All the studies compared neonates who received gastric suction or lavage with those who received usual care. Gastrointestinal symptoms were significantly reduced in neonates receiving gastric suction or gastric lavage compared with the control group (RR, 0.75; 95% CI, 0.63-0.89). Gastric lavage was beneficial for infants with meconium-stained amniotic fluid (RR 0.71; 95% CI, 0.60-0.84), while gastric suction had no significant benefit in reducing gastrointestinal symptoms in infants without meconium-stained amniotic fluid (RR 0.91; 95% CI, 0.61-1.37). Our findings suggest that gastric suction or lavage may reduce gastrointestinal symptoms in neonates; however, these procedures may only benefit infants born with meconium-stained amniotic fluid. Vigorous newborns without meconium-stained amniotic fluid may not benefit from these procedures. Furthermore, gastric suction may lead to adverse outcomes such as apnea and bradycardia. Registration: This study was registered in the PROSPERO International prospective register of systematic reviews in health and social care (CRD42023247780).
Topics: Infant, Newborn; Infant; Humans; Meconium; Therapeutic Irrigation; Suction; Stomach; Gastric Lavage; Vomiting; Amniotic Fluid
PubMed: 37440527
DOI: 10.1371/journal.pone.0288398 -
Intensive & Critical Care Nursing Oct 2023This systematic review aimed to identify the effects of normal saline instillation before endotracheal suctioning on clinical outcomes in critically ill patients on a... (Meta-Analysis)
Meta-Analysis Review
Benefits and harms of normal saline instillation before endotracheal suctioning in mechanically ventilated adult patients in intensive care units: A systematic literature review and meta-analysis.
OBJECTIVES
This systematic review aimed to identify the effects of normal saline instillation before endotracheal suctioning on clinical outcomes in critically ill patients on a mechanical ventilator.
RESEARCH METHODOLOGY
This review was based on the guidelines of the National Evidence-based Healthcare Collaborating Agency in Korea and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Six electronic databases were searched for relevant literature. Other sources were also searched, including the reference lists of identified reports and previous systematic reviews. After the initial literature search, a two-step retrieval process was performed to select eligible studies. Then, data were collected using a newly developed form, and the risk of bias was assessed using the checklists of the Joanna Briggs Institute. Data were analyzed using both narrative syntheses and meta-analyses.
RESULTS
In total, 16 studies: 13 randomized controlled trials and three quasi-experimental studies, were included. From the narrative syntheses, instilling normal saline before endotracheal suctioning was associated with a decrease in oxygen saturation, prolonged time for oxygen saturation to recover to baseline, decreased arterial pH, increased secretion amount, reduced incidence of ventilator-associated pneumonia, increased heart rate, and increased systolic blood pressure. Meta-analyses showed a significant difference in heart rate at five minutes after suctioning but no significant differences in oxygen saturation at two and five minutes after suctioning and heart rate at two minutes after suctioning.
CONCLUSION
This systematic review indicated that instilling normal saline before performing endotracheal suctioning has more harmful effects than benefits.
IMPLICATIONS FOR CLINICAL PRACTICE
As recommended in the current guidelines, it is necessary to refrain from routine normal saline instillation before endotracheal suctioning.
Topics: Humans; Adult; Saline Solution; Respiration, Artificial; Intubation, Intratracheal; Intensive Care Units; Heart Rate
PubMed: 37384975
DOI: 10.1016/j.iccn.2023.103477 -
PloS One 2023Medical device-related pressure injury (MDRPI) in intensive care unit (ICU) patients is a serious issue. We aimed to evaluate the risk factors for MDRPI associated with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Medical device-related pressure injury (MDRPI) in intensive care unit (ICU) patients is a serious issue. We aimed to evaluate the risk factors for MDRPI associated with ICU patients through systematic review and meta-analysis, and provide insights into the clinical prevention of MDRPI.
METHODS
We searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, and China BioMedical Literature Database (CBM) (from inception to January 2023) for studies that identified risk factors of MDRPI in ICU patients. In order to avoid the omission of relevant literature, we performed a secondary search of the above database on February 15, 2023. Meta-analysis was performed using Revman 5.3.
RESULTS
Fifteen studies involving 4850 participants were selected to analyze risk factors for MDRPI in ICU patients. While conducting a meta-analysis, we used sensitivity analysis to ensure the reliability of the results for cases with significant heterogeneity among studies. When the source of heterogeneity cannot be determined, we only described the risk factor. The risk factors for MDRPI in ICU patients were elder age (OR = 1.06, 95% CI: 1.03-1.10), diabetes mellitus (OR = 3.20, 95% CI: 1.96-5.21), edema (OR = 3.62, 95% CI: 2.31-5.67), lower Braden scale score (OR = 1.22, 95%CI: 1.11-1.33), higher SOFA score (OR = 4.21, 95%CI: 2.38-7.47), higher APACHE II score (OR = 1.38, 95%CI: 1.15-1.64), longer usage time of medical devices (OR = 1.11, 95%CI: 1.05-1.19), use of vasoconstrictors (OR = 6.07, 95%CI: 3.15-11.69), surgery (OR = 4.36, 95% CI: 2.07-9.15), prone position (OR = 24.71, 95% CI: 7.34-83.15), and prone position ventilation (OR = 17.51, 95% CI: 5.86-52.36). Furthermore, we found that ICU patients who used subglottic suction catheters had a higher risk of MDRPI, whereas ICU patients with higher hemoglobin and serum albumin levels had a lower risk of MDRPI.
CONCLUSION
This study reported the risk factors for MDRPI in ICU patients. A comprehensive analysis of these risk factors will help to prevent and optimize interventions, thereby minimizing the occurrence of MDRPI.
Topics: Humans; Aged; Pressure Ulcer; Reproducibility of Results; Intensive Care Units; Critical Care; Crush Injuries; Risk Factors
PubMed: 37352180
DOI: 10.1371/journal.pone.0287326 -
Actas Urologicas Espanolas 2024To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. (Review)
Review
OBJECTIVE
To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones.
BASIC PROCEDURES
A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded.
MAIN FINDINGS
Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure.
CONCLUSION
Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.
Topics: Adult; Humans; Child; Artificial Intelligence; Suction; Treatment Outcome; Kidney Calculi; Ureter
PubMed: 37302691
DOI: 10.1016/j.acuroe.2023.06.001 -
Arthroscopy : the Journal of... Feb 2024To systematically review and compare biomechanical properties of labral reconstruction to labral repair, intact native labrum, and labral excision in cadaveric studies. (Review)
Review
Acetabular Labral Reconstruction Does Not Demonstrate Superior Biomechanical Properties Compared to Labral Repair or Intact Native Labrum but Is Superior to Labral Excision: A Systematic Review of Cadaveric Studies.
PURPOSE
To systematically review and compare biomechanical properties of labral reconstruction to labral repair, intact native labrum, and labral excision in cadaveric studies.
METHODS
A search of the PubMed and Embase databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Cadaveric studies focused on hip biomechanics related to intact labrum, labral repair, labral reconstruction, labral augmentation, and labral excision were included. Investigated parameters included biomechanical data measures, such as distraction force, distance to suction seal rupture, peak negative pressure, contact area, and fluid efflux. Review articles, duplicates, technique reports, case reports, opinion articles, articles written in a language other than English, clinical studies focusing on patient-reported outcomes, studies performed in animals, and articles with no abstract available were also excluded.
RESULTS
Fourteen cadaveric biomechanical studies were included that compared labral reconstruction to labral repair (4 studies), labral reconstruction to labral excision (4 studies); and evaluation of distractive force of the labrum (3 studies), the distance to suction seal rupture (3 studies), fluid dynamics (2 studies), displacement at peak force (1 study), and stability ratio (1 study). Data pooling was not performed because of methodological heterogenicity of the studies. Labral reconstruction did not outperform labral repair in restoring the hip suction seal or any other biomechanical property. Labral repair significantly prevented greater fluid efflux when compared to labral reconstruction. Labral repair and reconstruction improved the distractive stability of the hip fluid seal from the labral tear and labral excision stage, respectively. Furthermore, labral reconstruction demonstrated to have better biomechanical properties than labral excision.
CONCLUSIONS
In cadaveric studies, labral repair or intact native labrum was biomechanically more superior than labral reconstruction; however, labral reconstruction can restore acetabular labral biomechanical properties and was biomechanically superior to labral excision.
CLINICAL RELEVANCE
In cadaveric models, labral repair outperforms segmental labral reconstruction in preserving the hip suction seal; nonetheless, segmental labral reconstruction biomechanically outperforms labral excision at time 0.
Topics: Humans; Acetabulum; Cadaver; Hip Joint; Fibrocartilage; Lacerations
PubMed: 37270115
DOI: 10.1016/j.arthro.2023.05.025 -
Current Opinion in Urology Jul 2023Retrograde intra renal surgery (RIRS) with laser lithotripsy represents the gold-standard to treat renal stones up to 20 mm. Controlling intraoperative parameters such...
PURPOSE OF REVIEW
Retrograde intra renal surgery (RIRS) with laser lithotripsy represents the gold-standard to treat renal stones up to 20 mm. Controlling intraoperative parameters such as intrarenal pressure (IRP) and temperature (IRT) is mandatory to avoid complications. This article reviews advances in IRP and IRT over the last 2 years.
RECENT FINDINGS
We conducted a PubMed/Embase search and reviewed publications that include temperature and pressure during RIRS. Thirty-four articles have been published which met the inclusion criteria. Regarding IRP, a consensus has emerged to control IRP during RIRS, in order to avoid (barotraumatic and septic) complications. Several monitoring devices are under evaluation but none of them are clinically approved for RIRS. Ureteral access sheath, low irrigation pressure and occupied working channel help to maintain a low IRP. Robotic systems and suction devices would improve IRP intraoperative management and monitoring. IRT determinants are the irrigation flow and laser settings. Low power settings(<20 W) with minimal irrigation flow (5-10 ml/min) are sufficient to maintain low IRT and allows continuous laser activation.
SUMMARY
Recent evidence suggests that IRP and IRT are closely related. IRP depends on inflow and outflow rates. Continuous monitoring would help to avoid surgical and infectious complications. IRT depends on the laser settings and the irrigation flow.
Topics: Humans; Temperature; Kidney; Kidney Calculi; Ureter; Lithotripsy, Laser
PubMed: 37140545
DOI: 10.1097/MOU.0000000000001102 -
Journal of Otolaryngology - Head & Neck... Mar 2023There is a lack of robust evidence in regards to whether the intra and post-operative safety and efficacy of conventional curettage adenoidectomy is better than those of... (Meta-Analysis)
Meta-Analysis
Comparison of the efficacy and safety of conventional curettage adenoidectomy with those of other adenoidectomy surgical techniques: a systematic review and network meta-analysis.
OBJECTIVES
There is a lack of robust evidence in regards to whether the intra and post-operative safety and efficacy of conventional curettage adenoidectomy is better than those of other available surgical techniques. Therefore, this study was conducted as a systematic review and network meta-analysis of published randomized controlled trials (RCTs) with the aim of comparing the safety and efficacy of conventional curettage adenoidectomy with all other available adenoidectomy techniques.
MATERIALS AND METHODS
A systematic search of published articles was performed in 2021 using databases such as PubMed/Medline, EMBASE, EBSCO, and the Cochrane Library. All RCTs that compared conventional curettage adenoidectomy with other surgical techniques and were published in English between 1965 and 2021 were included. The quality of the included RCTs have been assessed using Cochrane Collaboration Risk of Bias Tool.
RESULTS
After screening 1494 articles, 17 were identified for comparing several adenoidectomy techniques and were eligible for quantitative analysis. Of those, 9 RCTs were analyzed for intraoperative blood loss, and 6 articles were included for post-operative bleeding. Furthermore; 14, 10, and 7 studies were included for surgical time, residual adenoid tissue, and postoperative complications respectively. Endoscopic-assisted microdebrider adenoidectomy yielded a statistically significantly greater estimate of intraoperative blood loss compared with conventional curettage adenoidectomy (mean difference [MD], 92.7; 95% confidence interval [CI] 28.3-157.1), suction diathermy (MD, 117.1; 95% CI 37.2-197.1). Suction diathermy had the highest cumulative probability of being the preferred technique because it was estimated to result in the least intraoperative blood loss. Electronic molecular resonance adenoidectomy was estimated to be more likely to result in the shortest surgical time (mean rank, 2.2). Participants in the intervention group were 97% less likely to have residual adenoid tissue than children in the conventional curettage group (odds ratio 0.03; 95% CI 0.01-0.15); therefore, conventional curettage was not considered an appropriate technique for complete removal of adenoid tissue.
CONCLUSION
There is no single technique that can be considered best for all possible outcomes. Therefore, otolaryngologists should make an appropriate choice after critically reviewing the clinical characteristics of children requiring adenoidectomy. Findings of this systematic review and meta-analysis may guide otolaryngologists when making evidence-based decisions regarding the treatment of enlarged and symptomatic adenoids in children.
Topics: Child; Humans; Adenoidectomy; Blood Loss, Surgical; Network Meta-Analysis; Postoperative Hemorrhage; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 36870974
DOI: 10.1186/s40463-023-00634-9 -
Indian Journal of Critical Care... Jul 2022Ventilator-associated events (VAEs) are one of the main sources of concern in critically ill patients due to the high frequency and mortality. We conducted this analysis...
INTRODUCTION
Ventilator-associated events (VAEs) are one of the main sources of concern in critically ill patients due to the high frequency and mortality. We conducted this analysis to compare the effects of open endotracheal suctioning system with closed one on the incidences of VAEs in adult patients receiving mechanical ventilation (MV).
MATERIALS AND METHODS
A comprehensive literature search was performed in PubMed, Scopus, Cochrane Library, and hand searching bibliographies of retrieved articles. The search was confined to randomized controlled trials with human adults comparing closed tracheal suction systems (CTSS) vs open tracheal suction systems (OTSS) in prevention of ventilator-associated pneumonia (VAP). Full-text articles were used in order to extract the data. Data extraction was only started after completing the quality assessment.
RESULTS
The search resulted in 59 publications. Among them, 10 were identified as eligible for meta-analysis. There was a significant increase in incidence of VAP when using OTSS compared to CTSS, so that OCSS increased the incidence of VAP by 57% (OR 1.57, 95% CI 1.063-2.32, = 0.02).
DISCUSSION
Our results showed that using CTSS can significantly decrease VAP development compared to OTSS. This conclusion does not yet mean the routine use of CTSS as a standard VAP prevention measure for all patients since individual patient's disease and cost are other factors that should be in mind when determining the choice of the suctioning system. High-quality trials with a larger sample size are highly recommended.
HOW TO CITE THIS ARTICLE
Sanaie S, Rahnemayan S, Javan S, Shadvar K, Saghaleini SH, Mahmoodpoor A. Comparison of Closed vs Open Suction in Prevention of Ventilator-associated Pneumonia: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2022;26(7):839-845.
PubMed: 36864859
DOI: 10.5005/jp-journals-10071-24252