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Urology Journal Dec 2021The suctioning access sheath (SAS) is a novel access sheath connected to a negative pressure suction device and absorbs fragments. Some comparative studies have reported... (Meta-Analysis)
Meta-Analysis
PURPOSE
The suctioning access sheath (SAS) is a novel access sheath connected to a negative pressure suction device and absorbs fragments. Some comparative studies have reported SAS with a higher stone-free rate and lower operative time. However, no higher-level evidence was published to support SAS. Hence, this systematic review and meta-analysis aimed to assess the clinical safety and efficacy of SAS versus traditional access sheath (TAS) for the treatment of renal stones in mini-percutaneous nephrolithotomy (MPCNL).
MATERIALS AND METHODS
A systematic review of the literature was conducted using Pubmed, Embase(Ovid), Medline(EBSCO), Cochrane central register of controlled trials, and Sinomed to search comparative studies as recent as December 2020 that assessed the safety and effectiveness of SAS in PCNL. The quality of retrospective case-control studies (RCCs) and randomized controlled trials (RCTs) were evaluated by the Newcastle-Ottawa Scale (NOS) and the Cochrane risk of bias tool, respectively. The Oxford center set up evidence-based medicine was used to assess the level of evidence (LE). Statistical analyses were performed by the comprehensive meta-analysis program.
RESULTS
Seven studies, with a total of 1655 patients, were included. Compared with the TAS group, the SAS group had a shorter operative time (MD= -17.30; 95%CI:-23.09,-11.51; P<.00001), higher stone-free rate (OR=2.37;95%CI:1.56,3.61;P<.0001), fewer total complication rate (OR=0.50;95%CI:0.35,0.70;P<.0001), lower auxiliary procedures rate (OR=0.48;95%CI:0.36,0.64; P<.00001), and lower postoperative fever rate (OR=0.46;95%CI:0.34,0.62;P<.00001).
CONCLUSION
The SAS can significantly improve MPCNL in the stone-free rate, operative time, and total complication rate, especially for auxiliary procedures and postoperative fever rates.
Topics: Humans; Kidney Calculi; Nephrolithotomy, Percutaneous; Operative Time; Suction; Treatment Outcome
PubMed: 34866174
DOI: 10.22037/uj.v18i.6773 -
The Cochrane Database of Systematic... Mar 2016Endotracheal suctioning consists of the mechanical aspiration of pulmonary secretions from the endotracheal tube (ETT) to prevent obstruction. The optimal frequency of... (Review)
Review
BACKGROUND
Endotracheal suctioning consists of the mechanical aspiration of pulmonary secretions from the endotracheal tube (ETT) to prevent obstruction. The optimal frequency of ETT suctioning has not been defined.
OBJECTIVES
To determine the effect of specific ordered frequency of ETT suctioning ('as scheduled') versus ETT suctioning only in case of indications ('as needed') and of more frequent ETT suctioning versus less frequent ETT suctioning on respiratory morbidity in ventilated newborns.
SEARCH METHODS
We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 10), MEDLINE via PubMed (1966 to 31 October 2015), EMBASE (1980 to 31 October 2015), and CINAHL (1982 to 31 October 2015). We checked the reference lists of retrieved articles and contacted study authors to identify additional studies. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials.
SELECTION CRITERIA
Randomized, quasi-randomized, and cluster randomized controlled trials comparing different strategies regarding the frequency of ETT suctioning of newborn infants receiving ventilator support.
DATA COLLECTION AND ANALYSIS
We used the standard methods of the Cochrane Neonatal Review Group. Two review authors independently extracted data and assessed the risk of bias of trials. The primary outcome was bronchopulmonary dysplasia or chronic lung disease.
MAIN RESULTS
We identified one randomized controlled study recruiting 97 low birthweight infants that met the inclusion criteria. The study was conducted in the UK in 1987 and 1988. Randomized infants received ETT suctioning every six or 12 hours during the first three days of life. The quality of reporting was limited and we rated the trial at high risk of bias. Furthermore, the trial lacked adequate power. There were no statistically significant differences in any of reported outcomes: bronchopulmonary dysplasia (defined as oxygen at more than 30 days; risk ratio (RR) 0.49, 95% confidence interval (CI) 0.20 to 1.20); incidence of pneumothorax (RR 0.70, 95% CI 0.24 to 2.05); intraventricular hemorrhage (RR 1.12, 95% CI 0.44 to 2.85); neonatal death (RR 1.40, 95% CI 0.58 to 3.37); and time on ventilation (median time 39 hours in the 12-hourly group and 28 hours in the six-hourly group; RD not applicable for this outcome as mean and standard deviation were not reported). Tests for heterogeneity were not applicable as only one study was included.
AUTHORS' CONCLUSIONS
There was insufficient evidence to identify the ideal frequency of ETT suctioning in ventilated neonates. Future research should focus on the effects in the very preterm newborns, that is, the most vulnerable population as concerns the risk of both lung and brain damage. Assessment should include the cases of prolonged ventilation, when more abundant, dense secretions are common. Clinical trials might include comparisons between 'as-scheduled' versus 'as-needed' endotracheal suctioning, that is, based on specific indications, as well frequent versus less frequent suctioning schedules.
Topics: Catheter Obstruction; Humans; Infant, Low Birth Weight; Infant, Newborn; Intubation, Intratracheal; Lung; Randomized Controlled Trials as Topic; Respiration, Artificial; Suction; Time Factors
PubMed: 26945780
DOI: 10.1002/14651858.CD011493.pub2 -
The Cochrane Database of Systematic... Dec 2011Assisted mechanical ventilation is a necessity in the neonatal population for a variety of respiratory and surgical conditions. However, there are a number of potential... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Assisted mechanical ventilation is a necessity in the neonatal population for a variety of respiratory and surgical conditions. However, there are a number of potential hazards associated with this life saving intervention. New suctioning techniques have been introduced into clinical practice which aim to prevent or reduce these untoward effects.
OBJECTIVES
To assess the effects of endotracheal suctioning without disconnection in intubated ventilated neonates.
SEARCH METHODS
The review has drawn on the search strategy for the Cochrane Neonatal Review Group. A comprehensive search of Cochrane databases, MEDLINE and CINAHL, and the Society for Pediatric Research abstracts was undertaken by the review authors (July 2011).
SELECTION CRITERIA
All trials that utilised random or quasi-random patient allocation and in which suctioning with or without disconnection from the ventilator was compared.
DATA COLLECTION AND ANALYSIS
Standard methods of the Cochrane Neonatal Group were used. Each review author separately reviewed trials for eligibility and quality and extracted data; they then compared and resolved differences. Analysis was performed using the fixed-effect model and outcomes were reported using relative risk (RR) for categorical data and mean difference (MD) for outcomes measured on a continuous scale.
MAIN RESULTS
Four trials (252 infants) were included in this review. The trials employed a cross-over design in which suctioning with or without disconnection was compared. Suctioning without disconnection resulted in a reduction in episodes of hypoxia (typical RR 0.48, CI 95% 0.31 to 0.74; 3 studies; 241 participants). There were also fewer infants who experienced episodes where the transcutaneous partial pressure of oxygen (TcPO(2)) decreased by > 10% (typical RR 0.39, 95% CI 0.19 to 0.82; 1 study; 11 participants). Suctioning without disconnection resulted in a smaller percentage change in heart rate (weighted mean difference (WMD) 6.77, 95% CI 4.01 to 9.52; 4 studies; 239 participants) and a reduction in the number of infants experiencing a decrease in heart rate by > 10% (typical RR 0.61, CI 0.40 to 0.93; 3 studies; 52 participants).The number of infants having bradycardic episodes was also reduced during closed suctioning (typical RR 0.38, CI 95% 0.15 to 0.92; 3 studies; 241 participants).
AUTHORS' CONCLUSIONS
There is some evidence to suggest suctioning without disconnection from the ventilator improves the short term outcomes; however the evidence is not strong enough to recommend this practice as the only method of endotracheal suctioning. Future research utilising larger trials needs to address the implications of the different techniques on ventilator associated pneumonia, pulmonary morbidities and neurodevelopment. Infants less than 28 weeks also need to be included in the trials.
Topics: Cross-Over Studies; Heart Rate; Humans; Infant, Newborn; Intubation, Intratracheal; Randomized Controlled Trials as Topic; Respiration; Respiration, Artificial; Suction; Ventilator Weaning
PubMed: 22161374
DOI: 10.1002/14651858.CD003065.pub2 -
Indian Journal of Critical Care... Jan 2020Ventilator-associated pneumonia, a common cause of mortality and morbidity, is commonly seen among patients with endotracheal intubation due to unsafe suctioning...
INTRODUCTION
Ventilator-associated pneumonia, a common cause of mortality and morbidity, is commonly seen among patients with endotracheal intubation due to unsafe suctioning practices by health professionals.
OBJECTIVE
A systematic review was conducted to explore the gaps in the existing practices of nurses and thus proposing comprehensive guidelines for safe practice.
MATERIALS AND METHODS
A two-phase strategy was adopted to identify the studies through a comprehensive electronic search in PubMed, Google Scholar, ProQuest, Ovid, and Helinet Summon by using predefined keywords within a year limit of 2002-2016. The quality of studies was reviewed using tools endorsed by Joanna Briggs Institute. This review was conducted according to the guidelines described in the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Qualitative data were described through the process of metasynthesis. Quantitative analysis was performed to combine the competent quantitative evidences to identify knowledge and practices of endotracheal suctioning (ETS).
RESULTS
Thirty studies had been subjected for metasynthesis, among which six provided relevant information for quantitative analysis. Quantitative analysis of the studies reported that only 36% of the nurses had assessed patients prior to suctioning and had knowledge about the size of the suction catheter while only 46% were aware of the appropriate suction pressure to be used for ETS. Handwashing compliance prior to suctioning was observed in only 62% of the nurses. It is reported that, despite the awareness on possible complications, nurses fail to adhere to the recommended practice guidelines.
CONCLUSION
The current review would explore the best evidence-based practices (EBPs) among nurses related to ETS, which would ensure quality care to critically ill patients.
HOW TO CITE THIS ARTICLE
Pinto HJ, D'silva F, Sanil TS. Knowledge and Practices of Endotracheal Suctioning amongst Nursing Professionals: A Systematic Review. Indian J Crit Care Med 2020;24(1):23-32.
PubMed: 32148345
DOI: 10.5005/jp-journals-10071-23326 -
The Cochrane Database of Systematic... Jul 2011Mechanical ventilation is commonly used in Neonatal Intensive Care Units to assist breathing in a variety of conditions. Mechanical ventilation is achieved through the... (Review)
Review
BACKGROUND
Mechanical ventilation is commonly used in Neonatal Intensive Care Units to assist breathing in a variety of conditions. Mechanical ventilation is achieved through the placement of an endotracheal tube (ETT) which is left in-situ. The ETT is suctioned to prevent a build-up of secretions and blockage of the airway. Methods of suctioning the endotracheal tube vary according to institutional practice and the individual clinician performing the task. The depth of suctioning is one of these variables. The catheter may be passed to the tip of the ETT or beyond the tip into the trachea or bronchi to facilitate removal of secretions. However, trauma to the lower airways may result from the suction catheter being passed into the airway beyond the tip of the endotracheal tube.
OBJECTIVES
To compare the effectiveness and complications of deep (catheter passed beyond the tip of the ETT) versus shallow (catheter passed to length of ETT only) suctioning of the endotracheal tube in ventilated infants.
SEARCH STRATEGY
In this first update the searches were expanded to the Cochrane Central Register of Controlled Trials (The Cochrane Library, March 30), MEDLINE (from January 1966 to May 30 2011), CINAHL (from 1982 to May 30 2011) and EMBASE (1980 to May 2011) using text words and subject headings relevant to endotracheal suctioning. There were no language restrictions.
SELECTION CRITERIA
Controlled trials using random or quasi-random allocation of neonates receiving ventilatory support via an endotracheal tube to either deep or shallow endotracheal suctioning.
DATA COLLECTION AND ANALYSIS
The updated search resulted in 149 potentially relevant references. Two of the studies from this search were identified as potentially relevant. We included one of the potentially relevant studies and the other was excluded because it did not fit the inclusion criteria.
MAIN RESULTS
One small crossover trial (n = 27) of shallow versus deep suctioning met the criteria for inclusion in this review. The reported outcomes were oxygen saturation and heart rate, during and after suctioning. There were no significant differences when shallow and deep suctioning methods were compared.
AUTHORS' CONCLUSIONS
There is no evidence from randomised controlled trials concerning the benefits or risks of deep versus shallow suctioning of endotracheal tubes in ventilated neonates and infants. Further high quality research is required.
Topics: Humans; Infant; Infant, Newborn; Intubation, Intratracheal; Respiration, Artificial; Suction
PubMed: 21735391
DOI: 10.1002/14651858.CD003309.pub2 -
Nursing Outlook 2024The high burden of pressure ulcers (PUs) in Sub-Saharan Africa (SSA), coupled with the limited resources, underscores the need for preventive and context-specific... (Review)
Review
BACKGROUND
The high burden of pressure ulcers (PUs) in Sub-Saharan Africa (SSA), coupled with the limited resources, underscores the need for preventive and context-specific treatment strategies.
PURPOSE
Therefore, the purpose of this systematic review was to establish and elucidate PU prevention and treatment interventions tested in SSA.
METHODS
This systematic review of the literature used, PRISMA to guide the search.
FINDINGS
The review identified nine studies on PU prevention (three) and treatment (six). Low-cost interventions assembled from locally available materials and multifaceted policies significantly prevented and treated PUs. The interventions included wound dressing agents, simple negative pressure suction devices that significantly treated PUs, and water-based bed surfaces.
DISCUSSION
There were gaps in the interventions that have been proven successful in other global settings.
CONCLUSION
In SSA, there is a need for nurses to tailor, test, and disseminate findings from evidence-based projects for PU prevention that have been successful in similar settings.
Topics: Pressure Ulcer; Humans; Africa South of the Sahara; Female; Male; Adult; Middle Aged
PubMed: 38490058
DOI: 10.1016/j.outlook.2024.102151 -
The Journal of Maternal-fetal &... Dec 2024Postpartum hemorrhage is a leading cause of maternal mortality and morbidity around the globe. The novel low-suction vacuum hemorrhage device (VHD) provides an... (Review)
Review
OBJECTIVE
Postpartum hemorrhage is a leading cause of maternal mortality and morbidity around the globe. The novel low-suction vacuum hemorrhage device (VHD) provides an alternative treatment option for cases of postpartum hemorrhage when first-line uterotonic agents fail. This systematic review aims to review current data evaluating the overall efficacy and safety of VHDs in treating postpartum hemorrhage.
METHODS
We searched CINAHL Ultimate, Academic Search Premier, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE with Full Text, and PubMed and reference lists of retrieved studies for eligible studies that included outcomes of effectiveness, efficacy, or safety. Two independent reviewers used Covidence.org to screen Titles and Abstracts for 69 studies of which six were included in the analysis. Secondary outcomes measured across studies included time to bleeding control, total device deployment time, and adverse effects.
RESULTS
Six nonrandomized trials ( = 1018 participants) included studies conducted in Indonesia, the United States, Switzerland, and Canada. The VHDs were found to have 90% effectiveness in achieving bleeding control across the studies. For most patients, this was achieved in <5 min and required a total device deployment time of 3 h. Reported adverse events were not considered life-threatening, including endometritis in 11 patients and red blood cell transfusions in 38% of patients.
CONCLUSION
VHDs have the potential to be used as a rapidly effective means for mechanical intervention of postpartum hemorrhage. The efficacy and safety of VHDs must be further studied at the randomized controlled trial level to determine their clinical usage.
Topics: Humans; Postpartum Hemorrhage; Female; Pregnancy
PubMed: 38735867
DOI: 10.1080/14767058.2024.2349957 -
The Cochrane Database of Systematic... Jan 2011Hepatic hydatid cyst is an important public health problem in parts of the world where dogs are used for cattle breeding. Management of uncomplicated hepatic hydatid... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hepatic hydatid cyst is an important public health problem in parts of the world where dogs are used for cattle breeding. Management of uncomplicated hepatic hydatid cysts is currently surgical. However, the puncture, aspiration, injection, and re-aspiration (PAIR) method with or without benzimidazole coverage has appeared as an alternative over the past decade.
OBJECTIVES
To assess the benefits and harms of PAIR with or without benzimidazole coverage for patients with uncomplicated hepatic hydatid cyst in comparison with sham/no intervention, surgery, or medical treatment.
SEARCH STRATEGY
The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, DARE, and ACP Journal Club and full text searches were combined (all searched October 2010). Reference lists of pertinent studies and other identified literature were scanned. Researchers in the field were contacted.
SELECTION CRITERIA
Only randomised clinical trials using the PAIR method with or without benzimidazole coverage as the experimental treatment of uncomplicated hepatic hydatid cyst (ie, hepatic hydatid cysts, which are not infected and do not have any communication with the biliary tree or other viscera) versus no intervention, sham puncture (ie, performing all steps for puncture, pretending PAIR being performed, but actually not performing the procedure), surgery, or chemotherapy were included.
DATA COLLECTION AND ANALYSIS
Data were independently extracted, and the risk of bias in each trial was assessed by the authors. Principal authors of the trials were contacted to retrieve missing data.
MAIN RESULTS
We found no randomised clinical trials comparing PAIR versus no or sham intervention. We identified only two randomised clinical trials, one comparing PAIR versus surgical treatment (n = 50 participants) and the other comparing PAIR (with or without albendazole) versus albendazole alone (n = 30 participants). Both trials were graded as 'adequate' for allocation concealment; however, generation of allocation sequence and blinding methods were 'unclear' in both. Compared to surgery, PAIR plus albendazole obtained similar cyst disappearance and mean cyst diameter with fewer adverse events (32% versus 84%, P < 0.001) and fewer days in hospital (mean + SD) ( 4.2 + 1.5 versus 12.7 + 6.5 days, P < 0.001). Compared to albendazole, PAIR with or without albendazole obtained significantly more (P < 0.01) cyst reduction and symptomatic relief.
AUTHORS' CONCLUSIONS
PAIR seems promising, but there is insufficient evidence to support or refute PAIR with or without benzimidazole coverage for treating patients with uncomplicated hepatic hydatid cyst. Further well-designed randomised clinical trials are necessary to address the topic.
Topics: Albendazole; Anticestodal Agents; Benzimidazoles; Biopsy, Fine-Needle; Combined Modality Therapy; Echinococcosis, Hepatic; Humans; Radiography, Interventional; Randomized Controlled Trials as Topic; Suction; Ultrasonography, Interventional
PubMed: 21249654
DOI: 10.1002/14651858.CD003623.pub3 -
Canadian Journal of Surgery. Journal... Aug 2012We performed a systematic review and meta-analysis to determine the effect of suction with water seal, compared with water seal alone, applied to intra pleural chest... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
We performed a systematic review and meta-analysis to determine the effect of suction with water seal, compared with water seal alone, applied to intra pleural chest tubes on the duration of air leaks in patients undergoing pulmonary surgery.
METHODS
We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to find randomized controlled trials (RCTs) comparing the effect of the 2 methods on the duration of air leaks. Trials were systematically assessed for eligibility and validity. Data were extracted in duplicate and pooled across studies using a random-effects model.
RESULTS
The search yielded 7 RCTs that met the eligibility criteria. No difference was identified between the 2 methods in duration of air leak (weighted mean difference [WMD] 1.15 days, favours water seal; 95% confidence interval [CI] -0.64 to 2.94), time to discharge (WMD 2.19 d, favours water seal; 95% CI -0.63 to 5.01), duration of chest tubes (WMD 0.96 d, favours water seal; 95% CI -0.12 to 2.05) or incidence of prolonged air leaks (absolute risk reduction [ARR] 0.04, favours water seal; 95% CI -0.01 to 0.09). Water seal was associated with a significantly increased incidence of postoperative pneumothorax (ARR -0.14, 95% CI -0.21 to -0.07).
CONCLUSION
No differences were identified in terms of duration of air leak, incidence of prolonged air leak, duration of chest tubes and duration of hospital stay when chest tubes were placed to suction rather than water seal. Chest tube suction appears to be superior to water seal in reducing the incidence of pneumothorax; however, the clinical significance of this finding is unclear.
Topics: Adult; Aged; Anastomotic Leak; Chest Tubes; Device Removal; Equipment Design; Female; Follow-Up Studies; Humans; Length of Stay; Lung Diseases; Lung Neoplasms; Male; Middle Aged; Pneumonectomy; Pneumothorax; Postoperative Care; Postoperative Complications; Randomized Controlled Trials as Topic; Risk Assessment; Suction; Time Factors; Treatment Outcome; Water
PubMed: 22854148
DOI: 10.1503/cjs.001411 -
North American Journal of Medical... Jan 2016Endoscopic ultrasound (EUS)-guided tissue acquisition has emerged over the last decade as an invaluable diagnostic tool in approaching the different pancreatic lesions.... (Review)
Review
Endoscopic ultrasound (EUS)-guided tissue acquisition has emerged over the last decade as an invaluable diagnostic tool in approaching the different pancreatic lesions. Given the safety and minimal invasiveness of this approach combined with the high diagnostic yield, it became the standard of care when dealing with different pancreatic pathologies. However, some variables regarding this procedure remain not fully understood. These can influence the diagnostic yield of the procedure and include the presence of the on-site cytopathologist, the type and size of the needle used as well as obtaining aspiration versus core biopsy, the number of passes and the sampling technique, and the role of suction and stylet use among others. We performed a comprehensive literature search using PubMed, Google Scholar, and Embase for studies that assessed these variables. Eligible studies were analyzed using several parameters such as technique and procedure, with the aim of reviewing results from an evidence-based standpoint.
PubMed: 27011940
DOI: 10.4103/1947-2714.175185