scholarly journals Effects of individualized positive end-expiratory pressure combined with recruitment maneuver on intraoperative ventilation during abdominal surgery: a systematic review and network meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Xiang Li ◽  
Zhi-Lin Ni ◽  
Jun Wang ◽  
Xiu-Cheng Liu ◽  
Hui-Lian Guan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Recruitment Maneuver ◽  
Meta Analysis ◽  
Oxygenation Index ◽  
Dynamic Compliance ◽  
Ventilation Strategy ◽  
Positive End Expiratory Pressure ◽  
Low Tidal Volume ◽  
Volume Ventilation ◽  
Secondary Outcomes

AbstractLow tidal volume ventilation strategy may lead to atelectasis without proper positive end-expiratory pressure (PEEP) and recruitment maneuver (RM) settings. RM followed by individualized PEEP was a new method to optimize the intraoperative pulmonary function. We conducted a systematic review and network meta-analysis of randomized clinical trials to compare the effects of individualized PEEP + RM on intraoperative pulmonary function and hemodynamic with other PEEP and RM settings. The primary outcomes were intraoperative oxygenation index and dynamic compliance, while the secondary outcomes were intraoperative heart rate and mean arterial pressure. In total, we identified 15 clinical trials containing 36 randomized groups with 3634 participants. Ventilation strategies were divided into eight groups by four PEEP (L: low, M: moderate, H: high, and I: individualized) and two RM (yes or no) settings. The main results showed that IPEEP + RM group was superior to all other groups regarding to both oxygenation index and dynamic compliance. LPEEP group was inferior to LPEEP + RM, MPEEP, MPEEP + RM, and IPEEP + RM in terms of oxygenation index and LPEEP + RM, MPEEP, MPEEP + RM, HPEEP + RM, IPEEP, and IPEEP + RM in terms of dynamic compliance. All comparisons were similar for secondary outcomes. Our analysis suggested that individualized PEEP and RM may be the optimal low tidal volume ventilation strategy at present, while low PEEP without RM is not suggested.

Different ventilation strategies alter surfactant responses in preterm rabbits

1992 ◽  
Vol 73 (5) ◽  
pp. 2089-2096 ◽  
Author(s):  
E. D. Rider ◽  
A. H. Jobe ◽  
M. Ikegami ◽  
B. Sun
Keyword(s):  
Ventilation Strategy ◽  
Positive End Expiratory Pressure ◽  
Lung Volumes ◽  
Low Tidal Volume ◽  
Volume Ventilation ◽  
Ventilation Efficiency ◽  
Ventilation Strategies ◽  
Peak Pressures ◽  
Better Than

The effect of ventilation strategy on in vivo function of different surfactants was evaluated in preterm rabbits delivered at 27 days gestational age and ventilated with either 0 cmH2O positive end-expiratory pressure (PEEP) at tidal volumes of 10–11 ml/kg or 3 cmH2O PEEP at tidal volumes of 7–8 ml/kg after treatment with one of four different surfactants: sheep surfactant, the lipids of sheep surfactant stripped of protein (LH-20 lipid), Exosurf, and Survanta. The use of 3 cmH2O PEEP decreased pneumothoraces in all groups except for the sheep surfactant group where pneumothoraces increased (P < 0.01). Ventilatory pressures (peak pressures - PEEP) decreased more with the 3 cmH2O PEEP, low-tidal-volume ventilation strategy for Exosurf-, Survanta-, and sheep surfactant-treated rabbits (P < 0.05), whereas ventilation efficiency indexes (VEI) improved only for Survanta- and sheep surfactant-treated rabbits with 3 cmH2O PEEP (P < 0.01). Pressure-volume curves for sheep surfactant-treated rabbits were better than for all other treated groups (P < 0.01), although Exosurf and Survanta increased lung volumes above those in control rabbits (P < 0.05). The recovery of intravascular radiolabeled albumin in the lungs and alveolar washes was used as an indicator of pulmonary edema. Only Survanta and sheep surfactant decreased protein leaks in the absence of PEEP, whereas all treatments decreased labeled albumin recoveries when 3 cmH2O PEEP was used (P < 0.05). These experiments demonstrate that ventilation style will alter a number of measurements of surfactant function, and the effects differ for different surfactants.

scholarly journals 1106: LOW TIDAL VOLUME VENTILATION FOR EMERGENCY DEPARTMENT PATIENTS: SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 50 (1) ◽  
pp. 551-551
Author(s):  
Karlee De Monnin ◽  
Emily Terian ◽  
Lauren Yaegar ◽  
Ryan Pappal ◽  
Nicholas Mohr ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Tidal Volume ◽  
Meta Analysis ◽  
Low Tidal Volume ◽  
Low Tidal Volume Ventilation ◽  
Volume Ventilation ◽  
Emergency Department Patients

scholarly journals Systematic review and meta-analysis of female lifestyle factors and risk of recurrent pregnancy loss

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ka Ying Bonnie Ng ◽  
George Cherian ◽  
Alexandra J. Kermack ◽  
Sarah Bailey ◽  
Nick Macklon ◽  
...  
Keyword(s):  
Systematic Review ◽  
General Population ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Meta Analysis ◽  
Lifestyle Factors ◽  
Caffeine Intake ◽  
Increased Risk ◽  
Secondary Outcomes

AbstractIt is known that lifestyle factors affect sporadic miscarriage, but the extent of this on RPL (recurrent pregnancy loss) is less well known. A systematic review and meta-analysis was performed to assess the associations between lifestyle factors and RPL. Studies that analysed RPL in the context of BMI, smoking, alcohol and caffeine intake were included. The primary and secondary outcomes were odds of having RPL in the general population and odds of further miscarriage, respectively. Underweight and women with BMI > 25 are at higher odds of RPL in the general population (OR 1.2, 95% CI 1.12–1.28 and OR 1.21, 95% CI 1.06–1.38, respectively). In women with RPL, having BMI > 30 and BMI > 25 has increased odds of further miscarriages (OR 1.77, 95% CI 1.25–2.50 and OR 1.35, 95% CI 1.07–1.72, respectively). The quality of the evidence for our findings was low or very low. Being underweight and BMI > 25 contributes significantly to increased risk of RPL (general population). BMI > 25 or BMI > 30 increases the risk of further miscarriages (RPL population). Larger studies addressing the effects of alcohol, cigarette smoking and caffeine on the risk of RPL with optimisation of BMI in this cohort of women are now needed.

scholarly journals Effects of Exercise on Cardiac Function Outcomes in Women Receiving Anthracycline or Trastuzumab Treatment for Breast Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 (18) ◽  
pp. 8336
Author(s):  
Pedro Antunes ◽  
Dulce Esteves ◽  
Célia Nunes ◽  
Anabela Amarelo ◽  
José Fonseca-Moutinho ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Cardiac Function ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cochrane Library ◽  
Circulating Biomarkers ◽  
Ventricular Ejection Fraction ◽  
Secondary Outcomes

Background: we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of exercise training on cardiac function and circulating biomarkers outcomes among women with breast cancer (BC) receiving anthracycline or trastuzumab-containing therapy. Methods: PubMed, EMBASE, Cochrane Library, Web of Science and Scopus were searched. The primary outcome was change on left ventricular ejection fraction (LVEF). Secondary outcomes included diastolic function, strain imaging and circulating biomarkers. Results: Four RCTs were included, of those three were conducted during anthracycline and one during trastuzumab, involving 161 patients. All trials provided absolute change in LVEF (%) after a short to medium-term of treatment exposure (≤6 months). Pooled data revealed no differences in LVEF in the exercise group versus control [mean difference (MD): 2.07%; 95% CI: −0.17 to 4.34]. Similar results were observed by pooling data from the three RCTs conducted during anthracycline. Data from trials that implemented interventions with ≥36 exercise sessions (n = 3) showed a significant effect in preventing LVEF decline favoring the exercise (MD: 3.25%; 95% CI: 1.20 to 5.31). No significant changes were observed on secondary outcomes. Conclusions: exercise appears to have a beneficial effect in mitigating LVEF decline and this effect was significant for interventions with ≥36 exercise sessions.

scholarly journals Chinese Herbal Medicine (“3 Medicines and 3 Formulations”) for COVID-19: Rapid Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Xiao-Yang Hu ◽  
Yangzihan Wang ◽  
Junqiao Chen ◽  
Trisha Greenhalgh ◽  
Jon Wardle
Keyword(s):  
Systematic Review ◽  
Herbal Medicine ◽  
Disease Severity ◽  
Chinese Herbal Medicine ◽  
English Language ◽  
Meta Analysis ◽  
Chinese Herbal ◽  
Clinical Trial Registries ◽  
Inverse Variance ◽  
Secondary Outcomes

Abstract Background: To evaluate the evidence behind claims that Chinese Herbal Medicine, specifically “three medicines and three formulations” (3M3F, comprising Jinhua Qinggan, Lianhua Qingwen, Xuebijing, Qingfei Paidu, Huashi Baidu and Xuanfei Baidu), is an effective treatment for COVID-19. Methods: We searched PubMed, MEDLINE and CNKI databases, preprint servers, clinical trial registries and supplementary sources for Chinese- or English-language randomised trials or non-randomised studies with comparator groups, which tested the constituents of 3M3F in the treatment of COVID-19 up to September 2020. Primary outcome was change in disease severity. Secondary outcomes included various symptoms. Meta-analysis (using generic inverse variance random effects model) was performed when there were two or more studies reporting on the same symptom. Results: Of 607 articles identified, thirteen primary studies (six RCTs and seven retrospective non-randomised comparative studies) with 1467 participants met our final inclusion criteria. Studies were small and had significant methodological limitations, most notably potential bias in assessment of outcomes. No study convincingly demonstrated a statistically significant impact on change in disease severity. Eight studies reported sufficiently similar secondary outcomes to be included in a meta-analysis. Some statistically significant impacts on symptoms, chest CT manifestations, laboratory variables and length of stay were demonstrated, but such findings were sparse and many remain unreplicated.Conclusions: These findings neither support nor refute the claim that 3M3F alters the severity of COVID-19 or alleviates symptoms. More rigorous studies are required to properly ascertain the potential role of Chinese Herbal Medicine in COVID-19.Systematic review registration: This review was registered on PROSPERO (CRD42020187502) prior to data collection and analysis.

scholarly journals Analgesic medicines for adults with low back pain: protocol for a systematic review and network meta-analysis

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Michael A. Wewege ◽  
◽  
Matthew K. Bagg ◽  
Matthew D. Jones ◽  
James H. McAuley
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Analgesic Effect ◽  
Meta Analysis ◽  
Low Back ◽  
Randomised Trials ◽  
Limited Evidence ◽  
Pain Duration ◽  
Secondary Outcomes

Abstract Background There is limited evidence for the comparative effectiveness of analgesic medicines for adults with low back pain. This systematic review and network meta-analysis aims to determine the analgesic effect, safety, acceptability, effect on function, and relative rank according to analgesic effect, safety, acceptability, and effect on function of a single course of [an] analgesic medicine(s) or combination of these medicines for people with low back pain. Methods We will include published and unpublished randomised trials written in any language that compare an analgesic medicine to either another medicine, placebo/sham, or no intervention in adults with low back pain, grouped according to pain duration: acute (fewer than 6 weeks), sub-acute (6 to 12 weeks), and chronic (greater than 12 weeks). The co-primary outcomes are pain intensity following treatment and safety (adverse events). The secondary outcomes are function and acceptability (all-cause dropouts). We will perform a network meta-analysis to compare and rank analgesic medicines. We will form judgements of confidence in the results using the Confidence in Network Meta-Analysis (CINeMA) methodology. Discussion This network meta-analysis will establish which medicine, or combination of medicines, is most effective for reducing pain and safest for adults with low back pain. Systematic review registration PROSPERO CRD42019145257

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