scholarly journals Diagnosis Accuracy of Lung Ultrasound for ARF in Critically Ill Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Xueyan Yuan ◽  
Ling Liu ◽  
Wei Chang ◽  
Zongsheng Wu ◽  
Lili Huang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Sensitivity And Specificity ◽  
Critically Ill Patients ◽  
Lung Ultrasound ◽  
Early Recognition ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Cochrane Library ◽  
Bivariate Model

Background: Acute respiratory failure (ARF) is a commonly distressing condition in critically ill patients. Its early recognition and treatment may improve clinical outcomes. Mounting evidence suggests that lung ultrasound (LUS) could be an alternative to chest X-ray (CXR) or computed tomography (CT) for the diagnosis of ARF in critically ill patients. This meta-analysis aimed to determine whether LUS can be an alternative tool used to investigate the cause of ARF or thoracic pathologies associated with the diagnosis of ARF in critically ill patients.Method: A systematic literature search of the PubMed, Web of Science, Embase, and Cochrane Library databases was conducted from inception to March 2020. Two researchers independently screened studies investigating the accuracy of LUS with CXR or CT for adult critically ill patients with ARF. Data with baseline, true positives, false positives, false negatives, and true negatives were extracted. The study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The pooled sensitivity and specificity were obtained using a bivariate model.Results: Eleven studies, including 1,232 patients, were included in the meta-analysis. Most studies were of low quality. LUS had a pooled sensitivity of 92% (95% confidence interval [CI]: 85–96) and a pooled specificity of 98% (95% CI: 94–99). The area under the summary receiver operating characteristic curve was 98% (95% CI: 97–99). The sensitivity and specificity of LUS to identify different pathological types of ARF were investigated. For consolidation (1,040 patients), LUS had a sensitivity of 89% and a specificity of 97%. For pleural effusion (279 patients), LUS had a pooled sensitivity of 95% and a specificity of 99%. For acute interstitial syndrome (174 patients), LUS had a pooled sensitivity of 95% and a specificity of 91%.Conclusions: LUS is an adjuvant tool that has a moderate sensitivity and high specificity for the diagnosis of ARF in critically ill patients.Systematic Review Registration: The study protocol was registered with PROSPERO (CRD42020211493).

scholarly journals Diagnostic performance of lung ultrasound for transient tachypnea of the newborn: A meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248827
Author(s):  
Lili He ◽  
Yinghua Sun ◽  
Wei Sheng ◽  
Qiong Yao
Keyword(s):  
Sensitivity And Specificity ◽  
Diagnostic Performance ◽  
Large Scale ◽  
Lung Ultrasound ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Relevant Literature ◽  
Cochrane Library ◽  
Lower Sensitivity ◽  
Summary Receiver Operating Characteristic

Several recent studies demonstrated that lung ultrasound could achieve desired diagnostic accuracy for transient tachypnea of the neonate (TTN). However, the diagnostic performance of lung ultrasound for TTN has not been systematically studied to date. This meta-analysis aimed to investigate the performance of lung ultrasound in diagnosing TTN. The relevant literature was searched in PubMed, Medline, the Cochrane Library, and Embase databases without any restriction in terms of language and time until January 31, 2021. Studies that assessed the diagnostic performance of lung ultrasound for TTN were included. Seven studies with 1514 participants were summarized. The lung ultrasound provided more accurate performance for diagnosing TTN with pooled sensitivity and specificity of 0.67 [95% confidence interval (CI) = 0.63–0.71] and 0.97 (95% CI = 0.95–0.98), respectively. A higher summarized area under the summary receiver operating characteristic curve was observed as 0.9906. Lower sensitivity and area under the curve (AUC) of B-lines for TTN were observed as 0.330 (95% CI = 0.27–0.38) and 0.5000, respectively. Lung ultrasound provided highly accurate AUC, sensitivity, and specificity in detecting TTN. Large-scale studies are warranted in the future to confirm these results.

scholarly journals Diagnosis of elevated intracranial pressure in critically ill adults: systematic review and meta-analysis

BMJ ◽  
2019 ◽  
pp. l4225 ◽  
Author(s):  
Shannon M Fernando ◽  
Alexandre Tran ◽  
Wei Cheng ◽  
Bram Rochwerg ◽  
Monica Taljaard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intracranial Pressure ◽  
Physical Examination ◽  
Critically Ill ◽  
Sensitivity And Specificity ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Elevated Intracranial Pressure ◽  
Midline Shift ◽  
Non Invasive

Abstract Objectives To summarise and compare the accuracy of physical examination, computed tomography (CT), sonography of the optic nerve sheath diameter (ONSD), and transcranial Doppler pulsatility index (TCD-PI) for the diagnosis of elevated intracranial pressure (ICP) in critically ill patients. Design Systematic review and meta-analysis. Data sources Six databases, including Medline, EMBASE, and PubMed, from inception to 1 September 2018. Study selection criteria English language studies investigating accuracy of physical examination, imaging, or non-invasive tests among critically ill patients. The reference standard was ICP of 20 mm Hg or more using invasive ICP monitoring, or intraoperative diagnosis of raised ICP. Data extraction Two reviewers independently extracted data and assessed study quality using the quality assessment of diagnostic accuracy studies tool. Summary estimates were generated using a hierarchical summary receiver operating characteristic (ROC) model. Results 40 studies (n=5123) were included. Of physical examination signs, pooled sensitivity and specificity for increased ICP were 28.2% (95% confidence interval 16.0% to 44.8%) and 85.9% (74.9% to 92.5%) for pupillary dilation, respectively; 54.3% (36.6% to 71.0%) and 63.6% (46.5% to 77.8%) for posturing; and 75.8% (62.4% to 85.5%) and 39.9% (26.9% to 54.5%) for Glasgow coma scale of 8 or less. Among CT findings, sensitivity and specificity were 85.9% (58.0% to 96.4%) and 61.0% (29.1% to 85.6%) for compression of basal cisterns, respectively; 80.9% (64.3% to 90.9%) and 42.7% (24.0% to 63.7%) for any midline shift; and 20.7% (13.0% to 31.3%) and 89.2% (77.5% to 95.2%) for midline shift of at least 10 mm. The pooled area under the ROC (AUROC) curve for ONSD sonography was 0.94 (0.91 to 0.96). Patient level data from studies using TCD-PI showed poor performance for detecting raised ICP (AUROC for individual studies ranging from 0.55 to 0.72). Conclusions Absence of any one physical examination feature is not sufficient to rule out elevated ICP. Substantial midline shift could suggest elevated ICP, but the absence of shift cannot rule it out. ONSD sonography might have use, but further studies are needed. Suspicion of elevated ICP could necessitate treatment and transfer, regardless of individual non-invasive tests. Registration PROSPERO CRD42018105642.

P0625CONTINUOUS RENAL REPLACEMENT THERAPY WITHOUT ANTICOAGULATION IN CRITICALLY ILL PATIENTS AT HIGH RISK OF BLEEDING-A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Shiren Sun ◽  
Wei Zhang ◽  
Ming Bai ◽  
Lijuan Zhao ◽  
Xiaolan Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Replacement Therapy ◽  
High Risk ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Cochrane Library ◽  
Risk Of Bleeding

Abstract Background and Aims Continuous renal replacement therapy (CRRT) has been widely used in the critical care setting and anticoagulation is usually necessitated. However, critically ill patients are commonly at incremental risk of bleeding, which contributed to the hesitation of anticoagulant use for CRRT in clinical practice. The current guideline recommended CRRT proceed without anticoagulation in patients with contraindication to citrate and increased bleeding risk. Nevertheless, the efficacy of anticoagulation-free CRRT remains inconsistent. Therefore, the purpose of our present systematic review is to evaluate the efficacy and safety of anticoagulant-free CRRT based on the current literatures. Method We conducted a comprehensive search of PubMed (US National Library of Medicine, Bethesda, MD, USA), Cochrane Library databases and EMBASE from database inception to January 12, 2019 for potential candidate studies. Studies included adult critically ill (age > 18 years) patients with increased bleeding risk, and underwent CRRT without anticoagulation were considered for the inclusion. Results Finally, 17 observational studies and 3 randomized controlled trials with 1615 patients were included in our present meta-analysis. There was no significant difference in filter lifespan between the anticoagulation-free and systemic heparin group. The filter lifespan was significantly prolonged in the citrate (WMD -23.01, 95%CI [-28.62, -17.39], P < 0.001; I2 = 0%, P = 0.53) and nafamostat (WMD -8.4, 95%CI [-9.9, -6.9], P < 0.001; I2 = 33.7%, P = 0.21) groups, compared with anticoagulation-free group. The averaged filter lifespan of the anticoagulation-free CRRT ranged from 10.2 to 52.5 hours. Conclusion The filter lifespan in anticoagulation-free patients with increased bleeding risk was comparable to that in patients without increased bleeding risk underwent systemic heparin anticoagulation CRRT. Nafamostat was not recommended for CRRT anticoagulation due to its drawbacks. Currently, the optimal choice of anticoagulation strategy for critically ill patients without citrate contraindications at high risk of bleeding should be regional citrate anticoagulation. Further studies should focus on the special cut-off value of activated partial thromboplastin time (APTT), international normalized ratio (INR) and platelet (PLT) count, at which the anticoagulation-free CRRT would be beneficial.

scholarly journals Epidemiology, clinical characteristics and treatment of critically ill patients with COVID-19): a protocol for a living systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e042008
Author(s):  
Lazar Milovanovic ◽  
Erin Hessey ◽  
Meghan Sebastianski ◽  
Diana Keto-Lambert ◽  
Ben Vandermeer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Search Strategy ◽  
Meta Analysis ◽  
Case Series ◽  
Case Fatality ◽  
Cochrane Library ◽  
Icu Admission ◽  
Epidemiological Characteristics

IntroductionIn December 2019, the first cases of COVID-19 associated with SARS-CoV-2 viral infection were described in Wuhan, Hubei Province, China. Since then, it has spread rapidly affecting 188 countries and was declared a pandemic by the WHO on 11 March 2020. Preliminary reports suggest up to 30% of patients require intensive care unit (ICU) admission and case fatality rate estimate is 2.3%–7.2%. The primary reason for ICU admission is hypoxaemic respiratory failure, while factors associated with ICU admission include increased age, presence of comorbidities and cytokine storm. Case series and retrospective trials initially assessed proposed treatments with randomised controlled trials now reporting early outcomes. We conduct a systematic review and meta-analysis to identify epidemiological factors, treatments and complications that predict mortality among critically ill patients with COVID-19.Methods and analysisOur comprehensive search strategy was developed in consultation with a research librarian. We will search electronic databases: Ovid Medline, Ovid Embase, Ovid Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Wiley Cochrane Library. The search strategy combines concepts from COVID-19, validated COVID-19 search filters and geographical locations of large outbreaks. Citation screening, selection, quality assessment and data abstraction will be performed in duplicate. Clinically homogenous epidemiological characteristics, interventions and complications will be pooled in statistical meta-analysis. Within the framework of a living systematic review, the search and data analysis will be updated every 6 months.Ethics and disseminationOur systematic review will synthesise literature on risk factors and interventions associated with mortality in critically ill patients with COVID-19. Results will be presented at national and international conferences and submitted for peer-reviewed publication. The pooled analysis can provide guidance to inform clinical guidelines for care of critically ill patients with COVID-19. Iterative updates will be made public through open access. Research ethics approval is not required.PROSPERO registration numberCRD42020176672.

Accuracy and Reliability of Lung Ultrasound to Diagnose Transient Tachypnoea of the Newborn: Evidence from a Meta-analysis and Systematic Review

2020 ◽  
Author(s):  
Hai-Ran Ma ◽  
Jing Liu ◽  
Wen-Kang Yan
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Respiratory Distress ◽  
Lung Ultrasound ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Cochrane Library ◽  
Diagnostic Efficiency ◽  
Bivariate Model ◽  
Neonatal Respiratory Distress

Objective Transient tachypnoea of the newborn (TTN) is one of the most common causes of neonatal respiratory distress (RD) during the newborn period. Chest radiography (CXR) is commonly used to rule out the diagnosis, but TTN is often misdiagnosed as neonatal respiratory distress syndrome (NRDS) on the basis of CXR alone. Increasing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic tool for transient tachypnoea of the newborn. However, studies of the diagnostic efficiency of LUS are still lacking. This study was aimed to evaluate the accuracy and reliability of LUS for diagnosing TTN by conducting a systematic review and meta-analysis. Study Design We searched for articles in the Embase, PubMed, and Cochrane Library databases from inception until May 31, 2020. The selected studies were diagnostic accuracy studies that reported the utility of LUS in the diagnosis of TTN. Two researchers independently extracted data and assessed quality using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Then, we created a bivariate model of mixed effects to calculate the sensitivity and specificity of LUS in diagnosing TTN. A summary receiver operator characteristic (SROC) curve was constructed to summarize the performance characteristics of LUS. Results Six studies involving 617 newborns were included in the review. LUS had a pooled sensitivity of 0.98 (confidence interval [CI]: 0.92–1.00) and a specificity of 0.99 (CI: 0.91–1.00). The area under the curve for LUS was 1.00 (0.98–1.0). Meta-regression revealed that LUS had a significant diagnostic accuracy for TTN. Conclusion The performance of ultrasound for the detection of TTN was excellent. Considering the various advantages of LUS compared with chest radiographs in diagnosing TTN, this study supports the routine use of LUS for the detection of TTN. Key Points

scholarly journals MicroRNA-21 as a diagnostic marker for hepatocellular carcinoma: A systematic review and meta-analysis

2019 ◽  
Vol 35 (5) ◽  
Author(s):  
Juan Qu ◽  
Jizhi Yang ◽  
Ming Chen ◽  
Lihong Cui ◽  
Tianxi Wang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Sensitivity And Specificity ◽  
Diagnostic Marker ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Summary Receiver Operating Characteristic

Background: MicroRNA-21 (miR-21) is one of the oncogenic miRNAs which may be a potential diagnostic biomarker for hepatocellular carcinoma (HCC). Methods: We systematically searched Medline, Embase, the Cochrane Library, ISI Web of Knowledge, Scopus from inception to August 15, 2018, and reference lists of identified primary studies. Two independent investigators extracted patient and study characteristics. The sensitivity and specificity of microRNA-21 for HCC detection and were analyzed with a random effect model. The area under summary receiver operating characteristic curve (AUC) was used to estimate overall test performance. Results: A total of 515 HCC patients, and 338 healthy or chronic hepatitis controls from six published studies were enrolled in this meta-analysis. All articles were published in English with moderate-to-high quality. The overall pooled sensitivity and specificity were 85.2% (73.3% to 88.4%) and 79.2% (68.4% to 87.0%), respectively. The AUC area was 0.89 (95% CI: 0.85-0.91). The studies had moderate heterogeneity (I2=70.11%). None of the subgroups investigated-ethnicity, controls, sample source-could account for the heterogeneity. Conclusion: MiR-21 is a helpful biomarker for early diagnosis of HCC. Nevertheless, the results of the test must be interpreted carefully in the context of medical history, erological tests and imaging examinations for HCC surveillance. doi: https://doi.org/10.12669/pjms.35.5.685 How to cite this:Qu J, Yang J, Chen M, Cui L, Wang T, Gao W, et al. MicroRNA-21 as a diagnostic marker for hepatocellular carcinoma: A systematic review and meta-analysis. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.685 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Determining the optimal time for liberation from renal replacement therapy in critically ill patients: protocol for a systematic review and meta-analysis (DOnE RRT)

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023306 ◽  
Author(s):  
Abdalrhman Al Saadon ◽  
Riley Katulka ◽  
Meghan Sebastianski ◽  
Robin Featherstone ◽  
Ben Vandermeer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Biochemical Markers ◽  
Meta Analysis ◽  
Grey Literature ◽  
Cochrane Library

IntroductionRenal replacement therapy (RRT) is a complex and expensive form of life-sustaining therapy, reserved for our most acutely ill patients. While a number of randomised trials have evaluated the optimal timing to start RRT among critically ill patients in the intensive care unit (ICU), there has been a paucity of trials providing guidance on when and under what circumstances to ideally liberate a patient from RRT. We are conducting a systematic review and meta-analysis to identify clinical and biochemical markers that predict kidney recovery and successful liberation from acute RRT among critically ill patients with acute kidney injury.Methods and analysisOur comprehensive search strategy was developed in consultation with a research librarian and independently peer-reviewed by a second librarian. We will search electronic databases: Ovid Medline, Ovid Embase and Wiley Cochrane Library. Selected grey literature sources will also be searched. Our search strategies will focus on concepts related to RRT (ie, intermittent haemodialysis, slow low-efficiency dialysis, continuous renal replacement therapy), intensive care (ie, involving any ICU setting) and discontinuation of therapy (ie, either clinical, physiological and biochemical parameters of weaning acute RRT) from 1990 to October 10, 2017. Citation screening, selection, quality assessment and data abstraction will be performed in duplicate. Studies will, where possible, be pooled in statistical meta-analysis. When deemed sufficiently clinically homogenous, and we have four or more studies reporting, sensitivities and specificities will be pooled simultaneously using a hierarchical summary receiver operator characteristic curve and bivariate analysis.Ethics and disseminationOur systematic review will synthesise the literature on clinical and biochemical markers that predict liberation from RRT. Research ethics approval is not required.Trial registration numberCRD42018074615.

scholarly journals Mortality and Clinical Interventions in Critically ill Patient With Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhicheng Qian ◽  
Shuya Lu ◽  
Xufei Luo ◽  
Yaolong Chen ◽  
Ling Liu
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Case Series ◽  
Cochrane Library ◽  
Apache Ii Score ◽  
Clinical Interventions

Objective: The aims of this systematic review and meta-analysis were to summarize the current existing evidence on the outcome of critically ill patients with COVID-19 as well as to evaluate the effectiveness of clinical interventions.Data Sources: We searched MEDLINE, the Cochrane library, Web of Science, the China Biology Medicine disc, China National Knowledge Infrastructure, and Wanfang Data from their inception to May 15, 2021. The search strings consisted of various search terms related to the concepts of mortality of critically ill patients and clinical interventions.Study Selection: After eliminating duplicates, two reviewers independently screened all titles and abstracts first, and then the full texts of potentially relevant articles were reviewed to identify cohort studies and case series that focus on the mortality of critically ill patients and clinical interventions.Main Outcomes and Measures: The primary outcome was the mortality of critically ill patients with COVID-19. The secondary outcomes included all sorts of supportive care.Results: There were 27 cohort studies and six case series involving 42,219 participants that met our inclusion criteria. All-cause mortality in the intensive care unit (ICU) was 35% and mortality in hospital was 32% in critically ill patients with COVID-19 for the year 2020, with very high between-study heterogeneity (I2 = 97%; p < 0.01). In a subgroup analysis, the mortality during ICU hospitalization in China was 39%, in Asia—except for China—it was 48%, in Europe it was 34%, in America it was 15%, and in the Middle East it was 39%. Non-surviving patients who had an older age [−8.10, 95% CI (−9.31 to −6.90)], a higher APACHE II score [−4.90, 95% CI (−6.54 to −3.27)], a higher SOFA score [−2.27, 95% CI (−2.95 to −1.59)], and a lower PaO2/FiO2 ratio [34.77, 95% CI (14.68 to 54.85)] than those who survived. Among clinical interventions, invasive mechanical ventilation [risk ratio (RR) 0.49, 95% CI (0.39–0.61)], kidney replacement therapy [RR 0.34, 95% CI (0.26–0.43)], and vasopressor [RR 0.54, 95% CI (0.34–0.88)] were used more in surviving patients.Conclusions: Mortality was high in critically ill patients with COVID-19 based on low-quality evidence and regional difference that existed. The early identification of critical characteristics and the use of support care help to indicate the outcome of critically ill patients.

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