scholarly journals Early vs. Late Tracheostomy in Patients with Traumatic Brain Injury: Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (15) ◽  
pp. 3319
Author(s):  
Annachiara Marra ◽  
Maria Vargas ◽  
Pasquale Buonanno ◽  
Carmine Iacovazzo ◽  
Antonio Coviello ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Mechanical Ventilation ◽  
Brain Injury ◽  
Length Of Stay ◽  
Meta Analysis ◽  
Unit Length ◽  
Hospital Length Of Stay ◽  
Early Tracheostomy ◽  
Icu Length Of Stay

Introduction. Tracheostomy can help weaning in long-term ventilated patients, reducing the duration of mechanical ventilation and intensive care unit length of stay, and decreasing complications from prolonged tracheal intubation. In traumatic brain injury (TBI), ideal timing for tracheostomy is still debated. We performed a systematic review and meta-analysis to evaluate the effects of timing (early vs. late) of tracheostomy on mortality and incidence of VAP in traumatic brain-injured patients. Methods. This study was conducted in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We performed a search in PubMed, using an association between heading terms: early, tracheostomy, TBI, prognosis, recovery, impact, mortality, morbidity, and brain trauma OR brain injury. Two reviewers independently assessed the methodological quality of eligible studies using the Newcastle–Ottawa Scale (NOS). Comparative analyses were made among Early Tracheostomy (ET) and late tracheostomy (LT) groups. Our primary outcome was the odds ratio of mortality and incidence of VAP between the ET and LT groups in acute brain injury patients. Secondary outcomes included the standardized mean difference (MD) of the duration of mechanical ventilation, ICU length of stay (LOS), and hospital LOS. Results. We included two randomized controlled trials, three observational trials, one cross-sectional study, and three retrospective cohort studies. The total number of participants in the ET group was 2509, while in the LT group it was 2597. Early tracheostomy reduced risk for incidence of pneumonia, ICU length of stay, hospital length of stay and duration of mechanical ventilation, but not mortality. Conclusions. In TBI patients, early tracheostomy compared with late tracheostomy might reduce risk for VAP, ICU and hospital LOS, and duration of mechanical ventilation, but increase the risk of mortality.

Abstract 9115: Determining Optimal Hemoglobin Transfusion Threshold for Patients With Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Nitish Sood ◽  
Arnav Goyal ◽  
Dayton Grogan ◽  
Vamsi Reddy
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Length Of Stay ◽  
Severe Traumatic Brain Injury ◽  
Meta Analysis ◽  
Cost Of Care ◽  
Current Evidence ◽  
Transfusion Threshold ◽  
Significant Difference

Introduction: Multiple randomized controlled trials have found that a conservative approach to transfusing critically ill patients reduces mortality, with current guidelines recommending a hemoglobin (HgB) transfusion threshold of 7 g/dL. However, little work has examined whether this transfusion threshold reduces mortality in patients with severe traumatic brain injury (TBI). Here, we present a systematic review and meta-analysis of the literature. Methods: A systematic search was conducted on PubMed, Ovid, and Web of Science. Full-text articles were eligible if patients with TBI, defined as Glasgow Coma Score <= 8, were divided into multiple groups with varying hemoglobin transfusion thresholds and reported any outcome of interest including mortality, number of packed red blood cell (PRBC) units transfused, length of stay in ICU, and length of stay in the hospital. Eight studies were eligible (n = 3663). We compared mortality rates at HgB transfusion thresholds of < 7 g/dL, < 8 g/dL, < 9 g/dL, and < 10 g/dL. Results: We found that traditionally ‘conservative’ approaches to anemia management (HgB < 7 g/dL, < 8 g/dL, and < 9 g/dL) were associated with decreased mortality when compared to traditionally ‘liberal’ approaches (HgB < 10 g/dL), with p < 0.05. Results were robust across both frequentist and Bayesian analysis. As a surrogate for cost of care and use of hospital resources, the total number of PRBC units transfused to patients, length of stay in ICU, and length of stay in hospital were analyzed. We found that using a transfusion threshold < 7 g/dL compared to < 10 g/dL substantially decreased the number of PRBC units transfused. In three of five cohorts, the cohort with the lower HgB transfusion threshold or no transfusion had a significantly shorter length of stay in the ICU and in the hospital. The remaining two cohorts found no significant difference in the length of stays in ICU or hospital. Conclusion: This study demonstrates that conservative approaches to transfusions ( < 7 g/dL, < 8 g/dL, or < 9 g/dL) significantly reduce mortality and the number of PRBC units transfused when compared to more liberal approaches ( < 10 g/dL). Current evidence is unclear on the benefits of conservative approaches in reduction of ICU or hospital length of stay.

Clinical and Economic Outcomes of Telemedicine Programs in the Intensive Care Unit: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 33 (7) ◽  
pp. 383-393 ◽  
Author(s):  
Jing Chen ◽  
Dalong Sun ◽  
Weiming Yang ◽  
Mingli Liu ◽  
Shufan Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
The Impact

Objective: To evaluate the impact of telemedicine programs in intensive care unit (Tele-ICU) on ICU or hospital mortality or ICU or hospital length of stay and to summarize available data on implementation cost of Tele-ICU. Methods: Controlled trails or observational studies assessing outcomes of interest were identified by searching 7 electronic databases from inception to July 2016 and related journals and conference literatures between 2000 and 2016. Two reviewers independently screened searched records, extracted data, and assessed the quality of included studies. Random-effect models were applied to meta-analyses and sensitivity analysis. Results: Nineteen of 1035 records fulfilled the inclusion criteria. The pooled effects demonstrated that Tele-ICU programs were associated with reductions in ICU mortality (15 studies; risk ratio [RR], 0.83; 95% confidence interval [CI], 0.72 to 0.96; P = .01), hospital mortality (13 studies; RR, 0.74; 95% CIs, 0.58 to 0.96; P = .02), and ICU length of stay (9 studies; mean difference [MD], −0.63; 95% CI, −0.28 to 0.17; P = .007). However, there is no significant association between the reduction in hospital length of stay and Tele-ICU programs. Summary data concerning costs suggested approximately US$50 000 to US$100 000 per Tele-ICU bed was required to implement Tele-ICU programs for the first year. Hospital costs of US$2600 reduction to US$5600 increase per patient were estimated using Tele-ICU programs. Conclusions: This systematic review and meta-analysis provided limited evidence that Tele-ICU approaches may reduce the ICU and hospital mortality, shorten the ICU length of stay, but have no significant effect in hospital length of stay. Implementation of Tele-ICU programs substantially costs and its long-term cost-effectiveness is still unclear.

scholarly journals Comparison of culture-negative and culture-positive sepsis or septic shock: a systematic review and meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Yuting Li ◽  
Jianxing Guo ◽  
Hongmei Yang ◽  
Hongxiang Li ◽  
Yangyang Shen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
Mechanical Ventilation Duration ◽  
Culture Positive ◽  
Culture Negative

Abstract Background Mortality and other clinical outcomes between culture-negative and culture-positive septic patients have been documented inconsistently and are very controversial. A systematic review and meta-analysis was performed to compare the clinical outcomes of culture-negative and culture-positive sepsis or septic shock. Methods We searched the PubMed, Cochrane and Embase databases for studies from inception to the 1st of January 2021. We included studies involving patients with sepsis or septic shock. All authors reported our primary outcome of all-cause mortality and clearly compared culture-negative versus culture-positive patients with clinically relevant secondary outcomes (ICU length of stay, hospital length of stay, mechanical ventilation requirements, mechanical ventilation duration and renal replacement requirements). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI). Results Seven studies including 22,655 patients were included. The primary outcome of this meta-analysis showed that there was no statistically significant difference in the all-cause mortality between two groups (OR = 0.95; 95% CI, 0.88 to 1.01; P = 0.12; Chi-2 = 30.71; I2 = 80%). Secondary outcomes demonstrated that there was no statistically significant difference in the ICU length of stay (MD = − 0.19;95% CI, − 0.42 to 0.04; P = 0.10;Chi-2 = 5.73; I2 = 48%), mechanical ventilation requirements (OR = 1.02; 95% CI, 0.94 to 1.11; P = 0.61; Chi2 = 6.32; I2 = 53%) and renal replacement requirements (OR = 0.82; 95% CI, 0.67 to 1.01; P = 0.06; Chi-2 = 1.21; I2 = 0%) between two groups. The hospital length of stay of culture-positive group was longer than that of the culture-negative group (MD = − 3.48;95% CI, − 4.34 to − 2.63; P < 0.00001;Chi-2 = 1.03; I2 = 0%). The mechanical ventilation duration of culture-positive group was longer than that of the culture-negative group (MD = − 0.64;95% CI, − 0.88 to − 0.4; P < 0.00001;Chi-2 = 4.86; I2 = 38%). Conclusions Culture positivity or negativity was not associated with mortality of sepsis or septic shock patients. Furthermore, culture-positive septic patients had similar ICU length of stay, mechanical ventilation requirements and renal replacement requirements as those culture-negative patients. The hospital length of stay and mechanical ventilation duration of culture-positive septic patients were both longer than that of the culture-negative patients. Further large-scale studies are still required to confirm these results.

scholarly journals Timing of tracheostomy in acute traumatic spinal cord injury: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Sarah Foran ◽  
Shaurya Taran ◽  
JM Singh ◽  
Demetrios James Kutsogiannis ◽  
Victoria McCredie
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Meta Analysis ◽  
Hospital Length Of Stay ◽  
Optimal Timing ◽  
Early Tracheostomy ◽  
Methodologic Quality ◽  
Cord Injury

Abstract Background Patients with acute traumatic cervical or high thoracic level spinal cord injury (SCI) typically require mechanical ventilation (MV) during their acute admission. Placement of a tracheostomy is preferred when prolonged weaning from MV is anticipated. However, the optimal timing of tracheostomy placement in patients with acute traumatic SCI remains uncertain. We systematically reviewed the literature to determine the effects of early versus late tracheostomy or prolonged intubation in patients with acute traumatic SCI on important clinical outcomes.Methods Six databases were searched from their inception to January 2020. Conference abstracts from relevant proceedings and the gray literature were searched to identify additional studies. Data was obtained by two independent reviewers to ensure accuracy and completeness. The quality of observational studies was evaluated using the Newcastle Ottawa Scale (NOS).Results Seventeen studies (2,804 patients) met selection criteria, 14 of which were published after 2009. Meta-analysis showed that early tracheostomy was not associated with decreased short-term mortality (risk ratio [RR] 0.84; 95% confidence interval [CI] 0.39 to 1.79; p = 0.65; n = 2,072), but was associated with a reduction in MV duration (mean difference [MD] 13.1 days; 95% CI -6.70 to -21.11; p = 0.0002; n = 855), intensive care unit (ICU) length of stay (MD -10.20 days; 95% CI -4.66 to -15.74; p = 0.0003; n = 855), and hospital length of stay (MD -7.39 days; 95% CI -3.74 to -11.03; p < 0.0001; n = 423). Early tracheostomy was also associated with a decreased incidence of ventilator-associated pneumonia (VAP) and tracheostomy-related complications (RR 0.86; 95% CI 0.75 to 0.98; p = 0.08; n = 2,043 and RR 0.08; 95% CI -0.01 to -0.15; p = 0.02; n = 812 respectively). The majority of studies ranked as good methodologic quality on the NOS. Conclusions Early tracheostomy in patients with acute traumatic SCI may reduce duration of mechanical ventilation, length of ICU stay, and length of hospital stay. Current studies highlight the lack of high-level evidence to guide the optimal timing of tracheostomy in acute traumatic SCI. Future research should seek to understand whether early tracheostomy improves patient comfort, decreases duration of sedation and improves long-term outcomes.PROSPERO registration number: CRD42020162488

scholarly journals Comparison of Culture-Negative and Culture-Positive Sepsis or Septic Shock: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Yuting Li ◽  
Jianxing Guo ◽  
Hongmei Yang ◽  
Hongxiang Li ◽  
Yangyang Shen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Meta Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
Mechanical Ventilation Duration ◽  
Culture Positive ◽  
Culture Negative

Abstract Background: Mortality and other clinical outcomes between culture-negative and culture-positive septic patients have been documented inconsistently and are very controversial. A systematic review and meta-analysis was performed to compare the clinical outcomes of culture-negative and culture-positive sepsis or septic shock.Methods: We searched the PubMed, Cochrane, and Embase databases for studies from inception to the 1st of January 2021. We included studies involving patients with sepsis or septic shock. All authors reported our primary outcome of all-cause mortality and clearly comparing culture-negative versus culture-positive patients with clinically relevant secondary outcomes (ICU length of stay, hospital length of stay, mechanical ventilation requirements, mechanical ventilation duration and renal replacement requirements). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI).Results: Seven studies including 22655 patients were included. The primary outcome of this meta-analysis showed that there was no statistically significant difference in the all-cause mortality between two groups (OR=0.95; 95% CI, 0.88 to 1.01; P=0.12; Chi2=30.71; I2=80%) . Secondary outcomes demonstrated that there was no statistically significant difference in the ICU length of stay(MD=-0.19;95% CI, -0.42 to 0.04; P=0.10;Chi2=5.73; I2=48%), mechanical ventilation requirements(OR=1.05; 95% CI, 0.93 to 1.18; P=0.41; Chi2=5.89; I2=66%) and renal replacement requirements(OR=0.82; 95% CI, 0.67 to 1.01; P=0.06; Chi2=1.21; I2=0%) between two groups. The hospital length of stay of culture-positive group was longer than that of the culture-negative group(MD=-3.48;95% CI, -4.34 to -2.63; P<0.00001;Chi2=1.03; I2=0%). The mechanical ventilation duration of culture-positive group was longer than that of the culture-negative group(MD=-0.64;95% CI, -0.88 to -0.4; P<0.00001;Chi2=4.86; I2=38%).Conclusions: Culture positivity or negativity was not associated with mortality of sepsis or septic shock patients. Furthermore, culture-positive septic patients had similar ICU length of stay, mechanical ventilation requirements and renal replacement requirements as those culture-negative patients. The hospital length of stay and mechanical ventilation duration of culture-positive septic patients were both longer than that of the culture-negative patients. Further large-scale studies are still required to confirm these results.

Dexmedetomidine for Facilitating Mechanical Ventilation Extubation in Difficult-to-Wean ICU Patients: Systematic Review and Meta-Analysis of Clinical Trials

2020 ◽  
pp. 088506662093767
Author(s):  
Mitchell S. Buckley ◽  
Pamela L. Smithburger ◽  
Adrian Wong ◽  
Gilles L. Fraser ◽  
Michael C. Reade ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Icu Patients ◽  
Icu Length Of Stay ◽  
Increased Risk

Background: Agitation and delirium are common in mechanically ventilated adult intensive care unit (ICU) patients and may contribute to delayed extubation times. Difficult-to-wean ICU patients have been associated with an increased risk of longer ICU length of stays and mortality. The purpose of this systematic review and meta-analysis is to evaluate the evidence of dexmedetomidine facilitating successful mechanical ventilation extubation in difficult-to-wean ICU patients and clinical outcomes. Methods: A literature search was conducted using MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Global Health, Cochrane Central Register of Controlled Trials, Clinical Trial Registries, and the Health Technology Assessment Database from inception to December 5, 2019. Randomized controlled trials evaluating dexmedetomidine with the intended purpose to facilitate mechanical ventilation liberation in adult ICU patients (≥18 years) experiencing extubation failure were included. The primary outcome of time to extubation was evaluated using the weighted mean difference (WMD), with a random effects model. Secondary analyses included hospital and ICU length of stay, in-hospital mortality, hypotension, and bradycardia. Results: A total of 6 trials (n = 306 patients) were included. Dexmedetomidine significantly reduced the time to extubation (WMD: −11.61 hours, 95% CI: −16.5 to −6.7, P = .005) and ICU length of stay (WMD: −3.04 days; 95% CI: −4.66 to −1.43). Hypotension risk was increased with dexmedetomidine (risk ratio [RR]: 1.62, 95% CI: 1.05-2.51), but there was no difference in bradycardia risk (RR: 3.98, 95% CI: 0.70-22.78). No differences were observed in mortality rates (RR: 1.30, 95% CI: 0.45-3.75) or hospital length of stay (WMD: −2.67 days; 95% CI: −7.73 to 2.39). Conclusions: Dexmedetomidine was associated with a significant reduction in the time to extubation and shorter ICU stay in difficult-to-wean ICU patients. Although hypotension risk was increased with dexmedetomidine, no differences in other clinical outcomes were observed.

scholarly journals A Systematic Review and Meta-Analysis on Effect of Beta-Blockers in Severe Traumatic Brain Injury

2021 ◽  
pp. 1-7
Author(s):  
William A. Florez-Perdomo ◽  
Edgar Felipe Laiseca Torres ◽  
Sergio a Serrato ◽  
Tariq Janjua ◽  
Andrei F. Joaquim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Beta Blockers ◽  
Meta Analysis
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