Current Issue : October - December Volume : 2019 Issue Number : 4 Articles : 5 Articles
Background: The effect of high-flow nasal cannula (HFNC) therapy in patients after planned extubation remains\ninconclusive. We aimed to perform a rigorous and comprehensive systematic meta-analysis to robustly quantify the\nbenefits of HFNC for patients after planned extubation by investigating postextubation respiratory failure and other\noutcomes.\nMethod: We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library from inception to August\n2018. Two researchers screened studies and collected the data independently. Randomized controlled trials (RCTs)\nand crossover studies were included. The main outcome was postextubation respiratory failure.\nResults: Ten studies (seven RCTs and three crossover studies; HFNC group: 856 patients; Conventional oxygen\ntherapy (COT) group: 852 patients) were included. Compared with COT, HFNC may significantly reduce\npostextubation respiratory failure (RR, 0.61; 95% CI, 0.41, 0.92; z = 2.38; P = 0.02) and respiratory rates (standardized\nmean differences (SMD), - 0.70; 95% CI, - 1.16, - 0.25; z = 3.03; P = 0.002) and increase PaO2 (SMD, 0.30; 95% CI, 0.04,\n0.56; z = 2.23; P = 0.03). There were no significant differences in reintubation rate, length of ICU and hospital stay,\ncomfort score, PaCO2, mortality in ICU and hospital, and severe adverse events between HFNC and COT group.\nConclusions: Our meta-analysis demonstrated that compared with COT, HFNC may significantly reduce\npostextubation respiratory failure and respiratory rates, increase PaO2, and be safely administered in patients after\nplanned extubation. Further large-scale, multicenter studies are needed to confirm our results....
Background: Multiple predictive scores using Electronic Patient Record data have been developed for hospitalised\npatients at risk of clinical deterioration. Methods used to select patient centred variables for inclusion in these\nscores varies. We performed a systematic review to describe univariate associations with unplanned Intensive Care\nUnit (ICU) admission with the aim of assisting model development for future scores that predict clinical\ndeterioration.\nMethods: Data sources were MEDLINE, EMBASE, CINAHL, CENTRAL and the Cochrane Database of Systematic Reviews.\nIncluded studies were published since 2000 describing an association between patient centred variables and unplanned\nICU admission determined using univariate analysis. Two authors independently screened titles, abstracts and full texts\nagainst inclusion and exclusion criteria. DistillerSR (Evidence Partners, Canada, Ottawa, Ontario) software was used to\nmanage the data and identify duplicate search results. All screening and data extraction forms were implemented within\nDistillerSR. Study quality was assessed using an adapted version of the Newcastle-Ottawa Scale. Variables were analysed\nfor strength of association with unplanned ICU admission.\nResults: The database search yielded 1520 unique studies; 1462 were removed after title and abstract review; 57\nunderwent full text screening; 16 studies were included. One hundred and eighty nine variables with an evaluated\nunivariate association with unplanned ICU admission were described.\nDiscussion: Being male, increasing age, a history of congestive cardiac failure or diabetes, a diagnosis of hepatic disease\nor having abnormal vital signs were all strongly associated with ICU admission.\nConclusion: These findings will assist variable selection during the development of future models predicting unplanned\nICU admission....
Background: Timely initiation of physical, occupational, and speech therapy in critically ill patients is crucial to\nreduce morbidity and improve outcomes. Over a 5-year time interval, we sought to determine the utilization of\nthese rehabilitation therapies in the USA.\nMethods: We performed a retrospective cohort study utilizing a large, national administrative database including\nICU patients from 591 hospitals. Patients over 18 years of age with acute respiratory failure requiring invasive\nmechanical ventilation within the first 2 days of hospitalization and for a duration of at least 48 h were included.\nResults: A total of 264,137 patients received invasive mechanical ventilation for a median of 4.0 [2.0-8.0] days.\nOverall, patients spent a median of 5.0 [3.0-10.0] days in the ICU and 10.0 [7.0-16.0] days in the hospital. During\ntheir hospitalization, 66.5%, 41.0%, and 33.2% (95% CI = 66.3-66.7%, 40.8-41.2%, 33.0-33.4%, respectively) received\nphysical, occupational, and speech therapy. While on mechanical ventilation, 36.2%, 29.7%, and 29.9% (95% CI = 36.\n0-36.4%, 29.5-29.9%, 29.7-30.1%) received physical, occupational, and speech therapy. In patients receiving therapy,\ntheir first physical therapy session occurred on hospital day 5 [3.0-8.0] and hospital day 6 [4.0-10.0] for occupational\nand speech therapy. Of all patients, 28.6% (95% CI = 28.4-28.8%) did not receive physical, occupational, or speech\ntherapy during their hospitalization. In a multivariate analysis, patients cared for in the Midwest and at teaching hospitals\nwere more likely to receive physical, occupational, and speech therapy (all P < 0.05). Of patients with identical covariates\nreceiving therapy, there was a median of 61%, 187%, and 70% greater odds of receiving physical, occupational, and\nspeech therapy, respectively, at one randomly selected hospital compared with another (median odds ratio 1.61, 2.87, 1.\n70, respectively)....
Background: We aimed to examine recent trends in patient characteristics and mortality in patients with acute\nkidney injury (AKI) receiving renal replacement therapy (RRT), including continuous RRT (CRRT) and intermittent RRT\n(IRRT), in intensive care units (ICUs).\nMethods: From the Diagnosis Procedure Combination database in Japan during 6 months (July-December) from\n2007 to 2016, we identified patients with AKI who received RRT in ICUs. We restricted the study participants to\nthose admitted to hospitals (in which both CRRT and IRRT were available) that participated in the Diagnosis\nProcedure Combination database for all 10 years. We examined the trends in patient characteristics and mortality\noverall, by RRT modality, and by main diagnosis category subgroup. Logistic regression was used to adjust for\npatient characteristics.\nResults: We identified 51,758 patients starting RRT in 287 hospitals, including 39,471 (76.3%) and 12,287 (23.7%)\npatients starting CRRT and IRRT. The crude in-hospital mortality declined from 44.9 to 36.1% (P for trend < 0.001).\nCompared with 2007, the adjusted odds ratio (aOR) for in-hospital mortality was 0.66 (95% confidence interval (CI)\n0.60-0.72) in 2016, and the decreasing trend was observed in both patients starting CRRT (aOR 0.67, 95% CI\n0.61-0.75) and IRRT (0.58, 0.45-0.74), and in all subgroups except for coronary artery disease: sepsis aOR 0.68\n(95% CI 0.57-0.81); cardiovascular surgery 0.58 (0.45-0.76); coronary artery disease 0.84 (0.60-1.19); non-coronary heart\ndisease 0.78 (0.64-0.94); central nervous system disorders 0.42 (0.28-0.62); trauma 0.39 (0.21-0.72); and other\n0.64 (0.50-0.82).\nConclusions: This nationwide study confirmed a consistent decline in mortality among patients with AKI on\nRRT in ICUs. The adjusted mortality also declined during the study period; however, physiological variables\nwere not measured in this study and it is possible that RRT may have been indicated for patients with less\nsevere AKI in more recent years....
Background and Objectives: Views on living arrangement from elderly and\ninformal caregivers are crucial to â??ageing in placeâ?. They might be related to\nthe experience in the use of elderly care services, which remains inconclusive\nin previous literature. This study aimed to explore the association of previous\nexperience in formal and informal long-term care services with views of both\nelderly and their informal caregivers on living arrangement. Research Design\nand Methods: This study adopted a cross-sectional design. Assessment\nrecords of Minimum Data Set-Home Care for community-dwelling elderly\nwho were eligible for subsidized long-term care services in Hong Kong from\n2004 to 2014 were made available. Multivariate logistic regression was applied\nto examine associations between both views on elderâ??s living arrangement\nfrom the elderly, caregivers and their previous informal caregiver support,\nand experience in formal care services. Results: 82,306 dyads of elderly and\ninformal caregivers were included in the analysis. The elderly with previous\nuse of home and community-based services (OR = 0.84, 95% CI 0.80 - 0.88)\nand informal caregivers (OR = 0.78, 95% CI 0.76 - 0.81) believed that the elderly\nshould live away from home. Temporal trends of fewer elderly and caregivers\nsupporting the idea of living away from home were also observed.\nDiscussion and Implications: The results highlighted the importance of informal\ncaregiverâ??s support and previous utilization of formal home and\ncommunity-based services. It was concluded that resources and information\nof community-based care have a significant association with views on living\nat home also proper support services and training of care for the elderly\nshould be made available to informal caregivers to reduce their burden....
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