Intubation Rate Research Articles

The Effect of Vitamin D Supplementation Post COVID-19 Infection and Related Outcomes: A Systematic Review and Meta-Analysis

Background: Vitamin D’s role in COVID-19 management remains controversial. This meta-analysis aimed to evaluate the efficacy of vitamin D supplementation in patients with SARS-CoV-2 infection, focusing on mortality, intensive care unit (ICU) admissions, intubation rates, and hospital length of stay (LOS). Methods: A systematic review of PubMed/MEDLINE, Scopus, Cochrane, and Google Scholar databases was conducted. Randomized controlled trials (RCTs) and analytical studies investigating vitamin D supplementation in COVID-19 patients were included. The meta-analysis was performed using STATA MP 18.5, employing random-effect or fixed-effect models based on heterogeneity. Results: Twenty-nine studies (twenty-one RCTs, eight analytical) were analyzed. Vitamin D supplementation significantly reduced ICU admissions (OR = 0.55, 95% CI: 0.37 to 0.79) in RCTs and analytical studies (OR = 0.35, 95% CI: 0.18 to 0.66). Intubation rates were significantly reduced in RCTs (OR = 0.50, 95% CI: 0.27 to 0.92). Mortality reduction was significant in analytical studies (OR = 0.45, 95% CI: 0.24 to 0.86) but not in RCTs (OR = 0.80, 95% CI: 0.61 to 1.04). Subgroup analyses revealed more pronounced effects in older patients and severe COVID-19 cases. LOS showed a non-significant reduction (mean difference = −0.62 days, 95% CI: −1.41 to 0.18). Conclusions: This meta-analysis suggests potential benefits of vitamin D supplementation in COVID-19 patients, particularly in reducing ICU admissions. However, the evidence varies across outcomes and patient subgroups. Discrepancies between RCTs and analytical studies highlight the need for further large-scale, well-designed trials accounting for baseline vitamin D status, standardized supplementation protocols, and patient characteristics to inform clinical guidelines for vitamin D use in COVID-19 management.

Effect of an artificial intelligence-assisted recognition system on colonoscopy quality

Objective: To explore the value of the artificial intelligence (AI)-assisted recognition system in the detection quality of colonoscopy. Methods: From January 2023, the data on 700 patients who underwent colonoscopy in the Digestive Endoscopy Center of the First Affiliated Hospital of Zhejiang Chinese Medical University were collected prospectively. Based on a computerized number method, patients were divided into the AI assistance group and control group. The detection rate of adenomas (ADR) and polyps, number and size of adenomas, Boston bowel preparation scale (BBPS), intubation time, withdrawal time, and cecal intubation rate were compared between groups. Normally distributed data were analyzed with the t-test for independent samples. Non-normally distributed data were analyzed with the Rank sum test. Categorical data were analyzed with the Chi-square test. Results: In total, 691 patients were included in the analysis. According to the intention to treat (ITT) analysis and per-protocol (PP) analysis, the withdrawal time of the AI group was higher than that of the control group (ITT:436 (305, 620) vs 368 (265, 510) s, Z=-4.24, P<0.001;PP:439 (306, 618) vs 364 (262, 500) s,t=-4.50, P<0.001); however, there were no significant differences in the ADR (ITT:123(35.5%) vs 111(32.2%), χ2=0.88, P=0.349;PP:108(34.2%) vs 99(31.1%), χ2=0.67, P=0.414), the number of adenomas (ITT:0(0, 1) vs 0(0, 1),Z=-1.08, P=0.282;PP:0(0, 1) vs 0(0, 1),Z=-0.87, P=0.387), the polyp detection rate (ITT:85(24.6%) vs 85(24.6%),χ2=0.001, P=0.983;PP:79(25.0%) vs 77(24.2%),χ2=0.05, P=0.818), BBPS (ITT:6.5±0.9 vs 6.5±0.7,t=-0.59, P=0.555;PP:6.7±0.6 vs 6.6±0.6,t=-1.83, P=0.068), and cecal intubation rate (ITT:346(100.0%) vs 343(99.4%), χ2=0.50, P=0.478) between these two groups. After excluding inadequate bowel preparation and failed cecal intubation cases, the AI-assisted system was found to significantly improve the detection rate of small adenomas (≤5 mm) (PP:27.8%(88/316)vs 21.1%(67/318), χ2=3.94, P=0.047). Conclusions: The application of an AI-assisted system in colonoscopy can increase the withdrawal time and improve the detection rate of small adenomas.

Endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a McGrathTM video laryngoscope: a prospective randomized trial

Background: Airway management in the pediatric population is challenging because of the smaller size, different proportions of anatomical structures compared to adults, and a higher risk of hypoxemia. Efforts to improve the efficiency of pediatric intubation can be made by manually twisting a spiral endotracheal tube (ETT) using a flexible stylet to manipulate its shape and angle. Methods: This controlled trial randomized and assigned fifty children aged one month to six years who underwent elective surgery under general anesthesia into two groups (spiral ETT [sETT] and no-stylet ETT/standard ETT). The sETT was formed by twisting the ETT using a handmade tool. The primary objective of this study was to determine the effectiveness of the sETT compared to the standard ETT in reducing intubation time. Secondary objectives were ETT placement accuracy, first-attempt intubation success rate, and adverse effects.Results: The mean total tube handling time in the sETT group was significantly shorter compared to the no stylet ETT group (sETT 16.8 ± 3.6 vs. standard ETT 18.8 ± 3.7 seconds; t = 2.0; P = 0.049). sETT placement had a significantly greater central placement accuracy (odds ratio, 4.846; 95% confidence interval, 1.287-18.255; P = 0.015). However, first-attempt successful intubation rate (sETT 80% vs. standard ETT 64%, P = 0.208) and total intubation time (sETT: 46.5±5.2 vs. standard ETT 48.4±4.9 seconds; t = 1.3; P = 0.205) were not significantly different. No adverse effects were observed for either ETT type.Conclusions: This study demonstrated the effectiveness of the spiral ETT in reducing total tube handling time and improving ETT placement accuracy in children using video laryngoscopy.

The Effect of Different Antenatal Betamethasone Regimens on Neonatal Outcomes

Objective: Preterm births sometimes occur before the completion of antenatal steroid therapy. Some specialists recommend administering betamethasone at 12-h intervals when birth is expected to occur quickly. The purpose of this study was to compare neonatal outcomes in pregnancies in which betamethasone was administered at 12-or 24-h intervals. Material and Methods: Neonates born at &lt;34 gestational weeks were included in this retrospective study. They were assigned to groups based on antenatal betamethasone therapy: those receiving no steroid, a single dose, and two doses at 12 or 24-h intervals. Results: Six hundred forty-four babies were enrolled including 536 Turkish and 108 refugee pregnant women. The antenatal steroid treatment rate was lower in the refugee group (p&lt;0.05), while 12-h interval treatment was similar between Turkish and refugee groups. Intubation at birth among no steroid, a single dose and two-dose treatment groups (12- or 24-h) were 53/136 (38.9%), 62/222 (28%), and 65/286 (22.7%), and mortality rates were 34/136 (27.9%), 48/222 (21.6%), and 50/286 (17.5%), respectively (p&lt;0.05). Thirty-six (n: 286) of the patients received two doses of betamethasone as 12-h intervals (n:36) and 24-h intervals (n:250). Times elapsing from first betamethasone administration to birth in the 12 and 24-h groups were 22 h and 92 h, respectively (p&lt;0,001). Median gestational week and birth weight were lower in the 24-h interval group than 12-h interval group (29 and 30 weeks, p=0.007; 1190 and 1362 g, p=0.015, respectively). Conclusion: Antenatal betamethasone administered at 12-h intervals may be a suitable option when preterm birth is expected within 24 hours. This regimen is associated with better neonatal outcomes, including lower intubation and mortality rates, as well as higher gestational age and birth weight, compared to the 24-h interval group.

Patient characteristics and clinical outcome in acute myocardial infarction related cardiogenic shock according to vascular access site for PCI

Abstract Background / Introduction The optimal vascular access site for percutaneous coronary interventions (PCI) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains uncertain. While observational data favor trans-radial access (TRA) due to lower complication rates and mortality, trans-femoral (TFA) PCI offers advantages such as shorter access and procedure times, along with quicker escalation to mechanical circulatory support (MCS). Purpose In this study, we aimed to investigate factors associated with a transfemoral approach and compare mortality rates between TRA and TFA in AMI-CS patients undergoing PCI. Methods Data from a nationwide registry of AMI-CS patients undergoing PCI (2017-2021) were analyzed. We compared patient demographics, procedural details, and outcomes between TRA and TFA groups. Logistic regression identified access site factors and radial-to-femoral cross-over predictors. Propensity score matched (PSM) analysis examined the impact of access site on mortality. Results Of 1562 patients, 45% underwent TRA PCI, with an increasing trend over time. TFA patients were more often female, had a history of coronary artery bypass grafting (CABG), lower blood pressure, higher resuscitation and intubation rates, and elevated lactate levels. After PSM, 30-day mortality was lower in TRA (33% vs. 46%, p &amp;lt;0.001). Predictors for cross-over included left coronary artery interventions, multivessel PCI, and MCS initiation. Conclusion Significant differences exist between TRA and TFA PCI in AMI-CS. TFA was more common in patients with worse hemodynamics and was associated with higher 30-day mortality compared to TRA. TRA should be the default access, given its feasibility and favorable outcomes in many patients.Baseline characteristicsPredictors for femoral access

Continuous positive airway pressure in delivery room in extremely preterm infants: A single‐center retrospective study in China

AbstractTo assess the beneficial effects of delivery room continuous positive airway pressure (DRCPAP) in extremely preterm infants, a single‐center retrospective study was performed at the Women and Children's Hospital of Chongqing Medical University in China. Infants born between January 2016 and December 2018 were regarded as the control group, and those born between January 2019 and August 2022 were considered as the observation group (DRCPAP group). The primary outcome was tracheal intubation within 72 h after birth. Six hundred and seven patients were included in the study (control: 232; DRCPAP: 375). Compared with the control group, DRCPAP reduced the intubation rate (56.8% vs. 62.9%, OR 0.57, 95% CI 0.34–0.96, p = 0.035), including &lt;28 weeks gestational age (GA) subgroup (61.5% vs. 84.7%, OR 0.12, 95% CI 0.02–0.78, p = 0.027). One‐to‐one propensity score matching (195:195) was used to match the baseline characteristics of patients in DRCPAP and control group. After matching, no significant differences were observed in intubation rate within 72 h between the two groups (20.5% [40 of 195] vs. 22.1% [43 of 195]; p = 0.711). Whether DRCPAP can reduce intubation rate within 72 h requires further investigation.

Same-day discharge following lumbar spine neural decompression

IntroductionThe concept of same-day discharge following lumbar spine surgery for neural elements decompression, introduced in the 1980 s, represents a significant paradigm shift in postoperative care, offering potential benefits in terms of efficiency, convenience, and cost-effectiveness. However, concerns regarding patient safety and complications have persisted. This study aims to assess same-day discharge rates following lumbar spine decompression surgery, identify preoperative predictors, and compare outcomes between same-day discharge and hospitalization. MethodsA retrospective comparative analysis was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use File spanning 2016 to 2021. A total of 58,430 patients undergoing lumbar spine decompression procedures were included. Statistical analysis was performed using SPSS software, with significance determined at p < 0.05. ResultsSignificant differences were observed in preoperative factors, operative variables, and postoperative outcomes between patients discharged on the same day and those hospitalized. Preoperative comorbidities, operative time, length of stay, utilization of minimally invasive approaches, and 30-day mortality rates differed significantly between the two groups. Notably, same-day discharge demonstrated superior outcomes, with lower rates of unplanned intubation, readmission, and reoperation compared to hospitalization. ConclusionIn conclusion, same-day discharge following lumbar spine decompression procedures holds promise as a safe and effective practice, offering advantages in terms of patient outcomes and healthcare resource utilization. Further research and implementation of standardized protocols are warranted to maximize the benefits of same-day discharge while ensuring patient safety and satisfaction.

72 Hospital level of service, rural-urban hospital location, and neonatal resuscitation interventions at birth: A population-based study in Alberta, Canada from 2000-2020

Abstract Background Advanced neonatal resuscitation interventions (ANRIs: endotracheal intubation, chest compressions, and epinephrine) are rarely needed for infants born at ≥34 weeks gestational age (GA). However, healthcare providers (HCPs) in community hospitals can encounter the need for ANRIs, while having less experience and resources than HCPs in centers with neonatal intensive care units (NICUs). Understanding practice differences between hospitals of different levels of service (LofS) and rural/urban location can inform quality improvement to reduce health disparities. Objectives To examine how hospital level of service and rural/urban location relate to ANRI rates in Alberta, Canada, a universal public health system with standardized Neonatal Resuscitation Program (NRP) training. Design/Methods All live births ≥34 weeks GA in Alberta from 2000-2020 inclusive were examined using retrospective, population-level administrative data from the Alberta Perinatal Health Program (APHP). Hospitals (n=97) were contacted to determine annual LofS during the study period, with levels (0,1A/B/C,2,3) based on provincial obstetrical triage for availability of delivery support, cesarean-sections, obstetricians, paediatricians/neonatologists, and NICUs. Hospitals were further subcategorized by population and proximity to metropolitan centers.(Table 1) Rates of individual interventions or any ANRI were compared. Results There were 971,403 live births during the study period with a mean GA of 38.9 weeks; 1.6% were missing ANRI data, 955,835 births were included. Most occurred in hospitals with level 2 (57.4%) or level 3 (21.8%) NICUs; few occurred at sites with no delivery support (Level 0, 0.1%). ANRI rates were intubation (0.8%), chest compression (0.2%), and epinephrine (0.02%), any ANRI (0.96%, ~1/1000 live births). However, chest compression rates progressively decrease, and intubation rates progressively increase as LofS increases.(Table 1, Figure 1) When considering rural/urban location, there were outliers in chest compression rates in remote 0 (25.4/1000 live births) and metro-influenced 1A (30.2/1000 live births), intubation in remote 1C (33.3/1000 live births) and metro 0 (193.5/1000 live births) and epinephrine in metro 0 (64.5/1000 live births). Conclusion In this population-based cohort study of ≥34 weeks births, there were higher chest compressions rates and lower intubations rates at hospitals without NICUs despite standardized training. Reasons for this difference require further investigation; potential solutions such as targeted outreach education and introduction of laryngeal mask airways could be explored.

Beneficial effect of sequential treatment with high-dose steroids and short-course oral glucocorticoids in patients with severe influenza virus-associated pneumonia

Accumulating evidence supports that glucocorticoid treatment for viral pneumonia (VPA) can shorten the disease course and improve survival. However, currently, the use of glucocorticoids in treating VPA remains controversial. Moreover, a unified standard for the dosage and duration of glucocorticoid therapy has not been presented in published articles. A retrospective analysis was conducted in patients who were hospitalized for severe influenza virus-associated pneumonia, and they received sequential treatment with high-dose glucocorticoids and short-course oral glucocorticoids. Patients were followed up for 3 months. A total of 11 patients were included in the study (average age 56 years). There was no gender difference, but age and underlying diseases could be risk factors for severe influenza virus-associated pneumonia. The types of viruses causing pneumonia included influenza A/B. The main clinical symptoms of patients were fever, cough, sputum production, and dyspnea. Chest computed tomography showed multiple ground-glass shadows in the lobes, and the presence of bacterial and fungal infections was accompanied by consolidation shadows. After glucocorticoid therapy, the symptoms improved. None of the patients underwent tracheal intubation, and all survived. After a 3-month follow-up, lung CT absorption in all patients had reached more than 80%, and lung imaging absorption in 20% patients was complete. No serious complications occurred in any of the patients. Sequential treatment with high-dose steroids and short-course oral glucocorticoids may be helpful for reducing the tracheal intubation rate and mortality rate in patients with severe influenza virus-associated pneumonia. Additionally, short-course oral glucocorticoids may reduce pulmonary fibrosis in patients with severe influenza virus-associated pneumonia without any serious complications.

Visual rigid laryngoscopy versus video laryngoscopy for endotracheal intubation in elderly patients: A randomized controlled trial.

To assess the efficacy and safety of visual rigid laryngoscopy and video laryngoscopy and to provide clinical information for developing a more suitable intubation tool for elderly patients. In 75 consecutive elderly patients undergoing elective surgery in a single institution, tracheal intubation was randomly performed by 2 experienced anaesthesiologists using visual rigid laryngoscopy (Group I, n = 38) or video laryngoscopy (Group II, n = 37). The primary outcome was intubation time. Secondary outcomes were the first-attempt success rate of tracheal intubation, haemodynamic responses at 1, 3, and 5 min after intubation and the incidence of postoperative airway complications, including immediate complications and postoperative complaints. The intubation times were 35.0 (30.0-41.5) s and 42.5 (38.0-51.3) s in Groups I and II, respectively (P < 0.001). The difference in direct complications between the two groups was statistically significant (P < 0.05). In contrast, there was no significant difference between the two groups regarding the follow-up of the main complaint 30 min and 24 h after tracheal extubation (P > 0.05). There was no difference in the intubation success rate between the 2 groups (P > 0.05). The haemodynamic responses at 1, 3, and 5 min after intubation were not significantly different (P > 0.05). Compared with that of video laryngoscopy, the intubation time of visual rigid laryngoscopy in elderly patients was shorter. At the same time, visual rigid laryngoscopy reduced the incidence of immediate complications. However, during endotracheal intubation, there was no significant difference in haemodynamics between the two groups. ChiCTR2100054174.

Socioecological Determinants of Health and the Quality of Colonoscopy in Rural Alabama.

Rural patients suffer higher incidence of and mortality from colorectal cancer. Ensuring high-quality screening is essential to address these disparities. To investigate whether socioecological determinants of health are associated with colonoscopy quality in rural Alabama. Retrospective review. Data across three rural hospitals in Alabama from August 2021 to July 2023. We included adults (≥18 years) who underwent screening or diagnostic colonoscopy and completed a validated survey that measures socioecological determinants of health. Primary outcomes included bowel preparation quality, cecal intubation, and adenoma detection rate. We linked th e survey responses to these quality metrics to identify factors associated with outcomes. Analyses included the χ 2, Fisher's Exact and Kruskal-Wallis Rank sum tests, with p < 0.05 considered statistically significant. The 84 patients surveyed were 66.7% male, 50.0% Black, and had a median age of 64 years. Optimal bowel preparation was present in 88.0%, 89.3% had successful cecal intubations, and overall adenoma detection rate was 45.8%. Patients with suboptimal bowel preparation described lower rates of internet access (60.0% vs. 87.4%, p < 0.05), more difficulty understanding written information (30.0% vs. 1.4%, p < 0.05) and lacked a sense of responsibility for their health (30.0% vs. 51.4%, p < 0.05) compared to those having optimal bowel preparation. Those with unsuccessful cecal intubations had lower physician-trust (55.6% vs. 73.3%, p < 0.05), while patients with successful cecal intubations were more confident in preventing health-related problems (53.3% vs. 33.3%, p < 0.05) and had a more supportive social environment (72.0% vs. 66.7%, p < 0.05). Retrospective design and small sample size limiting multivariable analyses. In rural Alabama, health literacy, internet access, and physician-trust were associated with low-quality colonoscopy, while a higher patient sense of responsibility and a supportive social environment was associated with higher-quality metrics. These findings identify potential targets for improving colonoscopy quality in rural settings. See Video Abstract.

A Rare Case of a Child with Bended Scarf-Pin in Left Bronchus: Case Report with Systematic Review And Meta-Analysis.

In this report, we present the case of a 19-month-old female diagnosed with hijab pin aspiration after a week of persistent coughing, along with a meta analysis and systematic review of the relevant literature. A comprehensive search was conducted across multiple databases, including Ovid Medline, Cochrane, PubMed, Web of Science, and SCOPUS, yielding 182 records until August 2024. A total of 7 published study and our case included to final analysis. The complication, morbidity, and mortality analysis has been performed using Jamovi software v2.4 MAJOR proportion analysis section. A 19-month-old female was admitted to another hospital with a persistent cough complaint. In X-ray left hijab pin has been detected. The patient underwent a succesfull removal with rigid broncoscopy (RB). A total of 71 patients included this meta analysis. The thoracotomy rate was 8%. The bleeding rate was reported as 1.4%. The reoperation rate was reported as 9.8%. The postoperative intubation rate was reported as 1.4%. The calculated complication rate was found to be 5.6% based on the existing literature. The postoperative hemoptysis incidence was calculated as 0%. Mortality was not reported across any included studies. However, the mortality incidence was calculated as 0% based on included studies. Effective and timely intervention is crucial for managing pediatric hijab pin aspiration. Multidisciplinary approaches ensure successful outcomes and prevent serious complications.

Options for optimizing noninvasive respiratory support in the development of hypoxemic acute respiratory failure

Introduction. Acute respiratory failure (ARF) remains one of the most relevant problems of modern medicine and intensive care, and respiratory support (RS) remains the indispensable method of temporary external respiratory function replacement. Despite of widespread use of non-invasive ventilation (NIV) in clinical practice, at present systematic scientific data about possibilities for optimizing the use of these methods of RS in patients with hypoxemic ARF development is absent. It can be assumed that the combination of mask NIV and high-flow oxygen therapy (HFOT) at the stage of ARF development can improve results of treatment in this group of patients.The objective was to improve the results of treatment in patients with hypoxemic ARF through the combined use of mask NIV and HFOT.Materials and methods. The prospective cohort study included 77 patients aged 46.8 ± 11.8 years. Patients were randomized into three groups: in group A, RS was performed by using NIV and traditional low-flow oxygen therapy, in group B – by using HFOT, in group C – by sequential combination of NIV sessions and HFOT. The groups compared gas exchange rates, RS duration, intubation rate and nosocomial pneumonia (NP) incidence, length of treatment in the intensive care unit (ICU) and hospitalizations, overall mortality, and prognostic factors for tracheal intubation were also studied.Results. The combination of mask NIV and HFOT was found to be more clinically effective compared to their separate use. Combination of mask NIV and HFOT had the best effect on gas exchange rates in the long term period, reduced RS duration, intubation rate and pneumonia incidence, ICU treatment duration. Risk factors for tracheal intubation were revealed: RS duration more than 4.5 days, intra-abdominal pressure (IAP) more than 18 cm of water.Conclusions. The combination of mask NIV and HFOT increases the therapeutic potential of each of these RS methods and improves the results of treatment in patients with hypoxemic ARF development.

Can ketamine administration prevent intubation in patients who cannot comply with NIV due to agitation?

BackgroundIn patients presenting to the emergency department (ED) with acute respiratory failure, non-invasive mechanical ventilation (NIMV) is applied when conventional oxygen support is not sufficient. Patients who are agitated often have very low NIMV compliance and a transition to invasive mechanical ventilation (IMV) is often required. To avoid IMV, a suitable sedative agent can be utilized. The aim of this research is to investigate the relationship between ketamine administration to patients who are non-compliant with NIMV due to agitation and the outcome of their intubation.MethodsThis retrospective study included patients with acute respiratory failure who were admitted to the ED from 2021 to 2022 and used Richmond Agitation Sedation Scale (RASS) to identify agitation level of patients. The relationship between ketamine administration in this patient group and NIMV compliance and intubation rate was evaluated.ResultsA total of 81 patients, including 35 (43.2%) men and 46 (56.8%) women, were included in the study. Of these patients, 46 (56.8%) were intubated despite ketamine administration, while 35 (43.2%) were compliant with NIMV and were not intubated. When evaluating the RASS, which shows the agitation levels of the patients, the non-intubated group was found to be 2.17 ± 0.68, while the intubated group was 2.66 ± 0.73, and it was statistically significant that the NIMV intubated group was higher (p = 0.003).ConclusionThis study showed that agitation can impair NIMV compliance in patients with acute respiratory failure. However, a significant proportion of this patient group can be avoided through IMV with proper sedative agents.

Non-invasive positive pressure ventilation for acute asthma in children.

Asthma is one of the most common reasons for hospital admission among children, with significant economic burden and impact on quality of life. Non-invasive positive pressure ventilation (NPPV) is increasingly used in the care of children with acute asthma, although the evidence supporting it is weak, and clinical guidelines do not offer any recommendations on its routine use. However, NPPV might be an effective way to improve outcomes for some children with asthma. A previous review did not demonstrate a clear benefit, but was limited by few studies with small sample sizes. This is an update of the previous review. To assess the benefits and harms of NPPV as an add-on therapy to usual care (e.g. bronchodilators and corticosteroids) in children (< 18 years) with acute asthma. We searched the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, and Embase. We also conducted a search of ClinicalTrials.gov and the WHO ICTRP. We searched all databases from their inception to March 2023, with no restrictions on language of publication. We included randomised clinical trials (RCTs) assessing NPPV as add-on therapy to usual care versus usual care for children hospitalised for acute asthma exacerbations. We used standard Cochrane methods. We included three RCTs randomising 60 children with acute asthma to NPPV and 60 children to control. All included trials assessed the effects of bilevel positive airway pressure (BiPAP) for acute asthma in a paediatric intensive care unit (PICU) setting. None of the trials used continuous positive airway pressure (CPAP). The controls received standard care. The median age of children ranged from three to six years, and asthma severity ranged from moderate to severe. Our primary outcome measures were all-cause mortality, serious adverse events, and asthma symptom score. Secondary outcomes were non-serious adverse events, health-related quality of life, arterial blood gases and pH, pneumonia, cost, and PICU length of stay. None of the trials reported any deaths or serious adverse events (except one trial that reported intubation rate). Two trials reported asthma symptom score, each demonstrating reductions in asthma symptoms in the BiPAP group. In one trial, the asthma symptom score was (mean difference (MD) -2.50, 95% confidence interval (CI) -4.70 to -0.30, P = 0.03; 19 children) lower in the BiPAP group. In the other trial, a cross-over trial, BiPAP was associated with a lower mean asthma symptom score (MD -3.7; 16 children; very low certainty evidence) before cross-over, but investigators did not report a standard deviation, and it could not be estimated from the first phase of the trial before cross-over. The reduction in both trials was above our predefined minimal important difference. Overall, NPPV with standard care may reduce asthma symptom score compared to standard care alone, but the evidence is very uncertain. The only reported serious adverse event was intubation rate in one trial. The trial had an intubation rate of 40% and showed that BiPAP may result in a large reduction in intubation rate (risk ratio 0.47, 95% CI 0.23 to 0.95; 78 children), but the evidence is very uncertain. Post hoc analysis showed that BiPAP may result in a slight decrease in length of PICU stay (MD -0.87 day, 95% CI -1.52 to -0.22; 100 children), but the evidence is very uncertain. Meta-analysis or Trial Sequential Analysis was not possible because of insufficient reporting and different scoring systems. All three trials had high risk of bias with serious imprecision of results, leading to very low certainty of evidence. The currently available evidence for NNPV is uncertain. NPPV may lead to an improvement in asthma symptom score, decreased intubation rate, and slightly shorter PICU stay; however, the evidence is of very low certainty. Larger RCTs with low risk of bias are warranted.

Video laryngoscopy may improve the intubation outcomes in critically ill patients: a systematic review and meta-analysis of randomised controlled trials

BackgroundThe role of video laryngoscopy in critically ill patients requiring emergency tracheal intubation remains controversial. This systematic review and meta-analysis aimed to evaluate whether video laryngoscopy could improve the clinical...

Impact of respiratory syncytial virus infection among patients with hematological cancer in the era of post-coronavirus pandemic.

400 Background: Two vaccine is recently approved for elderly patient with compromised immunity. Despite the recommendation by Center for Disease Control and Prevention (CDC), RSV vaccination is remains low among patient with hematological malignancy, when compare to influenza vaccination. Thus, we conducted an observational study to estimate the impact of RSV infection among patients with hematological malignancy. Methods: We conducted a population-based retrospective cohort utilized the TritNetx dataset, which consist of patients across 63 U.S. healthcare organization. This study included patient who had respiratory viral infection after a diagnosis of hematological malignancy during 6/1/2022 - 4/1/2022. Hematological malignancy was identified using ICD-10 codes. CPT code and ICD-10 code were used to identify diagnosis of respiratory viral infection after respiratory pathogen panel testing. Patient who was diagnosed with RSV, influenza or COVID-19 were paired based on the following variable, including demographics, body mass index, comorbidities, and anti-neoplastic therapy. Hazard ratio (HR) was estimated by Cox proportional hazard regression models and log-rank test. Risk ratio (RR) was calculated by logistic regression. Results: A total of 6,088 patients with hematological malignancy contracted RSV, influenza or COVID during the observation period. When compare to influenza, patients with RSV infection were associate with high healthcare utilization, including emergency visit (HR: 1.20, 95% CI:[1.00-1.41]), and hospitalization (HR: 1.29, 95% CI:[1.06-1.57]). RSV infection was also resulted in higher acuity including viral pneumonia (HR: 15.42, 95% CI:[9.26-25.68]), use of antibiotics (HR: 1.54, 95% CI:[1.28-1.86]), renal replacement therapy (HR: 2.09, 95% CI:[1.10-3.96]), and acute respiratory failure (HR: 1.54, 95% CI:[1.14-2.07]). When compare to COVID-19, RSV infection showed similar trend including more frequent emergency visit (HR: 1.30, 95% CI:[1.10-1.54]), and high risk of developing viral pneumonia (HR 23.48, 95% CI: [12.79-43.09]). Interestingly, the intubation rate, 28 days all-cause mortality and 90 days all-cause mortality were similar between the three cohort. Conclusions: RSV infection was associated with higher rate of pneumonia and healthcare utilization. RSV vaccination should be considered to prevent RSV-associated morbidity among patients with hematological malignancy.

A high-flow nasal cannula versus noninvasive ventilation in acute exacerbations of chronic obstructive pulmonary disease

PurposeWe investigated the efficacy and safety of a high-flow nasal cannula (HFNC) at different flow rates compared to noninvasive ventilation (NIV) in patients with acute chronic obstructive pulmonary disease (COPD) exacerbations. MethodsThis prospective, randomized, single-blind study assigned patients to one of three study groups. The NIV group (n = 47) received bilevel positive airway pressure. The HFNC-30 (n = 44) and HFNC-50 (n = 46) groups received HFNC therapy at flow rates of 30 and 50 L/min, respectively. Demographic and clinical characteristics and arterial blood gas parameters before and 30, 60, and 120 min after treatment were compared among the treatment groups. ResultsThis study included 137 consecutive patients with acute exacerbations of COPD, comprising 90 males and 47 females, with a mean age of 68.1 ± 10.5 years. A total of 21 patients (15.33 %) were intubated, and the overall mortality rate was 10.2 %. The mean PaCO2 levels on admission were 64.69 ± 10.81, 61.51 ± 9.03, and 62.29 ± 9.87 in the NIV, HFNC-30, and HFNC-50 groups, respectively, with no significant differences observed (p = 0.372). A significant reduction in mean PaCO2 was observed in all treatment groups at 30, 60, and 120 min (p < 0.05 for all). However, the ΔPaCO2 at 60 min was significantly higher in the HFNC-30 group compared to the NIV group (p = 0.042). Additionally, neither intubation rates nor 28-day mortality differed among the treatment groups (p = 0.368 and p = 0.775, respectively). ConclusionHFNC was not inferior to NIV in improving arterial blood gas parameters, particularly PaCO2 in patients with COPD exacerbations, especially those with hypercarbia. Moreover, HFNC at a flow rate of 30 L/min was superior to NIV for reducing PaCO2 levels at 60 min. Trial RegistryNational Library of Medicine Clinical Trial Registry; No.: NCT06495086; URL: https://clinicaltrials.gov/study/NCT06495086

The Effectiveness and Safety of Remdesivir Use in COVID-19 Patients with Neutropenia: A Retrospective Cohort Study

Background: The COVID-19 pandemic poses severe risks for immunocompromised patients, especially those with neutropenia due to chemotherapy. This study evaluates the safety and effectiveness of remdesivir use in COVID-19 patients with neutropenia. Methods: This retrospective study used the Chang Gung Research Database (CGRD) and extracted data from 98,763 patients with COVID-19 diagnosed between April 2021 and September 2022. The patients were divided into groups based on their remdesivir use and the presence of neutropenia. The adverse effects of remdesivir and their outcomes were analyzed after propensity score matching. Results: We compared common adverse effects of remdesivir in neutropenic patients before and after a 5-day regimen. A slight decrease in heart rate was observed but lacked clinical significance. There were no significant differences observed in hemoglobin, liver function tests, and blood glucose levels. After propensity score matching of COVID-19 patients with neutropenia according to gender, age, dexamethasone use, oxygen use, MASCC score, and WHO ordinal scale, no significant differences were found in length of stay, intubation rate, or ICU admission rate between the matched patients. Conclusions: Our study found remdesivir to be safe for COVID-19 patients with neutropenia, with no common adverse reactions observed. However, its effectiveness for these patients remains uncertain.

A Comparison of Ketamine to Midazolam for the Management of Acute Behavioral Disturbance in the Out-of-Hospital Setting

ObjectiveAcute behavioral disturbance is characterized by altered mental status and psychomotor agitation. Pharmacological sedation may be required, risking potential respiratory compromise. We compared the need for emergent airway support following administration of midazolam or ketamine to treat acute behavioral disturbance in the prehospital setting. MethodsIn this retrospective cohort study of patients with acute behavioral disturbance in an urban Emergency Medical Service (EMS) system between 2017-2021, we compared the likelihood of prehospital advanced airway management following administration of midazolam or ketamine. Advanced airway management was defined as prehospital endotracheal intubation or supraglottic airway insertion. ResultsAmong 376 eligible patients, the median age was 35; and 78% were male. The most common etiologies of acute behavioral disturbance were substance use (51%), trauma (18%), and presumed postictal agitation (11%). In all, 162 patients (43%) initially received midazolam and 214 (57%) ketamine. The frequency of advanced airway management was similar between these respective groups (12% [n=19] vs 11% [n=24], difference 0.5%, 95% CI -6.0% to 7.0%). Adjusted for potential confounders, the odds of receiving advanced airway management did not differ between midazolam and ketamine (aOR 1.02, 95% CI 0.44 to 2.38), nor were differences observed in emergency department intubation rates (14% in midazolam recipients, 11% for ketamine) or overall mortality (2% in midazolam recipients, 1% for ketamine). ConclusionIn this cohort study of patients with acute behavioral disturbance, emergent airway support nor other outcomes differed following prehospital treatment with midazolam or ketamine.