Versus Bolus Research Articles

Comparison of Fractionated Dose Versus Bolus Dose of Bupivacaine Hyperbaric (0.5%) with Buprenorphine in Spinal Anaesthesia for Lower Limb Surgeries

Comparison of Fractionated Dose Versus Bolus Dose of Bupivacaine Hyperbaric (0.5%) with Buprenorphine in Spinal Anaesthesia for Lower Limb Surgeries

Weekly Versus Bolus Cisplatin Concurrent With Definitive Radiation Therapy for Squamous Carcinoma of the Head and Neck: A Systematic Review and Network Meta-Analysis

The schedule of cisplatin concurrent with definitive radiation for squamous carcinoma of the head and neck remains controversial. Most institutions deliver either a high-dose "bolus" schedule once every 3 weeks or a low-dose weekly schedule. We compared these 2 schedules via a simplified network meta-analysis with a common comparator. We performed a PRISMA-concordant systematic review to identify randomized controlled trials comparing cisplatin with cetuximab for nonmetastatic, locoregionally advanced squamous carcinoma of the head and neck treated with definitive radiation. Trials incorporating primary surgery or induction therapy were excluded. Patient survival times were extracted on a per-event basis from the published curves using a digitizer and validated against published point estimates and hazard ratios (HRs). Survival was compared using random effects Cox regression under a frequentist framework. Toxicity and secondary endpoints were analyzed qualitatively. The Cochrane method assessed the risk of bias. The analysis plan was preregistered with the Open Science Foundation. Five randomized trials were identified, including 1678 patients. There was no statistical difference in overall survival between weekly and bolus regimens (HR, 0.90; 95% CI, 0.53-1.52, P = .345). This Cox model suggested that for the average patient in the cohort, the absolute difference in 5-year overall survival between weekly and bolus regimens was +1.2% (95% CI, -6.1%-+5.9%, P = .345). Secondary endpoints and toxicity were not obviously different by regimen, qualitatively. The cetuximab trials provide indirect data suggesting that the differences between cisplatin schedules are subtle.

Bolus Versus Continuous Enteral Feeding for Critically Ill Patients: A Systematic Review and Meta-Analysis.

Enteral feeding is a crucial aspect of nutritional support for critically ill patients. However, the optimal feeding approach, whether bolus or continuous, remains a subject of debate. This systematic review and meta-analysis aimed to compare the outcomes of bolus feeding and continuous enteral feeding in critically ill patients. A systemic search was carried out in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ultimate, Web of Science, Scopus, and Google Scholar to identify relevant studies. To ensure that we obtain the latest evidence on the topic, the search was limited to the last five years. Risk of bias assessments and meta-analyses were performed for relevant clinical outcomes. A total of nine randomized controlled trials (RCTs) were included, involving a total of 863 patients. All the studies were published between 2020 and 2023. High-risk performance bias was observed in seven studies, with unclear risk in two studies. In terms of clinical outcomes, no statistically significant differences were found between bolus and continuous enteral feeding in terms of diarrhea (odds ratio {OR} 0.60, 95% CI 0.27 to 1.30, p=0.20), constipation (OR 1.52, 95% CI 0.91 to 2.53, p=0.11), vomiting (OR 0.74, 95% CI 0.36 to 1.49, p=0.39), distention (OR 0.70, 95% CI 0.14 to 3.58, p=0.66), aspiration (OR 0.61, 95% CI 0.16 to 2.73, p=0.48), and gastric residual volume (GRV) (OR 0.80, 95% CI 0.30 to 2.15, p=0.66). Furthermore, no significant differences between bolus and continuous feeding were observed in terms of intensive care unit (ICU) mortality (OR 0.66, 95% CI 0.42 to 1.04, p=0.07), hospital mortality (OR 0.57, 95% CI 0.31 to 1.03, p=0.06), ICU length of stay (OR 0.70, 95% CI 0.50 to 1.90, p=0.25), and hospital length of stay (OR -0.86, 95% CI -3.04 to 1.33, p=0.44). This systematic review and meta-analysis suggest that bolus and continuous enteral feeding methods exhibit comparable outcomes in critically ill patients. However, both ICU mortality and hospital mortality outcomes were close to achieving statistical significance, which favored the continuous feeding approach.

Phenylephrine Infusion Versus Bolus Regimens During Cesarean Delivery Under Spinal Anesthesia: An Observational Study to Assess Hemodynamic Changes.

Background The objective of this study was to evaluate and compare the efficacy of two modes of phenylephrine administration, namely continuous infusion and intermittent bolus, in maintaining maternal hemodynamics during cesarean delivery under spinal anesthesia (SA). Methods Eighty patients undergoing cesarean delivery with SA were allocated into two groups. In group I, 40 patients were administered a prophylactic phenylephrine infusion at a rate of 75 mcg/min immediately after SA. Conversely, group B, consisting of 40 patients, received a 75 mcg bolus dose promptly after SA and subsequently whenever their blood pressure fell by more than 20% from the baseline value. Crucial variables, such as heart rate (HR), blood pressure, and side effects, were closely monitored at a three-minute interval in both groups. Following the delivery of the child, APGAR scores were documented at the first and fifth minutes, and the gathered data underwent analysis using SPSS Statistics, version 17.0 (SPSS Inc., Chicago, IL). Results The results revealed that baseline HR and blood pressure were similar in both groups. Nevertheless, the bolus group exhibited a higher mean HR, whereas the infusion group maintained a closer proximity to the baseline reading throughout the measurement period. Despite these variations, changes in HR did not demonstrate statistically significant differences between the two groups at any measuring intervals. Additionally, the mean systolic blood pressure in group B exhibited an initial decrease from the baseline, whereas group I displayed an increase compared to the baseline values. Importantly, neither group reported instances of nausea or vomiting, and the APGAR scores were comparable between them. Conclusion In conclusion, the study found that a phenylephrine bolus of 75 mcg was more effective in maintaining blood pressure within acceptable limits without causing bradycardia or hypertension when compared to a phenylephrine infusion.

A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion in Patients Undergoing Primary Percutaneous Coronary Intervention for St-Elevation Myocardial Infarction Revealed Similar Outcome

A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion in Patients Undergoing Primary Percutaneous Coronary Intervention for St-Elevation Myocardial Infarction Revealed Similar Outcome

Continuous Infusion Versus Bolus Injection of Loop Diuretics for Patients With Congestive Heart Failure: A Meta-Analysis.

Loop diuretics continue to be a crucial component of pharmacological treatment, to eliminate extra fluid and enhance symptom control in acute decompensated heart failure (ADHF). Understanding the loop diuretics' more efficient form of administration would be very beneficial in improving the management of people's ADHF, resulting in a quicker resolution of symptoms and a notable decrease inmorbidity. To assess the outcomes of intravenous continuous infusion with bolus injection of loop diuretics for patients with ADHF, this meta-analysis was carried out. The current meta-analysis was conducted as per the Cochrane Collaboration guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension (PRISMA) guidelines. A search was carried out on PubMed and EMBASE databases for studies comparing continuous infusion with intermittent bolus injection of furosemide in patients with congestive heart failure without restriction on the language of publication from 1January 2001 to 31July 2022. The primary outcome of the meta-analysis was all-cause mortality and loss of body weight (kg). Pre-defined secondary outcomes included length of hospital stay (LOS) in days, brain natriuretic peptide(BNP) reduction (pg/ml), number of patients with hypokalemia, and urine output at 24 hours (ml). A total of nine articles were included in this meta-analysis enrolling 713 patients. No significant difference was reported between patients who received intermittent bolus injections and continuous infusion of furosemide in regards to all-cause mortality, LOS, total urine output, the incidence of hypokalemia, and change in BNP. However, the reduction of body weight was greater in the continuous infusion group compared to bolus administration. In conclusion, in the current meta-analysis of nine randomized controlled trials (RCTs), continuous infusion of furosemide seemed to have a greater reduction of body weight. However, no significant difference was there in 24-hrs urine output. However, we cannot conclude that intravenous continuous infusion has a better diuretic effect compared to bolus administration.

CRT-100.32 A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion in Patients Undergoing Primary Percutaneous Coronary Intervention for St-Elevation Myocardial Infarction Revealed Similar Outcome

CRT-100.32 A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion in Patients Undergoing Primary Percutaneous Coronary Intervention for St-Elevation Myocardial Infarction Revealed Similar Outcome

Comparison between Intermittent Bolus Versus Continuous Intravenous Infusion of Tranexamic Acid in Hematological Disorders with Thrombocytopenia (BRAVE TRIAL)- a Randomized, OPEN Label, Single Centre Study

Comparison between Intermittent Bolus Versus Continuous Intravenous Infusion of Tranexamic Acid in Hematological Disorders with Thrombocytopenia (BRAVE TRIAL)- a Randomized, OPEN Label, Single Centre Study

Optimization of Preprocedural Full-cycle Computed Tomography in Patients Referred for Transcatheter Tricuspid Valve Repair: Test Bolus Versus Bolus Tracking.

Advancements in transcatheter mitral and tricuspid valve repair have resulted in growing demands in preprocedural computed tomography (CT) imaging. Due to the introduction of multidetector CT (MDCT), shorter acquisition times as well as high rates of heart failure and arrhythmias in this specific patient population, optimal synchronization between the passage of contrast agent and data acquisition is mandatory. There is no consensus on which acquisition technique should be used in this patient population. We aimed to optimize our preprocedural CT protocol comparing bolus tracking (BT) and test bolus (TB) techniques. We performed a retrospective analysis on 151 patients referred for full-cycle MDCT evaluation for transcatheter tricuspid valve repair comparing BT with TB (BT n=75 TB n=75). Contrast-to-noise ratios (CNR) were obtained. Demographic data, laboratory, electrocardiographic, and transthoracic echocardiography/transoesophageal echocardiography parameters were collected from electronic health records. Also, the volume of contrast agent and saline chaser and radiation dose length product and milliampere seconds were collected. BT and TB resulted in comparable CNR (BT: 0.47 [0.34 to 0.98]; TB: 0.51 [0.41 to 1.40]; P =0.1). BT was associated with a shorter scan duration (BT: 8.3min [4.1 to 24.4]; TB: 13.9min [6.2 to 41.4]; P <0.001), less radiation in terms of dose length product (BT: 1186±585; TB: 1383±679, P =0.04), and lower total volume administration (BT: 101mL [63 to 16]; TB: 114mL [71 to 154]; P <0.001). In patients with severely impaired ejection fraction (left ventricular ejection fraction [LVEF] ≤35%; n=65 [TB n=31; BT n=34]) using the TB technique yielded significantly better image quality in terms of CNR (TB=0.57 [0.41 to 1.07); BT=0.41 [0.34 to 0.65]; P =0.02). In patients with impaired LVEF (LVEF≤35%), the TB technique yielded significantly superior image quality and may be the preferred approach in this specific patient population. BT showed advantages in terms of shorter duration, less radiation, and lower contrast agent volume.

TCT-303 Continuous Versus Bolus Thermodilution Derived CFR and MRR and Their Association With Symptoms of CMD: A Head-to-Head Comparison

TCT-303 Continuous Versus Bolus Thermodilution Derived CFR and MRR and Their Association With Symptoms of CMD: A Head-to-Head Comparison

Comparison between Oxytocin Bolus Versus Bolus Plus Infusion in Prevention of Postpartum Hemorrhage During Elective Cesarean Section

Comparison between Oxytocin Bolus Versus Bolus Plus Infusion in Prevention of Postpartum Hemorrhage During Elective Cesarean Section

Infusion Versus Bolus Esmolol on Hemodynamic Responses to Intubation in Patients Undergoing Coronary Artery Bypasses Grafting: a Randomized Clinical Trial

Infusion Versus Bolus Esmolol on Hemodynamic Responses to Intubation in Patients Undergoing Coronary Artery Bypasses Grafting: a Randomized Clinical Trial

Bolus Versus Continuous Nasogastric Feeds for Infants With Bronchiolitis: A Randomized Trial.

Infants hospitalized with bronchiolitis are commenced on nasogastric feeding to maintain hydration. Feeding strategies vary according to physician or institution preference. The current study hypothesized that continuous nasogastric feeding would prolong length of stay (LOS) when compared to bolus feeding. A randomized, parallel-group, superiority clinical trial was performed within an Australian children's hospital throughout 2 bronchiolitis seasons from May 2018 to October 2019. Infants <12 months hospitalized with bronchiolitis and requiring supplemental nasogastric feeding were randomly assigned to continuous or bolus nasogastric regimens. LOS was the primary outcome. Secondary outcome measures included pulmonary aspirations and admissions to intensive care. The intention-to-treat analysis included 189 patients: 98 in the bolus nasogastric feeding group and 91 in the continuous group. There was no significant difference in LOS (median LOS of the bolus group was 54.25 hours [interquartile range 40.25-82] and 56 hours [interquartile range 38-78.75] in the continuous group). A higher proportion of admissions to intensive care was detected in the continuous group (28.57% [26 of 91] of the continuous group vs 11.22% [11 of 98] of the bolus group [P value 0.004]). There were no clinically significant pulmonary aspirations or statistically significant differences in vital signs between the groups within 6 hours of feed initiation. No significant difference in LOS was found between bolus and continuous nasogastric feeding strategies for infants hospitalized with bronchiolitis. The continuous feeding group had a higher proportion of intensive care admissions, and there were no aspiration events.

Original Article Comparative Study to Evaluate Intravenous Dexmedetomidine as Bolus Versus Infusion with Spinal Anaesthesia for Infra-Umbilical Surgeries

Original Article Comparative Study to Evaluate Intravenous Dexmedetomidine as Bolus Versus Infusion with Spinal Anaesthesia for Infra-Umbilical Surgeries

Continuous Versus Bolus Gastric Feeding in Children Receiving Mechanical Ventilation: A Systematic Review

Nutrition guidelines recommend enteral nutrition in the form of gastric feedings for critically ill children and acknowledge a lack of evidence describing an optimal method for providing these feedings. To determine the state of the science regarding the efficacy of bolus (intermittent) or continuous gastric feedings to improve nutrition delivery in critically ill children receiving mechanical ventilation. Five hundred seventy-nine abstracts met the inclusion criteria and were screened by 2 reviewers according to prespecified criteria. Full-text reviews were performed on 28 articles; 11 studies were selected for detailed analysis. Because of the small number of eligible studies, broader searches were conducted. Only 5 studies with a collective enrollment of fewer than 200 children closely addressed the specific research question. These 5 studies did not report any similarity in feeding regimens, nor did they report nutritional outcomes. Two of the articles described findings from the same study population. Although 4 of the 5 studies randomized children to bolus versus continuous feedings, only 3 studies described attainment of nutrient delivery goals in both the intervention and the control groups; the remaining study did not report this outcome. The heterogeneity in methodology and outcomes among the 5 studies did not allow for a meta-analysis. The dearth of evidence regarding best practices and outcomes related to bolus versus continuous gastric feedings in critically ill children receiving mechanical ventilation requires additional rigorous investigation.

3D Printed Rigid Bolus Versus Silicone Bolus for Treatment of Tumors Involving the Skin: A Comparative Study

3D Printed Rigid Bolus Versus Silicone Bolus for Treatment of Tumors Involving the Skin: A Comparative Study

Bolus Versus Continuous Enteral Tube Feeding

Bolus Versus Continuous Enteral Tube Feeding

Patient Reported Nausea Associated with Concurrent Weekly Versus Bolus Cisplatin in Patients Treated for Head and Neck Cancer

Concurrent chemotherapy is administered to advanced head and neck cancer (HNC) patients (pts) receiving radiotherapy (RT). Most evidence and practice guidelines support concurrent bolus cisplatin (B-CP, 100 mg / m2 q3wks); however, weekly cisplatin (W-CP, 40 mg / m2) is commonly used. We investigated patient reported outcomes (PRO) related to nausea in HNC pts receiving B-CP versus W-CP with IMRT. We reviewed records from HNC pts treated with IMRT and CP between January 2015 and January 2018 at a single institution who completed institutionally-developed electronic PRO questionnaires at baseline and weekly during RT. We evaluated associations between PRO emesis/loss of appetite (LOA) measured on a 1-10 scale and B-CP versus W-CP. Significance (p<0.05, two-sided) was determined using the rank-sum test and Fisher's exact test. We identified 101 patients with median age of 59 years (IQR 55-65 years) who completed at least 3 questionnaires at beginning, middle, and end of treatment. Most pts were male (84%) with baseline ECOG 0 (86%). The most common subsite treated was the oropharynx (n=65, 64%), of which 83% (n=54) were HPV-associated. IMRT was delivered postoperatively in 21% (n=21). B-CP was administered to 24%, while 76% received W-CP. The median dose of cisplatin in the B-CP and W-CP groups were 300 mg/m2 and 280 mg/m2, respectively, and 92% of patients received >=200mg/m2 CP in both groups. There were no significant differences between B- and W-CP patients in the subsite treated or percentage who received postoperative versus definitive treatment. There were 59% of patients in the W-CP group and 70% in the B-CP group who had a PEG placed before or during RT. Regarding PROs, there were no significant differences in baseline, end of treatment (EOT) or change from baseline to EOT scores for either emesis or LOA (mean baseline/EOT/difference scores for emesis: B-CP 1.1/3.1/1.8, W-CP 0.6/3/2.3, p=0.17/0.58/0.49; and for LOA: B-CP 3.1/5.9/2.5, W-CP 2.8/6.1/3.3, p=0.62/0.70/0.46). There were also no significant differences in the percentages of patients hospitalized during RT (n=6, 25% B-CP; n=18, 23%, W-CP, p=1.0), or with PEG dependence at 3 or 6 months (3 months: n=7/29% B-CP, n=31/40%, W-CP, p=0.47; 6 months: n=2/8% B-CP, n=10/13% W-CP, p=0.73). There remains uncertainty about the tradeoffs regarding efficacy and toxicity when recommending B-CP versus W-CP to patients receiving HNC treatment. In this retrospective study focused on PRO of nausea / LOA in patients receiving IMRT, we find both B-CP and W-CP lead to similar decrements on treatment. We also find similar rates of hospitalization and PEG-dependence at 3 and 6 months. These data suggest that from a patient perspective, both B- and W-CP result in similar short-term toxicities.

MON-PO612: A Randomized Controlled Trial on the Effects of Intermittent Gravity Drip Versus Bolus Enteral Feeding on the Incidence of Hospital-Acquired Pneumonia Among Intensive Care Patients

MON-PO612: A Randomized Controlled Trial on the Effects of Intermittent Gravity Drip Versus Bolus Enteral Feeding on the Incidence of Hospital-Acquired Pneumonia Among Intensive Care Patients

The Relative Effectiveness of BOLUS Versus Continuous Nasogastric Feeding After Stroke: a Proof of Principal Study

The Relative Effectiveness of BOLUS Versus Continuous Nasogastric Feeding After Stroke: a Proof of Principal Study