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1.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880009
2.
Chest ; 160(4):A521, 2021.
Article in English | EMBASE | ID: covidwho-1457613

ABSTRACT

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Exaggerated inflammatory response with cytokine storm is the hallmark of moderate to severe cases of COVID-19. Several studies have investigated the use of colchicine in COVID-19 due to its anti-inflammatory effects. However, the data regarding its efficacy is still limited and conflicting. This meta-analysis aimed to evaluate the impact of colchicine on mortality and the risk of mechanical ventilation in patients with COVID-19. METHODS: We performed a comprehensive literature search of electronic databases from inception through April 10, 2021, for all peer-reviewed studies that evaluated the clinical benefits of colchicine COVID-19 patients. The primary outcome was the mortality rate. The secondary outcomes included the risk of mechanical ventilation, improvement in systematic inflammation as indicated by changes in serum C-reactive protein, and the risk of adverse events. Pooled risk ratio (RR) and 95% confidence intervals (CIs) were obtained by the Mantel-Haenszel method within a random-effect model. RESULTS: A total of eight studies involving 926 COVID-19 patients (406 patients received colchicine along with standard-of-care (SOC) therapy and 520 received SOC therapy alone) were included. The mean age was 63.7±14.7 years, and males represented 63.3%. Mortality rate was significantly lower in the colchicine group compared to SOC (RR 0.49 (95% CI: 0.34-0.72, P = 0.0002). However, there was no statistically significant difference in the risk of mechanical ventilation (RR 0.69, 95% CI: 0.31-1.57, P = 0.38). Furthermore, colchicine significantly lowered serum CRP levels (MD -0.40, 95% CI -0.77 to -0.03, P = 0.03). CONCLUSIONS: Our meta-analysis demonstrated that colchicine showed improvement in mortality in COVID-19 patients. However, there was no significant improvement in the risk of mechanical ventilation. CLINICAL IMPLICATIONS: Colchicine may be a potential therapeutic option for COVID-19. Even though the results are encouraging, we need more large-scale RCTs to better characterize the clinical benefits of colchicine in COVID-19 patients. DISCLOSURES: No relevant relationships by Nezam Altorok, source=Web Response No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Sami Ghazaleh, source=Web Response No relevant relationships by Muhamad Kalifa, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Asmaa Mhanna, source=Web Response No relevant relationships by Omar Sajdeya, source=Web Response No relevant relationships by Omar Srour, source=Web Response No relevant relationships by WAHOOD Waseem, source=Web Response

3.
Chest ; 160(4):A558, 2021.
Article in English | EMBASE | ID: covidwho-1457612

ABSTRACT

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Coronavirus disease 2019 (COVID-19) has become a leading cause of mortality globally. Inhaled pulmonary vasodilators, epoprostenol (iEPO) and nitric oxide (iNO), are used as adjunctive therapies for the treatment of refractory hypoxemia in patients with acute respiratory distress syndrome (ARDS). Hypoxemia in COVID-19 patients is mainly caused by ventilation-perfusion mismatch, which might be improved by inhaled pulmonary vasodilators. However, the effects of inhaled pulmonary vasodilator therapy on the clinical outcomes of COVID-19 remain unclear. Therefore, we conducted this meta-analysis to evaluate the impact of pulmonary vasodilators, iNO and iEPO, on the oxygenation parameters in COVID-19 patients with refractory hypoxemia. METHODS: We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases from inception through April 24, 2021, to include all published studies. All statistical analyses were performed using the Review Manager software (RevMan 5.3). The weighted mean difference (MD) with corresponding 95% confidence intervals (CI) were calculated using the random-effects model. A P-value <0.05 was considered statistically significant. The primary outcome measure was the change in oxygenation parameter (PaO2/FiO2) pre and post pulmonary vasodilators. RESULTS: A total of seven studies (three and four studies for iEPO and iNO, respectively) involving 211 patients with COVID-19 (140 patients in iEPO group and 71 in iNO) were included. Overall, pulmonary vasodilators showed significant improvement in oxygenation: PaO2/FiO2 (MD: 12.48, 95% CI: 4.51, 20.44, P = 0.002, I2 = 0%). On subgroup analysis, iEPO showed significant improvement in oxygenation: PaO2/FiO2 (MD: 13.39, 95% CI: 2.84, 23.94, P = 0.01, I2 = 0%), however, iNO showed no improvement in oxygenation: PaO2/FiO2 (MD: 12.80, 95% CI: -4.82, 30.42, P = 0.15, I2 = 47%). CONCLUSIONS: Our meta-analysis showed that inhaled epoprostenol improved oxygenation in COVID-19 patients. However, inhaled nitric oxide therapy was not associated with improvement in oxygenation. Major limitation being lack of control arm and adjustment for confounders. Clinical trials are needed to determine the effect of inhaled pulmonary vasodilators on oxygenation parameters and clinical outcomes of COVID-19 patients. CLINICAL IMPLICATIONS: Inhaled pulmonary vasodilators may play a role as rescue therapy in COVID-19 patients with refractory hypoxemia. DISCLOSURES: No relevant relationships by Ziad Abuhelwa, source=Web Response No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Sami Ghazaleh, source=Web Response No relevant relationships by Dana Ghazaleh, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Asmaa Mhanna, source=Web Response No relevant relationships by Rami Musallam, source=Web Response No relevant relationships by Omar Sajdeya, source=Web Response No relevant relationships by Omar Srour, source=Web Response

4.
Chest ; 160(4):A502, 2021.
Article in English | EMBASE | ID: covidwho-1457611

ABSTRACT

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Prone positioning (PP) in awake patients has been recently proposed as an adjunctive treatment for spontaneously breathing non-intubated coronavirus disease 2019 (COVID-19) patients requiring oxygen therapy to reduce the risk of intubation. However, the magnitude of the effect of PP on clinical outcomes (e.g., the risk of endotracheal intubation, intensive care unit [ICU] admission, or mortality) in these patients remains uncertain. Therefore, we performed a systematic review and meta-analysis to evaluate the effectiveness of PP to improve the clinical outcomes in non-intubated patients with COVID-19. METHODS: We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases from inception through February 24, 2020 for all the studies all studies that all compared PP versus no PP in non-intubated patients with COVID-19. The primary outcome of interest was the rate of endotracheal intubation. The secondary outcomes were in-hospital mortality and intensive care unit (ICU) rates. Pooled odds risk (OR) and 95% confidence intervals (CIs) were obtained by the Mantel-Haenszel method within a random-effect model. RESULTS: A total of five studies (two randomized controlled trials and three observational studies), involving 470 non-intubated patients with COVID-19 (185 patients received PP and 285 did not) were included. The mean age was 59.82 years, and males represented 67% of total patients. The follow-up period ranged from 14 to 30 days. The endotracheal intubation rate was similar between PP and control groups (OR 0.75, 95% CI 0.41-1.35, P = 0.33, I2 = 20%). There was no difference in the in-hospital mortality rate between the two groups (OR 0.68, 95% CI 0.16-2.85, P = 0.60, I2 = 60%). Four studies reported the risk of ICU admission and demonstrated no difference between the two groups (OR 0.77, 95% CI 0.30-1.95, P = 0.58, I2 = 37%). CONCLUSIONS: Our meta-analysis demonstrated that prone positioning in non-intubated COVID-19 patients did not reduce the risk of endotracheal intubation. Furthermore, PP failed to reduce in-hospital mortality and ICU admission rates. CLINICAL IMPLICATIONS: Although our meta-analysis showed that prone positioning might not reduce the risks of intubation, in-hospital mortality, or ICU admission rate in spontaneously breathing non-intubated COVID-19 patients, more large-scale trials with a standardized protocol for prone positioning are needed to better evaluate the effectiveness of prone positioning in this select population. DISCLOSURES: No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Sami Ghazaleh, source=Web Response No relevant relationships by Waleed Khokher, source=Web Response No relevant relationships by Saif-Eddin Malhas, source=Web Response No relevant relationships by Aadil Maqsood, source=Web Response No relevant relationships by Reem Matar, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Omar Sajdeya, source=Web Response No relevant relationships by Omar Srour, source=Web Response

5.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277298

ABSTRACT

IntroductionCoronaviruses are one of the common viruses that can cause diseases for humans and animals. In December 2019, a new coronavirus (Novel Coronavirus) was detected as the cause of pneumonia and then respiratory failure. One of the modalities that have been used for treatment is prone positioning. The purpose of this meta-analysis was to investigate the efficacy of awake early prone positioning on COVID-19 patients with respiratory failure.Methods We performed a comprehensive search in the literature for studies that evaluated prone positioning in COVID-19. We searched the databases of PubMed/MEDLINE, Embase, World Health Organization COVID-19 Database, LitCOVID, and Web of Science Core Collection databases from January 1, 2020, until November 30, 2020. The search was not limited by language, study design, or country of origin. Two researchers (MA and SG) independently selected the studies;discrepancies were resolved by a third researcher (OS). We considered randomized controlled trials, cohort studies, case-control studies, and case series. We excluded animal studies, case reports, reviews, editorials, and letters to editors. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The random-effects model was used to calculate the odds ratios (OR), and confidence intervals (CI). Our main outcomes were intubation rate and mortality rate for patients who were admitted to the hospital with hypoxic respiratory failure. Results We included 3 studies in our meta-analysis with a total of 290 patients. There was no significant difference between prone positioned awake patients compared to non-prone positioned awake patients regarding intubation rate OR 1.48 ( 95% CI: 0.751-2.927, P-value: 0.257 ) (Figure 1) and mortality rate OR 0.54 ( 95% CI: 0.219-1.326, Pvalue: 0.179) (Figure 2). Conclusion Early awake prone positioning does not have a significant impact on nonintubated COVID-19 patients with respiratory failure according to our meta-analysis. More randomized controlled trials should be done to evaluate the efficacy.

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