ABSTRACT
The noninvasive neurally adjusted ventilatory assist (NIV-NAVA) is a newly developed noninvasive ventilation technique with promising clinical and ventilatory outcomes for preterm infants. This systematic review and meta-analysis aimed to investigate whether NIV-NAVA has better clinical and ventilatory outcomes than nasal continuous airway pressure (NCPAP) or noninvasive positive pressure ventilation (NIPP) on premature infants. MEDLINE, Embase, and CENTRAL were searched, and randomized controlled trials (RCTs) that compared NIV-NAVA with NCPAP or NIPP for preterm infants (gestational age: <37 weeks) were included. We evaluated the following outcomes in the neonatal intensive care unit: the desaturation rate, failure of noninvasive modality requiring intubation when received as the primary mode or the need for re-intubation after extubation from mechanical ventilation in the secondary mode (weaning), length of stay, and fraction of inspired oxygen. The mean difference and risk ratio were used to represent continuous and dichotomous outcomes, respectively. We included nine RCTs involving 339 preterm infants overall. NIV-NAVA showed similar clinical and ventilatory outcomes to NCPAP or NIPP, except for the maximum diaphragmatic electrical activity. The rate of failure of the noninvasive modality was not statistically different between NIV-NAVA and NCPAP. The pooled estimates for the maximum electrical activity were significantly reduced in NIV-NAVA compared with those in NIPP. The findings suggest that NIV-NAVA may be as safe and effective as NCPAP and NIPP for preterm neonates, particularly those who may not tolerate these alternative noninvasive methods. However, further trials are recommended for greater evidence.
ABSTRACT
Objectives To estimate the prevalence of hypertriglyceridemia (HTG), determine the association between HTG and the risk of ischemic heart disease and major adverse cardiovascular events. Lastly, to assess the management outcomes of HTG in terms of the different drugs in the treatment plan. Methods A retrospective, longitudinal study at a tertiary hospital was conducted. All who came in were screened. Patients with HTG (TAG [triacylglyceride] 2.3 mmol/L) in the last five years were included in the study. The data included the demographic variables, potential causes, and the methods of management. All data were recorded in a standard data collection form and analyzed by an appropriate statistical tool, using the John Macintosh Project (JMP) software version 15 (Cary, NC: SAS Institute Inc.). Results Of 300 patients included, 174 (58.0%) were male, with a mean age of 57.8±13.4 years. Pre-treatment, the mean triglycerides (TG) was 3.2±2.3 mmol/L, low-density lipoprotein (LDL) 2.7±1.3 mmol/L, high-density lipoprotein (HDL) 0.93±0.30 mmol/L, and the total cholesterol (TC)was 5.2±1.3 mmol/L. All the patients have prescribed a statin, 144 (48.0%) received aspirin, six (2.0%) fenofibrate, and three (1.0%) gemfibrozil. At the follow-up, the level of the TG was 2.6±1.3 mmol/L (P=0.001), LDL 2.5±1.2 mmol/L (P=0.006) and total cholesterol (TC) 4.7±1.5 mmol/L (P=0.001). Almost a third (28.2%) developed cardiac complications, five (1.6%) presented with unstable angina, six (2.0%) as non-ST segment elevation myocardial infarction (NSTEMI), three (1.0%) had ST segment elevation myocardial infarction (STEMI), and 19 (6.3%) had heart failure. A small proportion (17.3%) had a percutaneous coronary intervention, 27 (9.0%) had single-vessel disease, 12 (4.0%) two-vessel disease, and 13 (4.3%) three-vessel disease. Conclusions Many physicians do not pay attention to HTG in everyday practice, although HTG contributes significantly to the occurrence of coronary heart disease. In our study, the majority had mixed hyperlipidemia. One-third of patients with high triglycerides developed ischemic heart disease. The use of fenofibrate and gemfibrozil was not high. A low occurrence of pancreatitis was noted in our series.
