Efficacy and safety of unrestricted visiting policy for critically ill patients: a meta-analysis.

AIM: To compare the safety and effects of unrestricted visiting policies (UVPs) and restricted visiting policies (RVPs) in intensive care units (ICUs) with respect to outcomes related to delirium, infection, and mortality. METHODS: MEDLINE, Cochrane Library, Embase, Web of Science, CINAHL, CBMdisc, CNKI, Wanfang, and VIP database records generated from their inception to 22 January 2022 were searched. Randomized controlled trials and quasi-experimental studies were included. The main outcomes investigated were delirium, ICU-acquired infection, ICU mortality, and length of ICU stay. Two reviewers independently screened studies, extracted data, and assessed risks of bias. Random­effects and fixed-effects meta­analyses were conducted to obtain pooled estimates, due to heterogeneity. Meta-analyses were performed using RevMan 5.3 software. The results were analyzed using odds ratios (ORs), 95% confidence intervals (CIs), and standardized mean differences (SMDs). RESULTS: Eleven studies including a total of 3741 patients that compared UVPs and RVPs in ICUs were included in the analyses. Random effects modeling indicated that UVPs were associated with a reduced incidence of delirium (OR = 0.4, 95% CI 0.25-0.63, I2 = 71%, p = 0.0005). Fixed-effects modeling indicated that UVPs did not increase the incidences of ICU-acquired infections, including ventilator-associated pneumonia (OR = 0.96, 95% CI 0.71-1.30, I2 = 0%, p = 0.49), catheter-associated urinary tract infection (OR 0.97, 95% CI 0.52-1.80, I2 = 0%, p = 0.55), and catheter-related blood stream infection (OR = 1.15, 95% CI 0.72-1.84, I2 = 0%, p = 0.66), or ICU mortality (OR = 1.03, 95% CI 0.83-1.28, I2 = 49%, p = 0.12). Forest plotting indicated that UVPs could reduce the lengths of ICU stays (SMD = - 0.97, 95% CI - 1.61 to 0.32, p = 0.003). CONCLUSION: The current meta-analysis indicates that adopting a UVP may significantly reduce the incidence of delirium in ICU patients, without increasing the risks of ICU-acquired infection or mortality. Further large-scale, multicenter studies are needed to confirm these indications.

Enhanced recovery after surgery management of perioperative period in surgical lung cancer patients: protocol for a systematic review and meta-analysis of randomised controlled trials.

INTRODUCTION: Enhanced recovery after surgery (ERAS) has been widely used in the perioperative period of lung cancer surgery. However, there remains a lack of comprehensive and systematic evidence on the effectiveness and safety of ERAS. This study aims to evaluate the efficacy and safety of ERAS in patients with lung cancer. METHODS AND ANALYSIS: Eight databases (PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, VIP and WANFANG) will be searched from inception to November 2021. Two reviewers will independently screen studies, extract data of interest and assess the risk of bias. The revised risk of bias tool 2 will be used to assess the risk of bias in randomised controlled trials. We will use the Grading of Recommendations, Assessment, Development and Evaluations to assess the certainty of evidence. We will carry out a random-effect meta-analysis focusing on the efficacy and safety variables. All analyses will be conducted using RevMan V.5.3. ETHICS AND DISSEMINATION: Since the study will be a systematic review and will not involve direct contact with patients or make alterations to patient care, ethical approval and informed consent are not required for this study. The results of this review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42021250761.

Chinesisation, adaptation and validation of the Chelsea Critical Care Physical Assessment Tool in critically ill patients: a cross-sectional observational study.

PURPOSE: To translate and adapt the Chelsea Critical Care Physical Assessment Tool (CPAx) into Chinese version ('CPAx-Chi'), test the reliability and validity of CPAx-Chi, and verify the cut-off point for the diagnosis of intensive care unit-acquired weakness (ICU-AW). STUDY DESIGN: Cross-sectional observational study. METHODS: Forward and back translation, cross-cultural adaptation and pretesting of CPAx into CPAx-Chi were based on the Brislin model. Participants were recruited from the general ICU of five third-grade class-A hospitals in western China. Two hundred critically ill adult patients (median age: 53 years; 64% men) with duration of ICU stay ≥48 hours and Glasgow Coma Scale ≥11 were included in this study. Two researchers simultaneously and independently assessed eligible patients using the Medical Research Council Muscle Score (MRC-Score) and CPAx-Chi. RESULTS: The content validity index of items was 0.889. The content validity index of scale was 0.955. Taking the MRC-Score scale as standard, the criterion validity of CPAx-Chi was r=0.758 (p<0.001) for researcher A, and r=0.65 (p<0.001) for researcher B. Cronbach's α was 0.939. The inter-rater reliability was 0.902 (p<0.001). The area under the receiver operating characteristic curves of CPAx-Chi for diagnosing ICU-AW based on MRC-Score ≤48 were 0.899 (95% CI 0.862 to 1.025) and 0.874 (95% CI 0.824 to 0.925) for researcher B. The best cut-off point for CPAx-Chi for the diagnosis of ICU-AW was 31.5. The sensitivity was 87% and specificity was 77% for researcher A, whereas it was 0.621, 31.5, 75% and 87% for researcher B, respectively. The consistency was high when taking CPAx-Chi ≤31 and MRC-Score ≤48 as the cut-off points for the diagnosis of ICU-AW. Cohen's kappa=0.845 (p=0.02) in researcher A and 0.839 (p=0.04) for researcher B. CONCLUSIONS: CPAx-Chi demonstrated content validity, criterion-related validity and reliability. CPAx-Chi showed the best accuracy in assessment of patients at risk of ICU-AW with good sensitivity and specificity at a recommended cut-off of 31.

[Early mobilization on mortality of patients with mechanical ventilation in intensive care unit after discharge: a Meta-analysis].

OBJECTIVE: To evaluate the effect of early mobilization on mortality in intensive care unit (ICU) patients with mechanical ventilation after discharge by Meta-analysis. METHODS: Databases including SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang data, PubMed, the Cochrane Library, Web of Science, and Embase were searched from inception to September 17th, 2020, to collect randomized controlled trials (RCT) about early mobilization on mortality of patients with mechanical ventilation in ICU after discharge, the references included in the literature were traced. The control group was given routine care, the experimental group was given early mobilization on the basis of the control group, including passive or active mobilization on the bed, sitting on the bed, standing by the bed, transferring to the bedside chair and assisting walking. The literature screening, data extracting, and the bias risk assessment of included studies were conducted independently by two reviewers. Stata 12.0 software was then used to perform Meta-analysis. Funnel plot was used to test publication bias. RESULTS: A total of 10 RCT studies involving 1 323 patients were included, with 660 patients in the control group and 663 patients in the experimental group. The results of literature quality evaluation showed that 7 studies were grade A and 3 studies were grade B, indicating that the overall quality of included literatures was high. The Meta-analysis results showed that early mobilization did not increase the mortality of patients with mechanical ventilation in ICU after discharge [odds ratio (OR) = 0.92, 95% confidence interval (95%CI) was 0.75-1.13, P = 0.449]. Subgroup analysis results showed that early mobilization had a tendency to reduce the mortality of ICU patients with mechanical ventilation at 3, 6 and 12 months after discharge, but the difference was not statistically significant (3-month mortality: OR = 1.02, 95%CI was 0.74-1.40, P = 0.927; 6-month mortality: OR = 0.95, 95%CI was 0.70-1.27, P = 0.712; 12-month mortality: OR = 0.60, 95%CI was 0.33-1.10, P = 0.101). Funnel plot showed that the distribution of included literatures was not completely symmetrical, suggesting that publication bias might exist. CONCLUSIONS: Early mobilization does not increase the mortality of ICU patients with mechanical ventilation after discharge. Although it tends to have a favorable outcome in reducing mortality, and has a trend to reduce the mortality. However, due to the small number of included literatures, small sample size and differences in the specific implementation of early mobilization among various studies, a large number of high-quality RCT studies are still needed for further verification.

Clinical efficacy of high-flow nasal humidified oxygen therapy in patients with hypoxemia.

To evaluate the effectiveness of high-flow nasal humidified oxygen (HFNHO) therapy in patients with mild hypoxemia after extubation. This study included 316 patients with mild hypoxemia after extubation from May 2016 to May 2018 from two intensive care units in China. Compare the effects of the Venturi Mask and High-Flow Nasal Humidified Oxygen (HFNHO) therapy on Heart Rate (HR), Respiratory Rate (RR), Oxygen Saturation (SpO2), Oxygen Partial Pressure (PO2), Partial Pressure Of Carbon Dioxide (PCO2), Oxygenation Index (PO2/FiO2) after extubation, the use of noninvasive mechanical ventilation and tracheal intubation after treatment failure were observed and recorded. Patients have both lower HR and RR than those who received mask treatment (75.4±18.5 vs. 83.0±20.4, p = 0.0004; 18±6.5 vs. 23.6±10.3, p<0.001, respectively). There was significant difference between those who had HFNHO and mask administration's SpO2 and PO2 (94.1±6.4 vs. 87.5±1.5, p<0.001; 88.16±2.9 vs. 77.3±2.3, p<0.001, respectively). For the HFNHO group, patients had lower PCO2 with the mask group. (41.3±0.99 vs 42.2±1.2, p<0.001). On the other hand, the levels of PO2/FiO2 was significantly higher in the HFNHO Group, (181.0±8.3 vs. 157.2±4.9, p<0.05). We concluded HFNHO therapy could significantly relieve the symptoms of dyspnea, improve oxygenation, reduce the use of noninvasive mechanical ventilation and reduce the rate of secondary tracheal intubation in patients with mild hypoxemia after extubation.

[High-flow nasal cannulae oxygen in patients with respiratory failure: a Meta-analysis].

OBJECTIVE: To systematically evaluate the efficacy of high-flow nasal cannulae oxygen (HFNC) in patients with respiratory failure. METHODS: Computerized PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP, Wanfang Database up to March 31st, 2017, all published available randomized controlled trials (RCTs) or cohort studies about HFNC therapy for patients with respiratory failure were searched. The control group was treated with face mask oxygen therapy (FM) or non-invasive positive pressure ventilation (NIPPV), while the experimental group was treated with HFNC. The main outcome measurements included endotracheal intubation rate, patient comfort, and the secondary outcome was in-hospital mortality. The quality of the literature was completed by two professionally trained evidence-based medical students, and meta-analysis was performed on quality-compliant literature. Funnel plot was used to analyze the publication bias. RESULTS: A total of 17 articles were enrolled including 15 RCTs and 2 cohort studies. There were 3 909 patients enrolled, 1 907 patients in HFNC group, and 2 002 in control group (1 068 patients with FM, and 934 with NIPPV). Meta-analysis showed that HFNC had a significant advantage over FM in reducing the tracheal intubation rate of patients with respiratory failure [odds ratio (OR) = 0.51, 95% confidence interval (95%CI) = 0.29-0.89, P = 0.02], but there was no significant difference as compared with that of NIPPV (OR = 0.80, 95%CI = 0.54-1.17, P = 0.25). It was shown by pooled analysis of two subgroups that compared with FM/NIPPV, HFNC had a significant advantage in reducing tracheal intubation rate in patients with respiratory failure (pooled OR = 0.66, 95%CI = 0.47-0.94, P = 0.02). Compared with FM, patients with respiratory failure were more likely to receive HFNC for comfort [standardized mean difference (SMD) = -0.41, 95%CI = -0.56 to -0.26, P < 0.000 01]. There was no significant difference in hospital mortality between HFNC and FM (OR = 0.82, 95%CI = 0.55-1.24, P = 0.35) or NIPPV (OR = 0.66, 95%CI = 0.37-1.17, P = 0.16). The results of pooled analysis of two subgroups were still unchanged (pooled OR = 0.75, 95%CI = 0.54-1.05, P = 0.09). It was shown by the funnel analysis that there was a bias in the study of tracheal intubation rate in the literature, while the bias of patient comfort and hospital mortality was low. CONCLUSIONS: Compared with FM, HFNC could reduce the rate of tracheal intubation in patients with respiratory failure, but no difference was found as compared with NIPPV. Compared with FM, HFNC made patients more comfortable, and it was easier to be accepted and tolerated. However, there was no difference in hospital mortality among FM, NIPPV, and HFNC.