The early, appropriate management of acute onset dyspnea is important but often challenging. The aim of this study was to investigate the effects of the use of Point-of-Care Ultrasound (PoCUS) versus conventional management on clinical outcomes in patients with acute onset dyspnea. The Cochrane Library, MEDLINE, EMBASE and reference lists were searched to identify eligible trials (inception to October 14, 2021). There were no language restrictions. Randomized controlled trials (RCTs), and prospective and retrospective cohort studies that compared PoCUS with conventional diagnostic modalities (controls) in patients with acute onset dyspnea were included. Two independent reviewers extracted data and assessed the risk of bias. Disagreements were resolved by consensus. The primary study outcomes were time to diagnosis, time to treatment, and length of stay (LOS). Secondary outcomes included rate of appropriate treatment, 30-day re-admission rate, and mortality. We included eight RCTs and six observational studies with a total of 5393 participants. Heterogeneity across studies was variable (from low to considerable), with overall low or moderate study quality and low or moderate risk of bias (except one article with serious risk of bias). Time to diagnosis (mean difference [MD], − 63 min; 95% CI, − 115 to − 11 min] and time to treatment (MD, − 27 min; 95% CI − 43 to − 11 min) were significantly shorter in the PoCUS group. In-hospital LOS showed no differences between the two groups, but LOS in the Intensive Care Unit (MD, − 1.27 days; − 1.94 to − 0.61 days) was significantly shorter in the PoCUS group. Patients in the PoCUS group showed significantly higher odds of receiving appropriate therapy compared to controls (odds ratio [OR], 2.31; 95% CI, 1.61–3.32), but there was no significant effect on 30-day re-admission rate and in-hospital or 30-day mortality. Our results indicate that PoCUS use contributes to early diagnosis and better outcomes compared to conventional methods in patients admitted with acute onset dyspnea. Graphical abstract
Introduction Critically ill patients admitted to the ICU have been shown to be at risk of developing acute liver dysfunction usually as part of multiorgan failure sequelae. Clearing the blood from toxic liver-related metabolites and cytokines could prevent further organ damage. Despite the increasing use of hemoadsorption for this purpose, evidence of its efficacy is lacking. Objectives To appraise the evidence for the efficacy of hemoadsorption (HA) treatment for critical illness-associated acute liver dysfunction. Methods A systematic search was conducted on Pubmed, Embase, Scopus, CENTRAL, and Web of Science (PROSPERO registration: CRD42022286213). The target population was patients with acute liver dysfunction or failure associated with critical illness and treated with HA. Outcomes of interest were pre- and post-treatment changes in organ functions and mortality. Results The search yielded 30eligible publications between 2011 and 2023, which reported the use of HA for a total of 335patients who presented with liver dysfunction related to acute critical illness. Of those, 26are case presentations (n=84), three are observational studies (n=142) and one is a registry analysis (n=109). Analysis of data from individual cases showed a significant reduction in levels of AST (p = 0.03) and vasopressor need (p = 0.03), and a tendency to lower levels of total bilirubin, ALT,CRP, and creatinine. Pooled data showed a significant reduction in total bilirubin (mean difference of -4.79 mg/dL [95% CI: -6.25; -3.33], p=0.002). In the case of creatinine, the post-treatment mean values were smaller as well; however, the difference was not significant (mean difference: -0.38mg/dL [95% CI:-1.27; 0.5],p=0.203). Evidence is lacking on the effect of HA on mortality. No device-related adverse events were reported. Conclusions The use of HA for critically ill patients with acute liver dysfunction or failure seems to be safe and yields a trend towards improved liver function after therapy, but more high-quality evidence is crucially needed.
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