BackgroundPrevious studies have shown that an awake prone position may be beneficial for the treatment of acute respiratory distress syndrome (ARDS) or acute hypoxic respiratory failure (AHRF) in patients with COVID-19, but the results are not consistent, especially in terms of oxygenation outcomes and intubation rate. This systematic review and meta-analysis assessed the effects of the awake prone position on AHRF in patients with COVID-19 with all randomized controlled trials (RCTs).MethodsAn extensive search of online databases, including MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials from 1 December 2019 to 30 October 2022, with no language restrictions was performed. This systematic review and meta-analysis are based on the PRISMA statement. We only included RCTs and used the Cochrane risk assessment tool for quality assessment.ResultsFourteen RCTs fulfilled the selection criteria, and 3,290 patients were included. A meta-analysis found that patients in the awake prone position group had more significant improvement in the SpO2/FiO2 ratio [mean difference (MD): 29.76; 95% confidence interval (CI): 1.39–48.13; P = 0.001] compared with the usual care. The prone position also reduced the need for intubation [odd ratio (OR): 0.72; 95% CI: 0.61 to 0.84; P < 0.0001; I2 = 0%]. There was no significant difference in mortality, hospital length of stay, incidence of intensive care unit (ICU) admission, and adverse events between the two groups.ConclusionThe awake prone position was a promising intervention method, which is beneficial to improve the oxygenation of patients with ARDS or AHRF caused by COVID-19 and reduce the need for intubation. However, the awake prone position showed no obvious advantage in mortality, hospital length of stay, incidence of ICU admission, and adverse events.Systematic review registrationInternational Prospective Register of Systematic Reviews (PROSPERO), identifier: CRD42022367885.
Background. Sufentanil is widely used during anesthesia induction. However, it can cause coughing via different mechanisms. This study is aimed at evaluating the effectiveness of a small dose of oxycodone and sufentanil in suppressing sufentanil-induced cough (SIC) during general anesthesia induction. Methods. Of the 174 patients scheduled for elective surgery, 144 were eligible and randomly divided into 3 groups ( n = 48 ). Five minutes before sufentanil bolus (0.4 μg/kg), patients in group O received 0.02 mg/kg oxycodone intravenously within 5 s, those in group S received 0.02 μg/kg sufentanil within 5 s, and those in group N received an equal volume of 0.9% normal saline within 5 s. Sufentanil was diluted to 5 μg/ml and administered within 5 s after pretreatment. The incidence and severity of cough in the three groups were evaluated within 1 minute after sufentanil injection during the anesthesia induction. Their mean arterial pressure (MAP) and heart rate (HR) were recorded at T0 (after entering the operation), T1 (3 minutes after pretreatment), T2 (before intubation), and T3 (1 minute after intubation). Results. The incidences of cough in group N, group O, and group S were 20 (41.6%), 7 (14.5%), and 6 (12.5%), respectively. Compared with group N, patients from group O and group S exhibited significantly reduced incidence and severity of cough, and the severity of cough in group O and group S was significantly reduced compared with group N ( P < 0.05 ). No significant differences in the rangeability of MAP and HR were noted at the four time points in the three groups ( P > 0.05 ). Conclusion. Preconditioning using intravenous oxycodone (0.02 mg/kg) or sufentanil (0.02 μg/kg) could represent an effective approach to reducing SIC in anesthesia induction and was associated with relatively stable hemodynamic state during general anesthesia. This trial is registered at Chinese Clinical Trial Registry with registration number ChiCTR1900021087.
Background: Sufentanil is widely used during anesthesia induction. However, sufentanil injections can cause cough through different mechanisms. This study aimed to evaluate the effectiveness of a small dose of oxycodone and sufentanil in suppressing sufentanil-induced cough (SIC) during general anesthesia induction.Methods: This prospective, randomized, controlled trial was conducted form February 12, 2019 to December 30, 2019. A total of 174 patients were scheduled for elective surgery, and 144 screened patients were randomly divided into 3 groups (n=48). Five minutes before sufentanil bolus (0.4 μg/kg), patients in group O received 0.02 mg/kg oxycodone intravenously within 5 s, those in group S received 0.02 μg/kg sufentanil within 5 s and those in group N received an equal volume of 0.9% normal saline within 5 s. Sufentanil was diluted to 5 μg/ml and administered within 5 s after pretreatment. The incidence and severity of cough in the three groups were evaluated within 1 minute after sufentanil injection during anesthesia induction. Mean arterial pressure (MAP) and heart rate (HR) were recorded at T0 (after entering the operation), T1 (3 minutes after pretreatment), T2 (before intubation), and T3 (1 minute after intubation).Results: The incidences of cough in group N, group O, and group S were 20 (41.6%), 7 (14.5%), and 6 (12.5%), respectively. Compared with group N, group O and group S exhibited significantly reduced incidence and severity of cough, and the severity of cough in group O and group S was dramatically reduced compared with that in group N (P<0.05). No significant differences in the rangeability of MAP and HR were noted at the four time points in the three groups (P> 0.05).Conclusion: Intravenous oxycodone (0.02 mg/kg) and sufentanil (0.02 μg/kg) represent effective approaches to reducing SIC in anesthesia induction and ensuring a relatively stable hemodynamic state during general anesthesia induction.Trial registration: Chinese Clinical Trial Registry (ChiCTR1900021087, registered date: January 28, 2019), http://www.chictr.org.cn
Background: Previous studies have shown that prone position may be beneficial for the treatment of acute respiratory distress syndrome (ARDS) or acute hypoxic respiratory failure (AHRF) in COVID-19 patients, but the results are not consistent, especially in terms of oxygenation outcomes and intubation rate. This systematic review and meta-analysis assessed the effects of prone position on AHRF in COVID-19 patients with all randomized controlled trials (RCTs). Methods: An extensive search of online databases, including MEDLINE, Embase, Web of Science and Cochrane Central Register of Controlled Trials from December 1, 2019 to October 30, 2022, with no language restrictions. This systematic review and meta-analysis are based on the PRISMA statement and has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) with the registered ID: CRD42022367885. We only included RCTs and used Cochrane risk assessment tool for quality assessment. Results: Twelve RCTs fulfilled the selection criteria and 3154 patients were included. Meta-analysis found that patients in prone position group had more significant improvement in the SpO2/FiO2 ratio (mean difference [MD]: 29.76; 95% confidence interval [CI]: 1.39 to 48.13; P=0.001) compared with usual care. Prone position also reduced the need for intubation (odd ratio [OR]: 0.72; 95% CI: 0.62 to 0.85; P<0.0001; I2=0%). There was no significant difference in mortality, hospital length of stay, incidence of intensive care unit (ICU) admission and adverse events between the two groups. Conclusions: Prone position was a promising intervention method, which is beneficial to improve the oxygenation of patients with ARDS or AHRF caused by COVID-19 and can reduce the need for intubation. However, prone position had no significant difference in mortality, hospital length of stay, incidence of ICU admission and adverse events.
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