Abstract-The effect of continuous positive airway pressure (CPAP) on blood pressures (BPs) in patients with resistant hypertension and obstructive sleep apnea is not established. We aimed to evaluate it in a randomized controlled clinical trial, with blinded assessment of outcomes. Four hundred thirty-four resistant hypertensive patients were screened and 117 patients with moderate/severe obstructive sleep apnea, defined by an apnea-hypopnea index ≥15 per hour, were randomized to 6-month CPAP treatment (57 patients) or no therapy (60 patients), while maintaining antihypertensive treatment. Clinic and 24-hour ambulatory BPs were obtained before and after 6-month treatment. Primary outcomes were changes in clinic and ambulatory BPs and in nocturnal BP fall patterns. Intention-to-treat and per-protocol (limited to those with uncontrolled ambulatory BPs) analyses were performed. Patients had mean (SD) 24-hour BP of 129 (16)
Purpose: Intravenous maintenance fluid therapy (IV-MFT) prescribing in acute and critically ill children is very variable among pediatric health care professionals. In order to provide up to date IV-MFT guidelines, the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) undertook a systematic review to answer the following five main questions about IV-MFT: (i) the indications for use (ii) the role of isotonic fluid (iii) the role of balanced solutions (iv) IV fluid composition (calcium, magnesium, potassium, glucose and micronutrients) and v) and the optimal amount of fluid.Methods: A multidisciplinary expert group within ESPNIC conducted this systematic review using the Scottish Intercollegiate Guidelines Network (SIGN) grading method. Five databases were searched for studies that answered these questions, in acute and critically children (from 37 weeks gestational age to 18 years), published until November 2020. The quality of evidence and risk of bias were assessed, and meta-analyses were undertaken when appropriate. A series of recommendations was derived and voted on by the expert group to achieve consensus through two voting rounds.Results: 56 papers met the inclusion criteria, and 16 recommendations were produced. Outcome reporting was inconsistent among studies. Recommendations generated were based on a heterogeneous level of evidence, but consensus within the expert group was high. "Strong consensus" was reached for 11/16 (69%) and "consensus" for 5/16 (31%) of the recommendations.
To Editor, We read the interesting article from Supino and colleagues [4]. The use of ultrasound in bronchiolitis diagnosis is an emerging topic. The validation of ultrasound scores integrated with clinical ones may allow the reduction of chest x-ray use [2]. Recent studies have shown the validity of ultrasound compared with chest x-ray in bronchiolitis [1]. The score used in this study is simple and easy; this can increase the inter-observer agreement. The aim of this study is to evaluate the predictivity for the need of respiratory support; it could be very useful for therapy and hospitalization or pediatric intensive care admission. Although studies that used other ultrasound scores [3] have shown a good correlation between ultrasound and clinical score, there are some key aspects to clarify for a proper clinical extrapolation. First, in this study, the correlation between the two scores was not evaluated although this was one of the study aims. Why? It could be interesting also to explain the reason why there is no correlation between the ultrasound score and the oxygen saturation on Emergency Department admission, which is an important parameter for the decision about respiratory support [5]. Secondly, the study shows a correlation between the ultrasound score and oxygen therapy duration, but the linear regression showed that includes the clinical score is the only explanatory variable: does it depend on the validity of the ultrasound score compared with the clinical score? This has important impact on clinical decisions. We agree that the ultrasound is repeatable; this would allow to follow the evolution of bronchiolitis; it would have been interesting to calculate the ultrasound score in various moments after Emergency Department admission to assess its ability to anticipate the patient's clinical deterioration. Multicenter studies on larger populations including patients even with severe bronchiolitis are required.
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