Background-Supplement oxygen therapy is often administered to almost all intensive care unit patients (ICU) who require invasive mechanical ventilation (IMV). This conventional practice of oxygen therapy is often more liberal and results in hyperoxia without any evidence of benefit. This liberal approach with perception of safety, however, is now being challenged by the increasing recognition of the potential harm of hyperoxemia, excessive FiO2 and tissue hyperoxia. Supplemental oxygen exposes them to a high fraction of inspired oxygen (Fio2 ) and a higher-than-normal partial pressure of arterial oxygen (Pao2) and is associated with high mortality. Methods-Electronic databases ( Medline, Embase, Scopus, Cochrane) were searched from inception until December 15th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p<0.05. Data was extracted for studies including conservative oxygenation strategy with target SpO2 of 88-97% or a liberal oxygenation strategy with target SpO2 of ≥97%. The primary outcome of interest was all-cause mortality. Results-A total of six studies with 2381 participants ( Conservative=1193, Liberal=1188) were included in our analysis. Average follow-up duration was 85 days. There was no statistically significant difference between patients receiving conservative oxygen and liberal oxygen in terms of all-cause mortality (OR 1.03; 95%CI 0.76-1.39; p=0.86) Conclusion-In adults undergoing mechanical ventilation in the ICU, the use of conservative oxygen therapy, as compared with liberal oxygen therapy, did not significantly increase survival.
Background:Type I interferons such as Anifrolumab have been implicated in Systemic lupus erythematosus (SLE) pathogenesis on the basis of increased interferon-stimulated gene expression and genetic susceptibility. Little is known regarding its efficacy and safety profile.Objectives:To assess the efficacy and safety of Anifrolumab in patients with SLE.Methods:Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception until December 15th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p<0.05. The primary outcome of interest was British Isles Lupus Assessment Group (BILAG)-based Composite Lupus Assessment (BICLA). Secondary outcomes included the proportion of patients who achieved an SLE responder index of 4 (SRI-4) reduction of 50% or more in the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI), reductions in the glucocorticoid dose and adverse effects.Results:A total of three studies1,2,3 with 839 participants (Anifrolumab=372, Placebo=467) were included in our analysis. Follow-up duration was at week 52. A statistically significant different was observed in the Anifrolumab arm in terms of BICLA response (OR 0.44 95%CI 0.34-0.59;p < 0.00001, I2=4), ≥50% reduction in CLASI activity score (OR 0.36 95%CI 0.21-0.60;p=0.0001, I2=0), glucocorticoid reduction (OR 0.41 95%CI 0.28-0.59;p<0.00001; I2=0) and SRI-4 response (OR 0.52 95% CI 0.30-0.90; p=0.02, I2=75). However, Adverse events were less likely in the placebo arm as compared to Anifrolumab (OR 1.54 95%CI 1.05-2.25; p=0.03; I2=0).Conclusion:Anifrolumab was found to be more effective than placebo for the management of SLE, but may also cause more severe adverse effects.References:[1]Morand EF, Furie R, Tanaka Y, Bruce IN, Askanase AD, Richez C, Bae SC, Brohawn PZ, Pineda L, Berglind A, Tummala R; TULIP-2 Trial Investigators. Trial of Anifrolumab in Active Systemic Lupus Erythematosus. N Engl J Med. 2020 Jan 16;382(3):211-221. doi: 10.1056/NEJMoa1912196. Epub 2019 Dec 18. PMID: 31851795.[2]Furie R, Khamashta M, Merrill JT, Werth VP, Kalunian K, Brohawn P, Illei GG, Drappa J, Wang L, Yoo S; CD1013 Study Investigators. Anifrolumab, an Anti-Interferon-α Receptor Monoclonal Antibody, in Moderate-to-Severe Systemic Lupus Erythematosus. Arthritis Rheumatol. 2017 Feb;69(2):376-386. doi: 10.1002/art.39962. PMID: 28130918; PMCID: PMC5299497.[3]Furie RA, Morand EF, Bruce IN, et al. Type I interferon inhibitor anifrolumab in active systemic lupus erythematosus (TULIP-1): a randomised, controlled, phase 3 trial. Lancet Rheumatol 2019; 1(4):e208-e219.Disclosure of Interests:None declared
Background-Acute respiratory failure and Chronic obstructive pulmonary disease, often complicated by acute exacerbation (AECOPD) can result in significant morbidity and mortality. High-flow oxygen through the nasal cannula (HFNC) provides adequate oxygenation and can be used as an initial support strategy for patients with acute respiratory failure (ARF). However, the efficacy and safety of HFNC and Non-invasive ventilation (NIV) when treating ARF of different etiologies in various settings is unknown. Methods-Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception until December 15th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p<0.05. The primary outcome of interest was all-cause mortality at day 30. Secondary outcome was the proportion of patients who required endotracheal intubation. Results-A total of six studies with 709 participants (HFNC= 353, NIV= 356) were included in our analysis. Average follow-up duration was 30 days. A significant reduction in mortality was observed in patients receiving high flow nasal cannula oxygen therapy (OR 0.58 95%CI 0.35-0.95; p=0.03, I 2 =0) However, the proportion of patients requiring intubation was not significantly different between the two groups (OR 0.70 95%CI 0.47-1.03; p=0.07, I 2 =0) Conclusion-Amongst patients with Acute respiratory failure and Acute exacerbation of Chronic obstructive pulmonary disease, treatment with high-flow oxygen and noninvasive ventilation did not result in significantly different intubation rates. However, there was a significant difference in favor of high-flow oxygen therapy in 30-day mortality.
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