SACM - United Kingdom
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9667
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Item Restricted Effectiveness of Adherence to Home Non-Invasive Ventilation (NIV) upon Hospitalisation Rate and Mortality of Chronic Obstructive Pulmonary Disease Patients with Chronic Hypercapnic Respiratory Failure: A Structured Literature Review.(Glasgow Caledonian University, 2024-08) Alomari, Osama; Sharp, KathrynIntroduction: Chronic Obstructive Pulmonary Disease (COPD) with Chronic Hypercapnic Respiratory Failure (CHRF) has a significant impact on hospitalisation rate and mortality. Non-invasive ventilation (NIV) is a clinically established home-based intervention; however, its impact on hospitalisation rate and mortality remains undetermined. Review Aim: This review aims to investigate existing literature to establish the impact of adherence to home NIV on reducing hospitalisation rate and mortality among patients with COPD and CHRF. Method: Between May 2024 and June 2024, this review conducted a systematic literature search of the primary medical databases (MEDLINE, Cochrane Library, CINAHL and Embase). A quality assessment was conducted using the Newcastle-Ottawa Quality Assessment tool and the National Heart, Lung, and Blood Institute (NIH) quality assessment tool. Findings: Six observational studies, involving 10,206 participants, analysed the impact of adherence to home NIV on hospitalisation rate and mortality. Five studies were considered to be high quality and one was moderate quality. Adherence to home NIV for at least four hours per day was associated with a significant reduction in hospitalisation rate and mortality. Conclusion: Adherence to home NIV significantly reduces hospitalisation rate and mortality among COPD patients with CHRF. These findings recommend the adoption of home NIV as a standard care practice for this population and emphasise the importance of patient compliance to maximise the therapeutic benefits of NIV. This review recommends that future research conducts additional randomised control trials (RCTs) to reinforce its initial findings.23 0Item Restricted Effectiveness of High Flow Nasal Oxygen in the Prevention of Intubation/Mechanical Ventilation in Adult Patients with Respiratory Failure: Using A Systematic Review and Meta-Analysis.(Queen Mary University of London, 2024-08-05) AlShammari, Mazen Khalaf; Parjam, ZolfaghariAims and Objectives: This systematic review is a study that evaluates the effectiveness of High Flow Nasal Oxygen (HFNO) in reducing the need for intubation and invasive mechanical ventilation in patients with acute respiratory failure (ARF). These findings are also compared with standardised oxygen therapy and non-invasive ventilation (NIV). The study also aims to analyse the effect of HFNO on clinical outcomes and patient mortality. Gaps in literature are also addressed and evidence-based suggestions are provided for the improvement of future research and clinical implementations. Methodology: MesH words were extracted and search strategy was formulated on the basis of these MesH words and alternative keywords on three databases: MedLine, Cochrane and Embase. A systematic review was conducted according to the PRISMA guidelines with primary and secondary screening, which revealed ten studies to be included. The Cochrane RoB tool was employed to undertake a risk of bias (RoB) analysis for randomized controlled trials (RCTs), whereas the quality of observational research was assessed using the Newcastle Ottawa Scale (NOS). Results: Ten studies were included in this systematic review, conducted in seven countries and four continents, with six of the included studies taking place in Europe. Six of the ten studies involved ARF secondary to COVID-19, while the rest included patients with heterogeneous secondary pathologies. The main intervention throughout the studies was the use of HFNO; however, the intervention structure varied. The primary outcomes included the rate of intubation and mortality rate, while secondary outcomes included the in-hospital length of stay, time to intubation, ventilator free days, and PaO2:FiO2 ratio. The adverse effects associated with HFNO use were also reported. A consistent improvement in the rates of intubation with a significant decline in comparison with standard oxygen therapy was also reported. The patient mortality showed a varying pattern, with some studies reporting a decreased mortality rate, some finding no significant difference and some with an increase in mortality. The studies also reported a reduction in the length of stay in the intensive care unit (ICU), but not in the emergency department. The number of ventilator-free days also declined with this intervention. The use of HFNO thus appears to be associated with an improvement in SaO2, PaO2:FiO2 ratio, and respiratory rate. Overall, the adverse events did not show a significant difference from standard therapy. Conclusion: HFNO has been associated with an improvement in both physiological and clinical parameters in patients with ARF, especially when considering the need for intubation. These changes reduce ventilator-associated complications. This study also addresses the gaps in literature and provides evidence-based suggestions for future research.25 0Item Restricted Characteristics and Outcomes of Chronic Bronchitis in Alpha-1 Antitrypsin Deficiency Related Lung Disease: A Retrospective Longitudinal Analysis(Saudi Digital Library, 2023-10) Alsaab, Sulaiman; Turner, Alice; Ellis, PaulAbstract Background: Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder associated with lung disease such as early-onset emphysema and chronic obstructive pulmonary disease (COPD). The presence of chronic bronchitis may accelerate disease progression in AATD patients, but few studies have specifically examined this phenotype. Objectives: To investigate the characteristics and outcomes such as FEV1 decline, DLCO decline, exacerbations frequency, and mortality of AATD patients with chronic bronchitis compared to those without chronic bronchitis. Methods: This retrospective cohort analysis utilised clinical data from the REDcap registry for 236 PiZZ and PiSZ AATD patients. Participants were categorised based on chronic bronchitis diagnosis and genotypes. Characteristics were compared between groups. Multiple linear regression analysis, logistic regression analysis, mixed linear model, and survival analysis are done to investigate outcomes including lung function decline, exacerbation frequency, and mortality among those patients. Results: Patients with chronic bronchitis (35% of the cohort) demonstrated significantly worse baseline lung function. FEV1 decline was steeper in PiZZ chronic bronchitis patients (-1.61% predicted/year, - 52 ml/year) versus PiZZ without chronic bronchitis (-1.07% predicted/year, - 31.5 ml/year). In the PiSZ genotype, the chronic bronchitis group similarly showed accelerated decline (-1.85% predicted/year, - 64 ml/year) versus the PiSZ without chronic bronchitis (-0.67% predicted/year, - 21 ml/year). Female sex was associated with higher odds of frequent exacerbations in both PiZZ and PiSZ individuals. There was no significance in terms of mortality between the groups. Conclusion: Chronic bronchitis in AATD is associated with impaired lung function and worse clinical outcomes compared to AATD alone. This high-risk phenotype warrants additional research into tailored interventions and closer monitoring. Larger longitudinal studies are needed to confirm the results and elucidate underlying mechanisms.19 0Item Restricted The Impact of Positive End-Expiratory Pressure on Mortality Rate among Patients with Acute Respiratory Distress Syndrome(Saudi Digital Library, 2023-08-23) Alrayes, Mashael; Hunter, JoannaBackground: High levels of Positive End-Expiratory Pressure (PEEP) have been found to potentially increase lung volume and improve oxygenation in patients with Acute Respiratory Distress Syndrome (ARDS). They also increase the risk of lung injury caused by overdistention. ARDS has a high mortality rate; however, the impact of increased PEEP on clinical outcomes in patients with ARDS is variable. Aim: The aim of this dissertation is to examine the available studies that compared the impact of high PEEP levels with that of low PEEP levels on the reduction of ARDS mortality rates. Methods: A comprehensive search of literature on Randomised Controlled Trials (RCTs) and cohort studies was conducted using four databases—MEDLINE, Embase, Cochrane Library and CINAHL (EBSCOhost) from the last 15 years to June 2023. The inclusion criteria were studies that examined the ARDS mortality rate in patients subjected to high PEEP levels (as the intervention group) and to low PEEP levels (as the control group). An automation tool was utilised, along with duplicates removal options through Endnote and Rayyan reference management tools. Results: A total of 1637 studies were identified. They were screened through the evaluation of their titles and abstracts and then, of their full text, in accordance with predetermined inclusion and exclusion criteria. Finally, seven studies were selected and included in this dissertation. Conclusion: The mortality reduction in patients with ARDS who received higher levels of PEEP did not differ significantly from that in patients with ARDS who received lower levels of PEEP.33 0Item Restricted The use of balanced crystalloids versus 0.9% normal saline among critically ill patients(Saudi Digital Library, 2023-11-01) Alotaibi, Amjad; Al-Haddad, MoBackground: Intravenous (IV) fluid administration is a fundamental element of critical care management. Balanced crystalloids and 0.9% normal saline are commonly used for resuscitation and maintenance among critically ill patients. However, the impact of fluid composition on critically ill patient outcomes remains uncertain. Aim: The current systematic literature search aimed to assess, through a comparison with 0.9% normal saline, whether the use of balanced crystalloids for resuscitation and maintenance reduces the mortality rate of critically ill patients. Methods: On June 6, 2023, a comprehensive systematic literature search was carried out by using the MEDLINE (OVID), Embase (OVID), Cochrane Library, CINAHL (EBSCOhost), and Scopus databases. Predefined study selection criteria were formulated to select the relevant articles. Results: The search yielded 2,614 articles. Seven studies—three randomised controlled trials with a total of 31,891 patients and four cohort studies with a total of 7,969 patients— met the inclusion criteria. The findings of the included studies were inconsistent. Evidence from well-conducted studies showed that, compared to 0.9% normal saline, the use of balanced crystalloids did not lower the mortality rate. The other cohort studies found that the administration of balanced crystalloids reduced the mortality rate. However, the quality of the cohort studies was considered weak based on the existing evidence. Conclusion: Compared to 0.9% normal saline, the use of balanced crystalloids did not decrease the mortality rate of critically ill patients.12 0Item Restricted Determinants of In-Hospital Mortality of Patients Receiving Ward-Based Non-invasive Ventilation for Acute Hypercapnic Respiratory Failure(Saudi Digital Library, 2023-08-25) Alqahtani, Ahmed S.; Mukherjee, RahulIntroduction: Door-to-mask time is a quality metric for Non-Invasive Ventilation (NIV) treatment that is applicable across the United Kingdom. This study examined the efficacy of this metric in predicting in-hospital mortality, alongside other variables including maximum IPAP, age, and degree of acidosis after rigorous infection control measures were introduced during COVID-19 pandemic that led to substantial delays in the provision of NIV treatment. Methods: All acute NIV applications for hypercapnic respiratory failure (AHRF) pre- and post-pandemic were included in this study (April – December 2019 and April – December 2021). Mann-Whitney U test and Chi-squared test were used for continuous and categorical variables, respectively. ANOVA test was used for the analysis of variance of mean door-to-mask time and mean maximum IPAP, and logistic regression was used to predict in-hospital death adjusted odds ratios across both cohorts combined. Results: From 2019 to 2021 total patients receiving NIV decreased by 26.2% (83 vs 45). There was not a significant difference in patients age across cohorts (p=0.93). Indications for NIV treatment was not significantly different, the majority received NIV treatment for COPD 87 (66.9%) vs 63 (65.6%) in 2019 and 2021, respectively. Door-to-mask time was significantly increased, 5.45 to 10.85 hours (p<0.001). However, in-hospital deaths were not significantly different, 27 (20.8%) vs 28 (29.2%) (p=0.15). Age and degree of acidosis affected significantly in-hospital mortality, odds ratio (95% CI), 1.037 (1.01, 1.07) (p=0.02) and 0.009 (0.00, 0.70) (p=0.03), respectively. However, door to mask time did not significantly affect odds ratio of in-hospital mortality, 1.004 (1.00, 1.01), (p=0.07). Prolonged door-to-mask time and lower maximum IPAP were associated with higher in-hospital mortality, (p=0.045) and (p=0.048), respectively. Conclusion: Within this cohort, age and degree of acidosis were independent predictors of in-hospital mortality. However, door-to-mask time was not a strong predictor of in-hospital mortality, despite the association observed between prolonged door-to-mask times and higher mortality rates. Hence further research on door-to-mask time is necessary to explore its association with increased in-hospital mortality.15 0