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Boscolo A, Pettenuzzo T, Sella N, Zatta M, Salvagno M, Tassone M, Pretto C, Peralta A, Muraro L, Zarantonello F, Bruni A, Geraldini F, De Cassai A, Navalesi P. Noninvasive respiratory support after extubation: a systematic review and network meta-analysis. Eur Respir Rev 2023; 32:32/168/220196. [PMID: 37019458 PMCID: PMC10074166 DOI: 10.1183/16000617.0196-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/08/2022] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND The effect of noninvasive respiratory support (NRS), including high-flow nasal oxygen, bi-level positive airway pressure and continuous positive airway pressure (noninvasive ventilation (NIV)), for preventing and treating post-extubation respiratory failure is still unclear. Our objective was to assess the effects of NRS on post-extubation respiratory failure, defined as re-intubation secondary to post-extubation respiratory failure (primary outcome). Secondary outcomes included the incidence of ventilator-associated pneumonia (VAP), discomfort, intensive care unit (ICU) and hospital mortality, ICU and hospital length of stay (LOS), and time to re-intubation. Subgroup analyses considered "prophylactic" versus "therapeutic" NRS application and subpopulations (high-risk, low-risk, post-surgical and hypoxaemic patients). METHODS We undertook a systematic review and network meta-analysis (Research Registry: reviewregistry1435). PubMed, Embase, CENTRAL, Scopus and Web of Science were searched (from inception until 22 June 2022). Randomised controlled trials (RCTs) investigating the use of NRS after extubation in ICU adult patients were included. RESULTS 32 RCTs entered the quantitative analysis (5063 patients). Compared with conventional oxygen therapy, NRS overall reduced re-intubations and VAP (moderate certainty). NIV decreased hospital mortality (moderate certainty), and hospital and ICU LOS (low and very low certainty, respectively), and increased discomfort (moderate certainty). Prophylactic NRS did not prevent extubation failure in low-risk or hypoxaemic patients. CONCLUSION Prophylactic NRS may reduce the rate of post-extubation respiratory failure in ICU patients.
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Affiliation(s)
- Annalisa Boscolo
- Department of Medicine (DIMED), University of Padua, Padova, Italy
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padova, Italy
- These authors contributed equally to this work
| | - Tommaso Pettenuzzo
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padova, Italy
- These authors contributed equally to this work
| | - Nicolò Sella
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padova, Italy
| | - Matteo Zatta
- Department of Medicine (DIMED), University of Padua, Padova, Italy
| | - Michele Salvagno
- Department of Medicine (DIMED), University of Padua, Padova, Italy
| | - Martina Tassone
- Department of Medicine (DIMED), University of Padua, Padova, Italy
| | - Chiara Pretto
- Department of Medicine (DIMED), University of Padua, Padova, Italy
| | - Arianna Peralta
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padova, Italy
| | - Luisa Muraro
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padova, Italy
| | | | - Andrea Bruni
- Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Federico Geraldini
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padova, Italy
| | - Alessandro De Cassai
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padova, Italy
| | - Paolo Navalesi
- Department of Medicine (DIMED), University of Padua, Padova, Italy
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padova, Italy
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De Cassai A, Tassone M, Geraldini F, Sergi M, Sella N, Boscolo A, Munari M. Trial Sequential Analysis explained using a post-hoc analysis of meta-analyses published in Korean Journal of Anesthesiology. Korean J Anesthesiol 2021; 74:383-393. [PMID: 34283909 PMCID: PMC8497914 DOI: 10.4097/kja.21218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background Trial sequential analysis (TSA) is a recent cumulative meta-analysis method used to weigh type I and II errors and to estimate when the effect is large enough to be unaffected by further studies. The aim of this study was to illustrate possible TSA scenarios and their significance using meta-analyses published in the Korean Journal of Anesthesiology (KJA) as working material. Methods We performed a systematic medical literature search for meta-analyses published in the KJA. TSA was performed on each main outcome, estimating the required sample size on the calculated effect size for the intervention, considering a type I error of 5% and a power of 90% or 99%. Results Six meta-analyses with a total of ten main outcomes were included in the analysis. Seven TSAs confirmed the results of the meta-analyses. However, only three of them reached the required sample size. In the two TSAs, the cumulative z-lines were not statistically significant. One TSA boundary for effect was reached with the 90% analysis, but not with the 99% analysis. Conclusions In TSA, a meta-analysis pooled effect may be established to assess if the cumulative sample size is large enough. TSA can be used to add strength to the conclusions of meta-analyses; however, pre-registration of the TSA protocol is of paramount importance. This study could be useful to better understand the use of TSA as an additional statistical tool to improve meta-analysis quality.
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Affiliation(s)
- Alessandro De Cassai
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Martina Tassone
- UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Federico Geraldini
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Massimo Sergi
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Nicolò Sella
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Annalisa Boscolo
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Marina Munari
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
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Scarano E, Tassone M, Graziano C, Gibertoni D, Tamburrino F, Perri A, Gnazzo M, Severi G, Lepri F, Mazzanti L. Novel Mutations and Unreported Clinical Features in KBG Syndrome. Mol Syndromol 2019; 10:130-138. [PMID: 31191201 DOI: 10.1159/000496172] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 01/06/2023] Open
Abstract
KBG syndrome is an autosomal dominant disorder caused by pathogenic variants within ANKRD11 or deletions of 16q24.3 which include ANKRD11. It is characterized by distinctive facial features, developmental delay, short stature, and skeletal anomalies. We report 12 unrelated patients where a clinical diagnosis of KBG was suspected and confirmed by targeted analyses. Nine patients showed a point mutation in ANKRD11 (none of which were previously reported) and 3 carried a 16q24.3 deletion. All patients presented with typical facial features and macrodontia. Skeletal abnormalities were constant, and the majority of patients showed joint stiffness. Three patients required growth hormone treatment with a significant increase of height velocity. Brain malformations were identified in 8 patients. All patients showed behavioral abnormalities and most had developmental delay. Two patients had hematological abnormalities. We emphasize that genetic analysis of ANKRD11 can easily reach a detection rate higher than 50% thanks to clinical phenotyping, although it is known that a subset of ANKRD11-mutated patients show very mild features and will be more easily identified through the implementation of gene panels or exome sequencing. Joint stiffness was reported previously in few patients, but it seems to be a common feature and can be helpful for the diagnosis. Hematological abnormalities could be present and warrant a specific follow-up.
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Affiliation(s)
- Emanuela Scarano
- Rare Disease Unit, Department of Pediatrics, St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Martina Tassone
- Rare Disease Unit, Department of Pediatrics, St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Graziano
- Unit of Medical Genetics, Department of Medical and Surgical Sciences, University Alma Mater Studiorum, St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Dino Gibertoni
- Unit of Hygiene and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University Alma Mater Studiorum, Bologna, Italy
| | - Federica Tamburrino
- Rare Disease Unit, Department of Pediatrics, St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Annamaria Perri
- Rare Disease Unit, Department of Pediatrics, St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Gnazzo
- Laboratory of Medical Genetics, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Giulia Severi
- Unit of Medical Genetics, Department of Medical and Surgical Sciences, University Alma Mater Studiorum, St. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesca Lepri
- Laboratory of Medical Genetics, Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Laura Mazzanti
- Rare Disease Unit, Department of Pediatrics, St. Orsola-Malpighi Hospital, Bologna, Italy
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Hui L, Pertile M, Tassone M, Bruno D. Minimal impact of maternal intravenous immunoglobulin infusion on cell-free DNA sequencing for fetal aneuploidy. Ultrasound Obstet Gynecol 2016; 48:250. [PMID: 26643390 DOI: 10.1002/uog.15803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/27/2015] [Indexed: 06/05/2023]
Affiliation(s)
- L Hui
- Perinatal Medicine, Mercy Hospital for Women, Heidelberg, VIC, Australia
- Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
- Public Health Genetics, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - M Pertile
- Cytogenetics, Victorian Clinical Genetics Services, Parkville, VIC, Australia
- Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - M Tassone
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - D Bruno
- Cytogenetics, Victorian Clinical Genetics Services, Parkville, VIC, Australia
- Translational Genomics Unit, Murdoch Childrens Research Institute, Parkville, VIC, Australia
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Abstract
A case of severe ovarian hyperstimulation syndrome (OHSS) prompted us to review our experience of the condition, and to critically evaluate its clinical associations and treatment. Severe OHSS complicated 1.8% of gamete intra-Fallopian transfer (GIFT) cycles, but none of the ovulation induction and artificial insemination by husband (OI/AIH) cycles. It is difficult to establish whether the higher pregnancy rate observed with OHSS was attributable to pregnancy increasing the risk of OHSS, or if it was the development of OHSS which increased the likelihood of pregnancy. Monitoring serum oestradiol levels and ultrasonographic evaluation of growing follicles may be helpful in identifying women at risk. Strategies for reducing the risk of developing severe OHSS were considered.
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Affiliation(s)
- M Tassone
- Reproductive Medicine Clinic, Mercy Hospital for Women, East Melbourne, Victoria
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