The effectiveness of hyaluronic acid in reducing adverse effects associated with inhaled hypertonic saline therapy in patients with cystic fibrosis: A systematic review and meta-analysis.

Background: Inhaled hypertonic saline (HS) is an effective mucolytic agent in patients with cystic fibrosis (CF). However, adverse events can impair the clinical utility of hypertonic saline (HS) in this patient population. In this study, we aimed to investigate the effectiveness of hyaluronic acid (HA) in reducing these adverse events. Methods: A literature search was conducted across three electronic databases (Medline, Cochrane Central, and EMBASE) from inception through February 2023. Randomized controlled trials (RCTs) assessing the impact of hyaluronic acid (HA) in reducing adverse events in patients taking hypertonic saline (HS) for CF were included in the analysis. Outcomes of interest included cough, throat irritation, unpleasant taste, and FEV1. Evaluations were reported as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CI). The Cochrane Risk of Bias Tool (CRBT) was employed to assess the quality of RCTs. The New Castle Ottawa Scale was used to assess the quality of observational studies. Results: From the 1960 articles retrieved from the initial search, five relevant studies (n=236 patients) were included in the final analysis. Compared with patients only on HS, patients with HS and HA were significantly less likely to experience cough (RR: 0.45; 95% CI, 0.28-0.72, p=0.001), throat irritation (RR: 0.43; 95% CI, 0.22-0.81, p= 0.009), and unpleasant smell (RR: 0.43; 95% CI, 0.23 - 0.80, p=0.09). In addition, patients with HS with HA had significantly less forced expiratory volume (FEV1) (MD: -2.97; 95% CI, -3.79-2.15, p=0.52) compared to patients only on HS. Discussion: The addition of HA to HS was linked to a better tolerability profile. When HS was coupled with HA, there was a reduction in all side effects. This may permit tolerance of the medication in otherwise difficult patients, improve adherence to patients receiving frequent inhalations, and improve therapeutic outcomes. Conclusion: The addition of HA is advantageous in CF patients who require continuous HS therapy and have previously shown poor tolerance to therapy.

Efficacy of hypertonic saline versus isotonic saline among children with cystic fibrosis: A systematic review and meta-analysis.

Background: Inhaled hypertonic saline (HS) reduces pulmonary exacerbations in patients with cystic fibrosis (CF) aged 6 or more years. However, the effectiveness of HS in improving clinical outcomes in younger children aged 6 or less years is not established. This study examines the efficacy of HS in younger CF patients. Methods: Searches were conducted across three databases (Medline, Cochrane Central and EMBASE) from inception through July 2022. Randomized controlled trials assessing the impact of HS in younger CF patients were included. Trials involving only patients greater than 6 years or control group other than isotonic saline (IS) were excluded. Outcomes measured included lung clearance index (LCI), cystic fibrosis questionnaire (CFQ-R) score, spirometry measures, oxygen saturation, respiratory rate, height and weight. Outcomes were reported as mean differences (MDs) with 95% confidence intervals. Results: Seven studies (n = 390 patients) were included in this review. HS significantly reduced the LCI (MD: -0.67; 95%CI, -1.05 to 0.29, P = 0.0006) compared to IS. In addition, HS was associated with significant improvements in height (MD: 2.23; 95%CI, -0.00 to 4.46, P = 0.05) and CFQ-R (MD: 4.30; 95%CI, 0.65-7.95, P = 0.02), but not in oxygen saturation (MD: -0.15; 95%CI, -0.54 to 0.25, P = 0.47), respiratory rate (MD: -0.21; 95%CI, -2.19 to 1.77, P = 0.83) or weight (MD: 0.70; 95%CI, -0.47 to 1.87, P = 0.24). Furthermore, HS did not significantly improve spirometry measures, including FEV1 (MD: -0.11; 95%CI, -0.21 to 0.43, P = 0.51) and forced vital capacity (MD: 0.27; 95%CI, -0.49 to 1.04, P = 0.48), but significantly improved FEF25-75 (MD: 0.12; 95% CI, 0.05-0.20; P = 0.002). Discussion: Treatment with HS in younger children with CF improves lung clearance, symptoms and quality of life. FEF25-75 may prove a more sensitive measure for assessing intervention related improvements in pediatric CF trials. Conclusion: The findings support HS as a therapeutic method in CF-affected children.

Uso profiláctico de apósitos de silicona para minimizar las lesiones por presión: revisión sistemática y metaanálisis / Prophylactic use of silicone dressing to minimize pressure injuries: Systematic review and meta-analysis

Objetivo: La prevención de las lesiones por presión (LPP) adquiridas en el hospital en pacientes críticos sigue siendo un reto clínico importante debido a su alto riesgo de comorbilidad asociada. Se evaluó la eficacia preventiva de los apósitos de silicona en los pacientes ingresados en las unidades de cuidados intensivos y en entornos no relacionados con dichas unidades. Métodos: Se realizó una búsqueda bibliográfica en 3bases de datos electrónicas (MEDLINE, EMBASE, Cochrane Central) desde el inicio hasta diciembre de 2021. Se incluyeron los estudios que evaluaban la eficacia de los apósitos de silicona en la incidencia de LPP en la zona sacra. Las evaluaciones se informaron como ratios de riesgo relativo (RR) con intervalos de confianza al 95% y el análisis se hizo mediante un modelo de efectos aleatorios. Resultados: De los 1.056 artículos recuperados en la búsqueda inicial, se incluyeron 11estudios en el análisis final. Los apósitos de silicona redujeron significativamente la incidencia de LPP en comparación con la atención habitual (RR: 0,30; IC 95%: 0,19-0,45; p<0,01). No se encontraron diferencias significativas entre los resultados de los estudios en contextos de cuidados intensivos (RR=0,25; IC 95%: 0,15-0,43; p<0,01) y en contextos de cuidados no intensivos (RR=0,38; IC 95%: 0,17-0,83; p=0,01) (interacción de p: 0,39). Los apósitos de silicona redujeron el riesgo de desarrollar LPP entre los pacientes que utilizaron el apósito de espuma de 5capas Border (Mepilex® Sacrum) (RR: 0,31; IC 95%: 0,20-0,48; p<0,01) y el apósito Allevyn Gentle Border® (RR: 0,10; IC 95%: 0,01-0,73; p=0,02) sin diferencias significativas tras el análisis de subgrupos (interacción de p: 0,27). Conclusión: El presente metaanálisis señala que los apósitos de silicona reducen de forma consistente la incidencia de las LPP en entornos de cuidados intensivos y no intensivos, independientemente del tipo de apósito utilizado.(AU)

Objective: Preventing hospital-acquired pressure injuries (PI) in critically ill patients remains a significant clinical challenge because of its associated high risk for comorbid conditions. We assessed the preventive effectiveness of silicone dressings among patients admitted in intensive care units and non-intensive care units settings. Methods:A literature search was conducted across 3electronic databases (MEDLINE, EMBASE, Cochrane Central) from inception through December 2021. Studies assessing the effectiveness of silicone dressing on the incidence of PI on the sacral area were included. evaluations were reported as risk ratios (RRs) with 95% confidence interval, and analysis was performed using a random-effects model. Results: Of the 1,056 articles retrieved from the initial search, 11studies were included in the final analysis. Silicone dressings significantly reduced the incidence of PI compared to usual care (RR: 0.30, 95%CI: 0.19-0.45, P<0.01). We found no significant difference between results of studies conducted in intensive care settings (RR=0.25, 95%CI: 0.15-0.43, P<0.01) and non-intensive care settings (RR=0.38, 95%CI: 0.17-0.83, P=0.01) (P-interaction: 0.39). Silicone dressings reduced the risk of developing PI among patients using five-layer foam Border dressing (Mepilex® Sacrum) (RR: 0.31, 95%CI: 0.20-0.48, P<0.01), and dressing Allevyn Gentle Border® (RR: 0.10, 95%CI: 0.01-0.73, P=0.02) with no significant difference upon subgroup analysis (P-interaction: 0.27). Conclusion: The present meta-analysis suggests that silicone dressings consistently reduce the incidence of PI in intensive as well as in non-intensive care settings, regardless of the type of dressing used.(AU)

Prophylactic use of silicone dressing to minimize pressure injuries: Systematic review and meta-analysis.

OBJECTIVE: Preventing hospital-acquired pressure injuries (PI) in critically ill patients remains a significant clinical challenge because of its associated high risk for comorbid conditions. We assessed the preventive effectiveness of silicone dressings among patients admitted in intensive care units and non-intensive care units settings. METHODS: A literature search was conducted across 3 electronic databases (MEDLINE, EMBASE, Cochrane Central) from inception through December 2021. Studies assessing the effectiveness of silicone dressing on the incidence of PI on the sacral area were included. Evaluations were reported as risk ratios (RRs) with 95% confidence interval, and analysis was performed using a random-effects model. RESULTS: Of the 1056 articles retrieved from the initial search, 11 studies were included in the final analysis. Silicone dressings significantly reduced the incidence of PI compared to usual care (RR: 0.30, 95% CI: 0.19-0.45, P<0.01). We found no significant difference between results of studies conducted in intensive care settings (RR=0.25, 95% CI: 0.15-0.43, P<0.01) and non-intensive care settings (RR=0.38, 95% CI: 0.17-0.83, P=0.01) (P-interaction: 0.39). Silicone dressings reduced the risk of developing PI among patients using five-layer foam Border dressing (Mepilex® Sacrum) (RR: 0.31, 95% CI: 0.20-0.48, P<0.01), and dressing Allevyn Gentle Border® (RR: 0.10, 95% CI: 0.01-0.73, P=0.02) with no significant difference upon subgroup analysis (P-interaction: 0.27). CONCLUSION: The present meta-analysis suggests that silicone dressings consistently reduce the incidence of PI in intensive as well as in non-intensive care settings, regardless of the type of dressing used.