RESUMO
Background: BackgroundThe effectiveness of non-invasive respiratory strategies, namely CPAP and HFNO, in reducing the risk of mortality and tracheal intubation in patients with severe COVID-19 is not well established. Methods: A thorough literature search was conducted across 3 electronic databases (Medline, EMBASE and Cochrane Central) from inception through July 2022. Randomized controlled trials (RCTs) and observational studies assessing the impact of CPAP or HFNO on clinical outcomes in patients infected with COVID-19 were considered for inclusion. End-points included all-cause mortality and risk of tracheal intubation. Evaluations were reported as risk ratios (RRs) with 95% confidence intervals (CI) and analysis was performed using a random effects model. I2 index was used to assess heterogeneity. Results: From the 1041 articles retrieved from initial search, 7 potentially relevant studies (n = 2831 patients) were included in the final analysis. Compared to conventional oxygen therapy, non-invasive respiratory strategies reduced the risk of tracheal intubation (RR = 0.84, [95% CI 0.72, 0.98]; p = 0.02, I2 = 43%) and all-cause mortality (RR = 0.83, [95% CI 0.71-0.97]; p = 0.02, I2 = 0%) in patients infected with COVID-19 However, reduction in length of hospital stay was not significant between the non-invasive respiratory group and conventional oxygen therapy (MD = -0.60, [95% CI -2.17 - 0.98]; p = 0.46, I2 = 26%). Conclusion: This meta-analysis supports the application of non-invasive respiratory strategy is feasible as it can delay the start of tracheal intubation and reduce mortality rates among patients infected with COVID-19.
RESUMO
Background: Thoracoabdominal aortic aneurysms (TAAAs) are associated with significant comorbidities. The aim of our study is to compare the outcomes of open repair versus endovascular repair of TAAAs. Methods: A thorough literature search was conducted on MEDLINE, Embase, and Cochrane Central databases. The analysis included observational studies comparing the outcomes of surgical vs endovascular aneurysm repair (EVAR) of TAAA. Mortality, spinal cord ischemia (SCI), renal failure, stroke, paraplegia, and respiratory and cardiac problems were all included in the studies. The results were provided as relative risks (RRs) with 95% confidence intervals (CIs). These were then aggregated using an inverse variance weighted random-effects model, and the pooled analysis was displayed using forest plots. Results: This meta-analysis compromising of twelve studies revealed significant results, favoring endovascular repair versus open surgery for all-cause mortality (HR = 1.91; 95% CI: 1.68-2.18; P < 0.00001), SCI (HR = 1.62; 95% CI: 1.18-2.21; P = 0.003), respiratory complications (HR = 2.22; 95% CI: 1.78-2.77; P < 0.00001), and cardiac complications (HR = 1.66; 95% CI: 1.38-2.00; P < 0.00001). Upon subgroup analysis based on propensity matched, results were consistent and significant for the outcomes of all-cause mortality, cardiac complications, and respiratory complications. For the propensity unmatched subgroup, the incidence of all-cause mortality, SCI, respiratory complications, and cardiac complications were lower among endovascular repair cohort. Conclusion: Current evidence supports the use of endovascular repair over open surgery. However, there is a need to conduct dedicated randomized controlled trials to effectively compare and determine the benefits and risk of both strategies.