Eman E. Shaban; Mohamed AM Elgassim; Ahmed Shaban; Amira Shaban; Amina Ahmed; Amro Abdelraman; Moayad Elgassim; Stuart A Lloyd; Hany A. Zaki
Articles in Press, Accepted Manuscript, Available Online from 06 October 2024
Abstract
Objective: The present study was performed to investigate the efficacy of different resuscitation fluids incritically ill patients presenting any type of hypovolemic shock.Methods: We comprehensively searched PubMed, Web of Science, ScienceDirect, Cochrane Library, andGoogle Scholar for randomized trials ...
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Objective: The present study was performed to investigate the efficacy of different resuscitation fluids incritically ill patients presenting any type of hypovolemic shock.Methods: We comprehensively searched PubMed, Web of Science, ScienceDirect, Cochrane Library, andGoogle Scholar for randomized trials published in English from January 1990 to August 2023. The risk of biasand methodological quality assessment was performed using Cochrane’s risk of bias tool embedded withinthe Review Manager software (RevMan 5.4.1). Moreover, this software was used to perform all the statisticalanalyses in the present study. During these analyses, the random effects model and 95% confidence intervalwas employed. The overall effect sizes for continuous and dichotomous data were calculated using the MeanDifference (MD) and Risk ratio (RR), respectively.Results: Our initial database search resulted in 4768 articles, of which only 16 were reviewed and analyzed.A subgroup analysis of data from 4 of these studies showed that hydroxyethyl starches (HES), gelatins andalbumins had no significant mortality benefit compared to crystalloids (RR: 0.94; 95% CI: 0.75–1.17; P=0.58,RR: 0.71; 95% 0.46–1.08; P=0.11 and RR: 1.05; 95% CI: 0.77–1.43; P=0.77, respectively). Similarly, a subgroupanalysis of data from 9 studies showed that hypertonic saline plus dextran (HSD) had no significant mortalitybenefit over normal saline (RR: 0.84; 95% CI: 0.62–1.13; P=0.24) or Lactated ringer’s solution (RR: 1.03; 95%CI: 0.75–1.42; P=0.87). In addition, we found that hypertonic saline had a similar effect on the overall mortalityas isotonic crystalloids (RR: 0.92; 95% CI: 0.68–1.25; P=0.60). Also, our analysis shows that modified fluidgelatins had a similar mortality effect as HES ((RR: 1.02; 95% CI: 0.52–2.02; P=0.95).Conclusion: Colloids, whether individually or in hypertonic crystalloids (HSD), had no mortality benefit overcrystalloids in adult patients with hypovolemic shock.
Hany A. Zaki; Yavuz Yigit; Mohamed AM Elgassim; Eman E. Shaban; Stuart A Lloyd; Thamir Hashim; Mazin SE Mohamed; Aftab Mohammad Azad
Volume 12, Issue 3 , July 2024, , Pages 103-110
Abstract
Objective: The present study aimed to evaluate the clinical benefits and drawbacks of administering ECMO/ECLS therapies to drug-intoxicated patients.Methods: From inception until April 30, 2024, an extensive search was performed on four main databases:PubMed, Web of Science, Cochrane Library, and EMBASE. ...
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Objective: The present study aimed to evaluate the clinical benefits and drawbacks of administering ECMO/ECLS therapies to drug-intoxicated patients.Methods: From inception until April 30, 2024, an extensive search was performed on four main databases:PubMed, Web of Science, Cochrane Library, and EMBASE. There was no restriction on the search period. Onlythe studies that reported survival to hospital discharge rates, adverse events, and the utilization of ECMO/ECLSin the treatment of intoxicated patients were included. On the other hand, articles that did not report adverseevents or hospital discharge rates as outcomes, as well as studies published in languages other than English,were excluded. The evaluated outcomes were the rate of survival to hospital discharge rate and the incidenceof adverse events associated with ECMO therapy. The Newcastle Ottawa scale was employed to appraise eachstudy to determine its methodological quality. The Comprehensive Meta-Analysis (CMA) software (version3.0) for statistical analysis was used, with the random effects model (due to high heterogeneity among thestudies) and a 95% confidence interval.Results: From a total search of 2216 search results, only 10 studies were included. The pooled analysis from10 studies indicated that ECMO therapies among drug-overdosed/poisoned patients were associated witha significant survival to hospital discharge rate of 65.6% ([95% CI: 51.5%-77.4%], p=0.030). However, theoutcomes were highly heterogeneous (I2=83.47%), which could be attributed to the use of several medicinesby different studies. In contrast, ECMO therapies among drug-overdosed patients were associated with asignificant incidence rate of adverse events of 23.1% ([95% CI: 12.3%-39.2%], p=0.002). However, the pooledanalysis had a significant heterogeneity (I2=70.27%).Conclusion: Despite various health complications, extracorporeal membrane treatment enhanced survival tohospital discharge with good neurological outcomes. Hence, it was a viable, effective, and feasible alternativefor managing drug-induced intoxication in patients.