New and Updated Cochrane Systematic Reviews

PURPOSE OF REVIEW: The scope of this article is to provide an updated review examining the role of early feeding in the postoperative period. RECENT FINDINGS: Guidelines for postoperative care after abdominal surgery have historically outlined the dogma of 'nil by mouth' until bowel movement returns, but they are currently questioned. This change in mindset, especially after colorectal surgery, was initiated with fast-track or enhanced recovery after surgery programs, which particularly led to an opioid-sparing strategy. Many randomized trials and meta-analyses suggested an absence of benefit in keeping patients 'nil by mouth'. Conversely, in elective abdominal surgery, improvement in comfort without increased morbidity is now demonstrated with a liberal strategy, and a recent meta-analysis even demonstrated a decrease in mortality. Early caloric hydration and chewing gum are the most acceptable actions with a high level of proof. After emergency surgery, few data are available but a similar strategy should probably be chosen with no obvious benefit from maintenance of fasting. SUMMARY: Early oral intake is possible after elective abdominal surgery and should be moderate and progressive to be well tolerated. Any sign of nausea may mean intestinal or gastric disturbance and is a caution not to pursue this policy. The strategy in emergency abdominal surgery still requires adequately powered, randomized controlled trials. Copyright Lippincott Williams & Wilkins. Publication type: Journal: Review Source: EMBASE 10.Title: Effect of pharmaconutrition-supplemented parenteral nutrition for severe acute pancreatitis: A metaanalysis of randomized controlled trials Citation: Journal of the Pancreas, 2014, vol./is. 15/4(371-377), 1590-8577 (2014) Author(s): Shen Y., Deng X., Jin W., Zhang C., Zhang X., Wang Y. Language: English Abstract: Objective To evaluate the effectiveness of pharmaconutrition-supplemented parenteral nutrition (PN) for severe acute pancreatitis (SAP). Methods A comprehensive search of abstracts was performed in the MEDLINE, OVID, Springer, and Cochrane Library database. Published data of randomized clinical trials (RCTs) comparing the clinically relevant outcomes of pharmaconutrition-supplemented PN versus PN for patients with SAP were analyzed. The analyzed outcome variables included infection, mortality, intensive care unit (ICU) stay, hospital stay, and leukocytes change. Statistical analyses were performed using the Cochrane Collaboration's RevMan 5.1 software. Results Four RCTs published in 1998 or later were included in this meta-analysis, in which 76 patients with pharmaconutritionsupplemented PN and 77 patients with PN. Pharmaconutrition-supplemented PN showed significantly better results in terms of infection (OR, 0.42; 95% CI, 0.20-0.91; P =0.03) and leukocytes change (before treated: mean different, 0.93; 95% CI, 0.21-1.65; P =0.01; after treated: mean different, -0.77; 95% CI, -1.47-0.08; P =0.03). No significant difference could be found in mortality (OR, 0.30; 95% CI, 0.07-1.19; P =0.09), ICU stay (mean different, -3.65; 95% CI, -9.39-2.10; P =0.21), and hospital stay (mean different, -1.20; 95% CI, -9.89-7.48; P =0.79). Conclusions The current meta-analysis indicates that pharmaconutrition-supplemented PN only show advantages in infection and leukocytes change. Publication type: Journal: Article Source: EMBASE 11.Title: Effects of alveolar recruitment maneuvers on clinical outcomes in patients with acute respiratory distress syndrome: A systematic review and meta-analysis Citation: Intensive Care Medicine, 2014, vol./is. 40/9(1227-1240), 0342-4642;1432-1238 (2014) Author(s): Suzumura E.A., Figueiro M., Normilio-Silva K., Laranjeira L., Oliveira C., Buehler A.M., Bugano D., Passos Amato M.B., Ribeiro Carvalho C.R., Berwanger O., Cavalcanti A.B. Language: English Abstract: Purpose: To assess the effects of alveolar recruitment maneuvers (ARMs) on clinical outcomes in patients with acute respiratory distress syndrome (ARDS). Methods: We conducted a search of the MEDLINE, EMBASE, LILACS, CINAHL, CENTRAL, Scopus, and Web of Science (from inception to July 2014) databases for all (i.e. no language restriction) randomized controlled trials (RCTs) evaluating the effects of ARMs versus no ARMs in adults with ARDS. Four teams of two reviewers independently assessed the eligibility of the studies identified during the search and appraised the risk of bias and extracted data from those which were assessed as meeting the inclusion criteria. Data were pooled using the random-effects model. Trial sequential analysis (TSA) was used to establish monitoring boundaries to limit global type I error due to repetitive testing for our primary outcome (in-hospital mortality). The GRADE system was used to rate the quality of evidence. Results: Our database search identified ten RCTs (1,594 patients, 612 events) which satisfied the inclusion criteria. The meta-analysis assessing the effect of ARMs on in-hospital mortality showed a risk ratio (RR) of 0.84 [95 % confidence interval (CI) 0.74-0.95; I 2 = 0 %], although the quality of evidence was considered to be low due to the risk of bias in the included trials and the indirectness of the evidence-that is, ARMs were usually conducted together with other ventilatory interventions which may affect the outcome of interest. There were no differences in the rates of barotrauma (RR 1.11; 95 % CI 0.78-1.57; I 2 = 0 %) or need for rescue therapies (RR 0.76, 95 % CI 0.41-1.40; I 2 = 56 %). Most trials found no difference between groups in terms of duration of mechanical ventilation and length of stay in the intensive care unit and hospital. The TSA showed that the available evidence for the effect of ARMs on in-hospital mortality is precise in the case of a type I error of 5 %, but it is not precise with a type I error of 1 %. Conclusions: Although ARMs may decrease the mortality of patients with ARDS without increasing the risk for major adverse events, current evidence is not definitive. Large-scale ongoing trials addressing this question may provide data better applicable to clinical practice. 2014 Springer-Verlag and ESICM. Publication type: Journal: Review Source: EMBASE 12.Title: Enteral nutrition vs total parenteral nutrition in patients with severe acute pancreatitis: A systematic review of randomized controlled trials Citation: World Chinese Journal of Digestology, 2014, vol./is. /21(3153-3160), 1009-3079 (2014) Author(s): Zhou X.-H., He J.-D., Qiu X., Chen O., Liu L., Zhu Y.-J. Language: English Abstract: CONCLUSION: The current evidence shows that enteral nutrition is safe and effective and is the preferred nutrition feeding method in patients with severe acute pancreatitis. Publication type: Journal: Article Source: EMBASE 13.Title: Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically Ill patients: A systematic review and meta-analysis Citation: Critical Care Medicine, September 2014, vol./is. 42/9(2118-2125), 0090-3493;1530-0293 (September 2014) Author(s): Zhang Z., Xu X. Language: English Abstract: OBJECTIVES:: Lactate clearance has been widely investigated for its prognostic value in critically ill patients. However, the results are conflicting. The present study aimed to explore the diagnostic accuracy of lactate clearance in predicting mortality in critically or acutely ill patients. DATA SOURCES:: Databases of Medline, Embase, Scopus, and Web of Knowledge were searched from inception to June 2013. STUDY SELECTION:: Studies investigating the prognostic value of lactate clearance were defined as eligible. The searched item consisted of terms related to critically ill patients and terms related to lactate clearance. DATA EXTRACTION:: The following data were extracted: the name of the first author, publication year, subjects and setting, mean age of study population, sample size, male percentage, mortality of study cohort, definition of clearance, and the initial lactate level. Relative risk was reported to estimate the predictive value of lactate clearance on mortality rate, with relative risk less than 1 indicating that lactate clearance was a protective factor. Meta-analysis of diagnostic accuracy of lactate clearance in predicting mortality was performed by using hierarchical summary receiver operating characteristic model. DATA SYNTHESIS:: A total of 15 original articles were included in the study. Because of the significant heterogeneity across studies (I = 61.4%), random-effects model was used to pool relative risks. The pooled relative risk for mortality was 0.38 (95% CI, 0.29-0.50). The overall sensitivity and specificity for lactate clearance to predict mortality were 0.75 (95% CI, 0.58-0.87) and 0.72 (95% CI, 0.61-0.80), respectively. The diagnostic performance improved slightly when meta-analysis was restricted to ICU patients, with sensitivity and specificity of 0.83 (95% CI, 0.67-0.92) and 0.67 (95% CI, 0.59-0.75), respectively. CONCLUSION:: Our study demonstrates that lactate clearance is predictive of lower mortality rate in critically ill patients, and its diagnostic performance is optimal for clinical utility. 2014 by the Society of Critical Care Medicine and Lippincott Williams and Wilkins. Publication type: Journal: Review Source: EMBASE Full text: Available Critical care medicine at Critical Care Medicine 14.Title: Nasal bridles for securing nasoenteric tubes: A meta-analysis Citation: Nutrition in Clinical Practice, October 2014, vol./is. 29/5(667-671), 0884-5336;1941-2452 (01 Oct 2014) Author(s): Bechtold M.L., Nguyen D.L., Palmer L.B., Kiraly L.N., Martindale R.G., McClave S.A. Language: English Abstract: Background: Nasoenteric feeding tubes may easily become dislodged due to patient mental status, transfers, or positional changes. Nasal bridles were introduced to provide a better, more reliable system to secure these tubes. This meta-analysis was performed to evaluate the effectiveness of nasal bridles compared with the traditional method of adhesive tape alone in securing enteral feeding tubes. Materials and Methods: Multiple databases were searched (October 2013). All studies that evaluated the use of nasal bridles in adult patients were included in the analysis. Metaanalysis for the outcomes from use of a nasal bridle vs the more traditional method of adhesive tape alone for securing nasoenteric tubes was analyzed by calculating pooled estimates of dislodgement, skin complications, and sinusitis. Statistical analysis was performed using RevMan 5.1. Results: Six studies (n = 594) met the inclusion criteria. Use of a nasal bridle for securing enteral tubes resulted in a statistically significant reduction in tube dislodgement compared with traditional adhesive tape alone (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.10-0.27; P <.01). The use of nasal bridles was associated with a higher rate of skin complications compared with traditional adhesive tape (OR, 4.27; 95% CI, 1.79-10.23; P <.01). Incidence of sinusitis was no different between the 2 groups (OR, 0.26; 95% CI, 0.03-2.28; P =.22). Conclusion: Nasal bridles appear to be more effective at securing nasoenteric tubes and preventing dislodgement than traditional use of tape alone. Publication type: Journal: Article Source: EMBASE 15.Title: New frontiers in aortic therapy: Focus on deep hypothermic circulatory arrest Citation: Journal of Cardiothoracic and Vascular Anesthesia, August 2014, vol./is. 28/4(1171-1175), 1053-0770;15328422 (August 2014) Author(s): Gutsche J.T., Ghadimi K., Patel P.A., Robinson A.R., Lane B.J., Szeto W.Y., Augoustides J.G.T. Language: English Abstract: There is currently a paradigm shift in the conduct of adult aortic arch repair. Although deep hypothermic circulatory arrest has been the classic perfusion platform for adult aortic arch repair, recent developments have challenged this aortic arch paradigm. There has been a gradual clinical drift towards moderate, and even mild, hypothermic circulatory arrest combined with antegrade cerebral perfusion. This paradigm shift appears to be associated with equivalent clinical outcomes, and in certain settings, with improved outcomes. The advent of endovascular therapy has challenged even further the concept that circulatory arrest is required for adult aortic arch repair. These dramatic advances have resulted in the emergence of an international aortic arch surgery study group that aims to advance this dynamic field through consensus statements, meta-analysis, clinical database analysis, prospective registries, and randomized controlled trials. 2014 Elsevier Inc. Publication type: Journal: Review