This systematic review and meta-analysis aimed to evaluate the complications of lung biopsy in patients with acute respiratory failure (ARF), including acute respiratory distress syndrome (ARDS). We searched the MEDLINE and Cochrane Central Register of Controlled Trials. The primary outcomes were biopsy-related death, respiratory failure, cardiac complications, bleeding, and other major complications. We used the McMaster Quality Assessment Scale of Harms (McHarm) to evaluate the risk of bias. A random-effects model was used to calculate the pooled frequencies. Thirteen studies (consisting of 574 patients) were included in the meta-analysis. Furthermore, most of the included studies had a high or unclear risk of bias in half of the items in McHarm. All included studies evaluated surgical lung biopsies. The median overall hospital mortality was 53% (range: 17%–90%). The pooled frequencies of biopsy-related death, respiratory failure, cardiac complication, bleeding, and other major complications were 0.00% (95% confidence interval [CI]: 0.00%–0.21%), 1.30% (95% CI: 0.00%–5.69%), 1.03% (95% CI: 0.00%–3.73%), 1.46% (95% CI: 0.16%–3.56%), and 4.26% (95% CI: 0.00%–13.0%), respectively. The results of this study will be valuable information in considering the indications of lung biopsy in patients with ARF, including ARDS. The protocol was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN 000040650). 

https://doi.org/10.1016/j.resinv.2022.08.008

Complications of a lung biopsy for severe respiratory failure: A systematic review and meta-analysis

Behçet's syndrome is a systemic vasculitis affecting arteries and veins of all sizes as well as recurrent oral, genital, and intestinal ulcers, skin lesions, predominantly posterior uveitis, and parenchymal brain lesions. These can be present in various combinations and sequences over time and diagnosis is made by recognizing the manifestations, as there are no diagnostic biomarkers or genetic tests. Treatment modalities include immunomodulatory agents, immunosuppressives and biologics, tailored according to prognostic factors, disease activity, severity, and patients' preferences. 

Behçet Syndrome.

The authors reply.

/pdf/paramedicine-literature-search-march-may-2023-28wf2yuf.pdf

Paramedicine Literature Search: March-May 2023

Introduction Acute respiratory distress syndrome (ARDS) is a type of acute respiratory failure characterised by non-cardiac pulmonary oedema caused by various underlying conditions. ARDS is often pathologically characterised by diffuse alveolar damage, and its pathological findings have been reported to be associated with prognosis, although the adverse effects of lung biopsies to obtain pathological findings are still unclear. The purpose of this systematic review and meta-analysis is to reveal the safety and feasibility of lung biopsy in the diagnosis of ARDS. Methods and analysis We will include studies that were published in MEDLINE and Cochrane Central Register of Controlled Trials until 1 June 2020. We will include the reports for critically ill patients in an intensive care unit or emergency department who undergo lung biopsy and require a mechanical ventilation. Two review authors will independently scan titles and abstracts of all identified studies. Furthermore, these two authors will read and assess the full text of study reports to identify trials that appeared broadly to address the subject of the review. We will perform a risk of bias assessment using the McMaster Quality Assessment Scale of Harms. Ethics and dissemination This study will be based on the published data, therefore, it does not require ethical approval. The final results of the study will be published in a peer-reviewed journal. Trial registration number UMIN000040650.

https://bmjopen.bmj.com/content/bmjopen/11/2/e043600.full.pdf

Safety and feasibility of lung biopsy in diagnosis of acute respiratory distress syndrome: protocol for a systematic review and meta-analysis.

Potential Biases in Critical Care Observational Studies: Comments on an Observational Study on Association Between Family Presence and Delirium in Critically Ill Patients.

The shock index (heart rate divided by systolic blood pressure) of trauma patients upon emergency department arrival predicts blood loss and death. However, some patients with normal shock indices (0.4 < shock index <0.9) upon emergency department arrival also have poor prognoses. This study aimed to determine whether abnormal prehospital shock indices in trauma patients with normal shock indices upon emergency department arrival were predictors of a high risk of mortality. We conducted a retrospective cohort study of emergency department-admitted trauma patients from 2004 to 2017. The study included 89,495 consecutive trauma patients aged ≥16 years, with Abbreviated Injury Scale score of ≥3, who were transported to the emergency department directly from the field and had a normal shock index upon emergency department arrival. According to the prehospital shock index scores, the patients were categorized into low shock index (≤ 0.4), normal shock index, and high shock index (≥ 0.9) groups. Odds ratios and 95% confidence intervals were calculated using logistic regression analysis. The 89,495 patients had a median age of 64 (interquartile range: 43–79) years, and 55,484 (62.0%) of the patients were male. There were 1350 (1.5%) 24-h deaths in total; 176/4263 (4.1%), 1017/78,901 (1.3%), and 157/6331 (2.5%) patients were in the low, normal, and high prehospital shock index groups, respectively. The adjusted odds ratios for 24-h mortality compared with the normal shock index group were 1.63 (95% confidence interval: 1.34–1.99) in the low shock index group and 1.62 (95% confidence interval: 1.31–1.99) in the high shock index group. Trauma patients with abnormal prehospital shock indices but normal shock indices upon emergency department arrival are at a higher risk of 24-h mortality. Identifying these indices could improve triage and targeted care for patients. 

Prehospital shock index predicts 24-h mortality in trauma patients with a normal shock index upon emergency department arrival.

Comment on: Femoral vein wall thickness measurement: A new diagnostic tool for Behçet's disease.

Introduction Acute respiratory distress syndrome (ARDS) is a type of acute respiratory failure characterized by non-cardiac pulmonary edema caused by various underlying conditions. ARDS is often pathologically characterized by diffuse alveolar damage (DAD), and its pathological findings have been reported to be associated with prognosis, although the adverse effects of lung biopsies to obtain pathological findings are still unclear. The purpose of this systematic review and meta-analysis is to reveal the safety and feasibility of lung biopsy in the diagnosis of ARDS.
Methods and analysis We will include studies that were published in MEDLINE and Cochrane Central Register of Controlled Trials until June 1, 2020. We will include the reports for critically ill patients in an intensive care unit or emergency department who undergo lung biopsy and require a mechanical ventilation. Two review authors will independently scan titles and abstracts of all identified studies. Furthermore, these two authors will read and assess the full text of study reports to identify trials that appeared broadly to address the subject of the review. We will perform a risk of bias assessment using the McMaster Quality Assessment Scale of Harms.
Ethics and dissemination This study will be based on the published data, therefore, it does not require ethical approval. The final results of the study will be published in a peer-reviewed journal.

/pdf/safety-and-feasibility-of-lung-biopsy-in-diagnosis-of-acute-17cb5ul5go.pdf

Yoshie Yamada

Papers

Safety and feasibility of lung biopsy in diagnosis of acute respiratory distress syndrome: protocol for a systematic review and meta-analysis.

Potential Biases in Critical Care Observational Studies: Comments on an Observational Study on Association Between Family Presence and Delirium in Critically Ill Patients.

Prehospital shock index predicts 24-h mortality in trauma patients with a normal shock index upon emergency department arrival.

Comment on: Femoral vein wall thickness measurement: A new diagnostic tool for Behçet's disease.

Safety and feasibility of lung biopsy in diagnosis of acute respiratory distress syndrome: protocol for a systematic review and meta-analysis