Objectives To systematically review the preventive effects of different pressure relief devices. Methods Databases including PubMed, The Cochrane Library, Web of Science, EMbase, CBM, CNKI, VIP and WanFang Data were searched to collect randomized control trials (RCTs) on the preventive effects of pressure relief devices for the surgical pressure sore from inception to December 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Network meta-analysis was then performed using gemtc package of R 3.5.0 software, Stata 13.0 and JAGS 3.4.0 software. Results A total of 20 RCTs involving 4 183 patients were included. The network meta-analysis showed that micropulse dynamic pad was superior to standard pad. The gel pad was superior to sponge pad. The standard pad and cotton gauze pad. The foam dressing was superior to gel pad. All of the differences were statistically significant. The results of the ranking probability plot suggested foam dressing as an optimal resolution for preventing surgical pressure sore. Conclusions According to the network meta-analysis and rankings, foam dressing is superior to other decompression devices in preventing surgical pressure sores.
ObjectiveTo systematically review the risk factors associated with sleep disorders in ICU patients.MethodsWe searched The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, Wanfang Data, VIP and CBM databases to collect cohort studies, case-control studies and cross-sectional studies on the risk factors associated with sleep disorders in ICU patients from inception to October, 2018. Two reviewers independently screened literature, extracted data and evaluated the bias risk of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 9 articles were included, with a total of 1 068 patients, including 12 risk factors. The results of meta-analysis showed that the combined effect of equipment noise (OR=0.42, 95%CI 0.26 to 0.68, P=0.000 4), patients’ talk (OR=0.53, 95%CI 0.42 to 0.66, P<0.000 01), patients’ noise (OR=0.39, 95%CI 0.21 to 0.74, P=0.004), light (OR=0.29, 95%CI 0.18 to 0.45, P<0.000 01), night treatment (OR=0.36, 95%CI 0.26 to 0.50, P<0.000 01), diseases and drug effects (OR=0.17,95%CI 0.08 to 0.36, P<0.000 01), pain (OR=0.37, 95%CI 0.17 to 0.82, P=0.01), comfort changes (OR=0.34,95%CI 0.17 to 0.67,P=0.002), anxiety (OR=0.31,95%CI 0.12 to 0.78, P=0.01), visit time (OR=0.72, 95%CI 0.53 to 0.98, P=0.04), economic burden (OR=0.63, 95%CI 0.48 to 0.82, P=0.000 5) were statistically significant risk factors for sleep disorders in ICU patients.ConclusionCurrent evidence shows that the risk factors for sleep disorders in ICU patients are environmental factors (talking voices of nurses, patient noise, and light), treatment factors (night treatment), disease factors (disease itself and drug effects, pain,) and psychological factors (visiting time, economic burden). Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusions.
ObjectivesTo assess the efficacy of non-drug interventions on improving sleep quality in ICU patients by network meta-analysis.MethodsThe Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on non-drug interventions on improving sleep quality in ICU patients from inception to December, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, network meta-analysis was performed by using the Stata 13.0 software.ResultsA total of 12 RCTs, involving 1 223 patients and 9 non-pharmacological interventions (music therapy, comprehensive nursing intervention, TCM emotions, music therapy+TCM emotions, Chinese medicine pillow therapy, ear acupressure, eye mask+earplugs+music, eye mask+earplugs, regular care) were included. The results of Pittsburgh sleep quality index (PSQI) showed that eye mask+earplugs, eye masks, and comprehensive nursing interventions were superior to conventional care in improving sleep quality in ICU patients, and the rankings were: eye mask+earplugs>eye mask>comprehensive nursing intervention, music therapy+TCM emotional>Chinese medicine emotional>music therapy>general care. The results of Richards-Campbell sleep scale (RCSQ) showed that eye mask+earplugs+music, Chinese medicine pillow therapy, and auricular pressure beans were superior to conventional care, and the rankings were: eye mask+earplugs+music>Chinese medicine pillow therapy>music therapy>ear acupressure beans>general care.ConclusionsThe evidence shows that in improving the sleep quality of ICU patients, eye mask + earplug, eye mask, comprehensive nursing intervention, music therapy + TCM emotional characteristics may all be effective intervention methods. It is suggested that more non-drug interventions should be carried out in the future for enhancing the sleep quality of ICU patients.
ObjectiveTo analyze the treatment effect of sequential noninvasive following invasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with respiratory failure.MethodsA review of randomized controlled trials with meta-analysis performed by searching databases of PubMed, the Cochrane Library, Embase, Chinese BioMedical Literature Database, China National Knowledge Infrastructure, and WanFang data. Randomized controlled trials by using sequential noninvasive following invasive mechanical ventilation in COPD patients with respiratory failure were eligible for inclusion.ResultsEleven trials were included, involving 553 COPD patients with respiratory failure. Meta-analysis showed that sequential noninvasive following invasive mechanical ventilation reduced the mortality rate [RR=0.37, 95%CI(0.22 to 0.61), P=0.000 1], the incidence of ventilator-associated pneumonia (VAP) [RR=0.20, 95%CI(0.13 to 0.32), P<0.000 01], reintubation rate [RR=0.40, 95%CI(0.23 to 0.68), P=0.0008]; it also decreased the duration of invasive mechanical ventilation [MD=–10.47, 95%CI(–13.80 to –7.14), P<0.000 01] and duration of mechanical ventilation [MD=–4.54, 95%CI(–7.01 to –2.06), P=0.000 3], which also shortened the lengths of stay in an intensive care unit (ICU) [MD=–8.75, 95%CI(–13.49 to –4.01), P=0.000 3], as well as length of hospital stay [MD=–9.11, 95%CI(–11.68 to –6.55), P<0.000 01］.ConclusionSequential noninvasive following invasive mechanical ventilation can significantly reduce the incidence of VAP, the duration of invasive mechanical ventilation, the length of hospital stay in COPD patients with respiratory failure, and reduce the mortality, reintubation rate, the duration of mechanical ventilation and the length of ICU stay as well.