Tocilizumab is an IL-6 receptor-blocking agent proposed for the treatment of severe COVID-19. The aim of this systematic review was to describe the rationale for the use of tocilizumab for the ...treatment of COVID-19 and to summarize the available evidence regarding its efficacy and safety.
MEDLINE, PubMed, EMBASE, pre-print repositories (bioRxiv and medRxiv) and two trial Registries were searched for studies on the use of tocilizumab in COVID-19 or SARS-CoV-2 infection, viral pneumonia, and/or sepsis until 20th June 2020.
We identified 3 indirect pre-clinical studies and 28 clinical studies including 5776 patients with COVID-19 (13 with a comparison group, 15 single-arm). To date, no randomized trials have been published. We retrieved no studies at low risk of bias. Forty-five ongoing studies were retrieved from trial registries.
There is insufficient evidence regarding the clinical efficacy and safety of tocilizumab in patients with COVID-19. Its use should be considered experimental, requiring ethical approval and clinical trial oversight.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
In dolomitic headwater catchments, intense rainstorms of short duration produce runoff discharges that often trigger debris flows on the scree slopes at the base of rock cliffs. In order to measure ...these discharges, we placed a measuring facility at the outlet (elevation 1770 m a.s.l.) of a small, rocky headwater catchment (area ∼0.032 km2, average slope ∼320%) located in the Venetian Dolomites (North Eastern Italian Alps). The facility consists of an approximately rectangular basin, ending with a sharp‐crested weir. Six runoff events were recorded in the period 2011–2014, providing a unique opportunity for characterizing the hydrological response of the catchment. The measured hydrographs display impulsive shapes, with an abrupt raise up to the peak, followed by a rapidly decreasing tail, until a nearly constant plateau is eventually reached. This behavior can be simulated by means of a distributed hydrological model if the excess rainfall is determined accurately. We show that using the Soil Conservation Service Curve‐Number (SCS‐CN) method and assuming a constant routing velocity invariably results in an underestimated peak flow and a delayed peak time. A satisfactory prediction of the impulsive hydrograph shape, including peak value and timing, is obtained only by combining the SCS‐CN procedure with a simplified version of the Horton equation, and simulating runoff routing along the channel network through a matched diffusivity kinematic wave model. The robustness of the proposed methodology is tested through a comparison between simulated and observed timings of runoff or debris flow occurrence in two neighboring alpine basins.
Key Points:
Hydrological response to convective rainfalls in headwater rocky catchments is impulsive and mainly ruled by excess infiltration
Combining SCS‐CN method for estimating excess rainfall and constant velocity for routing, the observed hydrographs cannot be reproduced
Observed peaked hydrographs need a simplified Hortonian equation and the Muskingum‐Cunge scheme along network to be simulated
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
Postoperative pulmonary complications, generally defined as any pulmonary abnormality occurring in the postoperative period, are still a significant issue in clinical practice increasing ...hospital length of stay, morbidity and mortality. Non-invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic pulmonary failure, is nowadays also used in perioperative settings.
Objective
Investigate the application and results of preventive and therapeutic NIV in postsurgical patients.
Design
A systematic review.
Data sources
Medical literature databases were searched for articles about “clinical trials,” “randomized controlled trials” and “meta-analyses.” The keywords “cardiac surgery,” “thoracic surgery,” “lung surgery,” “abdominal surgery,” “solid organ transplantation,” “thoraco-abdominal surgery” and “bariatric surgery” were combined with any of these: “non-invasive positive pressure ventilation,” “continuous positive airway pressure,” “bilevel ventilation,” “postoperative complications,” “postoperative care,” “respiratory care,” “acute respiratory failure,” “acute lung injury” and “acute respiratory distress syndrome.”
Results
Twenty-nine articles (
N
= 2,279 patients) met the inclusion criteria. Nine studies evaluated NIV in post-abdominal surgery, three in thoracic surgery, eight in cardiac surgery, three in thoraco-abdominal surgery, four in bariatric surgery and two in post solid organ transplantation used both for prophylactic and therapeutic purposes. NIV improved arterial blood gases in 15 of the 22 prophylactic and in 4 of the 7 therapeutic studies, respectively. NIV reduced the intubation rate in 11 of the 29 studies and improved outcome in only 1.
Conclusions
Despite these limited data and the necessity of new randomized trials, NIV could be considered as a prophylactic and therapeutic tool to improve gas exchange in postoperative patients.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose
Single studies of Noninvasive Ventilation (NIV) in the management of acute respiratory failure in chest trauma patients have produced controversial findings. The aim of this study is to ...critically review the literature to investigate whether NIV reduces mortality, intubation rate, length of stay and complications in patients with chest trauma, compared to standard therapy.
Methods
We performed a systematic review and meta-analysis of randomized controlled trials, prospective and retrospective observational studies, by searching PubMed, EMBASE and bibliographies of articles retrieved. We screened for relevance studies that enrolled adults with chest trauma who developed mild to severe acute respiratory failure and were treated with NIV. We included studies reporting at least one clinical outcome of interest to perform a meta-analysis.
Results
Ten studies (368 patients) met the inclusion criteria and were included for the meta-analysis. Five studies (219 patients) reported mortality and results were quite homogeneous across studies, with a summary relative risk for patients treated with NIV compared with standard care (oxygen therapy and invasive mechanical ventilation) of 0.26 (95 % confidence interval 0.09–0.71,
p
= 0.003). There was no advantage in mortality of continuous positive airway pressure over noninvasive pressure support ventilation. NIV significantly increased arterial oxygenation and was associated with a significant reduction in intubation rate, in the incidence of overall complications and infections.
Conclusions
These results suggest that NIV could be useful in the management of acute respiratory failure due to chest trauma.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Helmet CPAP (H-CPAP) has been recommended in many guidelines as a noninvasive respiratory support during COVID-19 pandemic in many countries around the world. It has the least amount of particle ...dispersion and air contamination among all noninvasive devices and may mitigate the ICU bed shortage during a COVID surge as well as a decreased need for intubation/mechanical ventilation. It can be attached to many oxygen delivery sources. The MaxVenturi setup is preferred as it allows for natural humidification, low noise burden, and easy transition to HFNC during breaks and it is the recommended transport set-up. The patients can safely be proned with the helmet. It can also be used to wean the patients from invasive mechanical ventilation. Our article reviews in depth the pathophysiology of COVID-19 ARDS, provides rationale of using H-CPAP, suggests a respiratory failure algorithm, guides through its setup and discusses the issues and concerns around using it.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Positive end expiratory pressure (PEEP) may prevent cyclic opening and collapsing alveoli in acute respiratory distress syndrome (ARDS) patients, but it may play a role also in general anesthesia. ...This review is organized in two sections. The first one reports the pathophysiological effect of PEEP on thoracic pressure and hemodynamic and cerebral perfusion pressure. The second section summarizes the knowledge and evidence of the use of PEEP in general anesthesia and intensive care. More specifically, for intensive care this review refers to ARDS and traumatic brain injured patients.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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