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Background: The aim of this systematic review was to assess the estimated incidence of pseudoaneurysm (PSA) with follow‐up computed tomography (CT) for adult splenic injury with nonoperative management (NOM). Methods: A systematic literature search was conducted in MEDLINE, Central, CINAHL, Clinical Trials, and ICTRP databases between January 1, 2010, and December 31, 2023. Quality assessment was performed using the Risk of Bias in Non‐randomized Studies of Exposures (ROBINS‐E) tool. Adult splenic injury patients who were initially managed with NOM and followed‐up by protocolized CT were included. The primary outcome was the incidence of delayed PSA. Secondary outcome measures were delayed angiography and delayed splenectomy. Subgroup analyses were performed between NOM patients without initial splenic angioembolization (SAE) and NOM patients with initial SAE. Results: Twelve studies were enrolled, including 11 retrospective studies and one prospective study, with 1746 patients in total. The follow‐up CT rate in the included patients was 94.9%. The estimated incidence of PSA was 14% (95% confidence interval (CI), 8%–21%). The estimated delayed angiography and delayed splenectomy incidence rates were 7% (95% CI, 4%–12%) and 2% (95% CI, 1%–6%), respectively. Subgroup analyses showed that the estimated PSA incidence was 12% in NOM patients without initial SAE (95% CI, 7%–20%) and was also 12% in NOM patients with SAE (95% CI, 5%–24%). Conclusions: The estimated incidence of delayed PSA after follow‐up CT for adult splenic injury with NOM was 14%. The estimated incidence of PSA in NOM with initial SAE was similar to that in NOM without initial SAE. [ABSTRACT FROM AUTHOR]

Out-of-hospital cardiac arrest (OHCA) is heterogeneous in terms of etiology and severity. Owing to this heterogeneity, differences in outcome and treatment efficacy have been reported from case to case; however, few reviews have focused on the heterogeneity of OHCA. We conducted a literature review to identify differences in the prognosis and treatment efficacy in terms of CA-related waveforms (shockable or non-shockable), age (adult or pediatric), and post-CA syndrome severity and to determine the preferred treatment for patients with OHCA to improve outcomes. [ABSTRACT FROM AUTHOR]

Objective: Pain in pediatric musculoskeletal (MSK) injuries can lead to increased anxiety, fear, and avoidance of medical care, making analgesic management critical. Therefore, we evaluated analgesic efficacy and adverse effects to select the optimal analgesic agent in pediatric patients with MSK injuries. Methods: Four databases were searched from inception to March 2023 for peer‐reviewed, open randomized controlled trials (RCTs). Inclusion criteria were: (1) trials with RCT design, (2) children aged 1 month–18 years with MSK injury, (3) outpatient setting, (4) interventions and control, (5) primary outcome of pain score at 60 and 120 min and secondary outcome of adverse effects, and (6) full‐text and peer‐reviewed articles. Two reviewers screened, extracted data, and assessed the risk of bias. A frequentist random‐effects network meta‐analysis (NMA) was performed. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation working group approach. Results: We included eight trials comprising 1645 children. Ibuprofen was significantly associated with pain reduction at 120 min, compared with acetaminophen (SMD 0.31 [95% CI 0.11–0.51]; moderate certainty) and opioids (SMD 0.34 [95% CI 0.20–0.48]; moderate certainty). Compared with opioids alone, ibuprofen–opioid combination was significantly associated with pain reduction at 120 min (SMD 0.19 [95% CI 0.03–0.35]). No significant differences were found in pain interventions at 60 min. Ibuprofen had statistically fewer adverse events than opioids (RR, 0.54 [95% CI 0.33–0.90]; moderate certainty) and ibuprofen with opioids (RR 0.47 [95% CI 0.25–0.89]; moderate certainty). In terms of limitations, the eight RCTs included had relatively small sample sizes; only two were high‐quality RCTs. Conclusions: Our NMA found ibuprofen to be the most effective and least adverse analgesic in pediatric patients with MSK injuries. [ABSTRACT FROM AUTHOR]

Although airway management is important in pediatric resuscitation, the effectiveness of bag-mask ventilation (BMV) and advanced airway management (AAM), such as endotracheal intubation (ETI) and supraglottic airway (SGA) devices, for prehospital resuscitation of pediatric out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to determine the efficacy of AAM during prehospital resuscitation of pediatric OHCA cases. We searched four databases from their inception to November 2022 and included randomized controlled trials and observational studies with appropriate adjustments for confounders that evaluated prehospital AAM for OHCA in children aged <18 years in quantitative synthesis. We compared three interventions (BMV, ETI, and SGA) via network meta-analysis using the GRADE Working Group approach. The outcome measures were survival and favorable neurological outcomes at hospital discharge or 1 month after cardiac arrest. Five studies (including one clinical trial and four cohort studies with rigorous confounding adjustment) involving 4852 patients were analyzed in our quantitative synthesis. Compared with ETI, BMV was associated with survival (relative risk [RR] 0.44 [95% confidence intervals (CI) 0.25–0.77]) (very low certainty). There were no significant association with survival in the other comparisons (SGA vs. BMV: RR 0.62 [95% CI 0.33–1.15] [low certainty], ETI vs. SGA: RR 0.71 [95% CI 0.39–1.32] [very low certainty]). There was no significant association with favorable neurological outcomes in any comparison (ETI vs. BMV: RR 0.33 [95% CI 0.11–1.02]; SGA vs. BMV: RR 0.50 [95% CI 0.14–1.80]; ETI vs. SGA: RR 0.66 [95% CI 0.18–2.46]) (all very low certainty). In the ranking analysis, the hierarches for efficacy for survival and favorable neurological outcome were BMV > SGA > ETI. Although the available evidence is from observational studies and its certainty is low to very low, prehospital AAM for pediatric OHCA did not improve outcomes. • Network meta-analysis improves the detection power and accuracy by synthesizing direct and indirect comparisons. • Prehospital advanced airway management for pediatric OHCA does not improve outcomes. • Most of the available evidence was from observational studies. [ABSTRACT FROM AUTHOR]

This document is a reply to a comment made by Sethuraman et al. regarding a study on the differences in pathophysiology and treatment efficacy for out-of-hospital cardiac arrest. Sethuraman et al. raised concerns about the cutoff values of a specific test for neurological outcomes. The authors of the original study defended their interpretation of the cutoff values and acknowledged an error in citing a reference. They thanked Sethuraman et al. for their suggestions and stated that it helped them refine their report. The document includes a graph illustrating the possibility of reversed median and cutoff values in a small sample of patients. The authors declare no conflicts of interest. [Extracted from the article]

The benefits of introducing a systematic lung-protective protocol for coronavirus disease 2019 (COVID-19) pneumonia requiring invasive ventilation in the intensive care unit (ICU) are unknown. Herein, we aimed to evaluate the clinical effects of introducing such a protocol in terms of mortality, duration of ventilation, and length of ICU stay. In this single-centre, retrospective, quality comparison study, we identified patients with COVID-19 pneumonia who received invasive ventilation in our ICU between February 2020 and October 2021. We established a systematic lung-protective protocol for the pre-introduction group until March 2021 and the post-introduction group after April 2021. Patients who did not receive invasive ventilation and who underwent veno-venous extracorporeal membrane oxygenation in a referring hospital were excluded. We collected patient characteristics at the time of ICU admission, including age, sex, body mass index (BMI), comorbidities, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, and Murray score. The study outcomes were ICU mortality, length of ICU stay, and duration of ventilation. The pre-introduction and post-introduction groups included 18 and 50 patients, respectively. No significant differences were observed in sex, BMI, SOFA score, APACHE II score, and Murray score; however, age was lower in the post-introduction group (70 vs. 56, P = 0.003). The introduction of this protocol did not improve ICU mortality. However, it reduced the ICU length of stay (26 days vs. 11 days, P = 0.003) and tended to shorten the duration of ventilation (15 days vs. 10 days, P = 0.06). The introduction of the protocol was associated with a decrease in the length of ICU stay and duration of ventilation; however, it did not change mortality. The application of the protocol could improve the security of medical resources during the COVID-19 pandemic. Further prospective multicentre studies are needed. [ABSTRACT FROM AUTHOR]

• Reports of Corynebacterium ulcerans infection from companion animals are increasing. • In pneumonia with pseudomembrane, C. ulcerans pneumonia should be suspected. • Venovenous extracorporeal membrane oxygenation is necessary for airway obstruction due to C. ulcerans pneumonia. We report the first case of airway obstruction due to toxin-producing Corynebacterium ulcerans , successfully managed with venovenous extracorporeal membrane oxygenation (V-V ECMO). A woman aged 73 years who was living with companion animals was intubated for pneumonia of unknown origin and treated with an empirical antimicrobial agent. Corynebacterium species were detected in the sputum and treated as commensal bacteria. Subsequently, the patient suddenly could not ventilate because of central airway obstruction caused by pseudomembrane formation. Therefore, V-V ECMO was initiated. Additional mass spectrometry identified the Corynebacterium species as C. ulcerans. After treatment with antitoxin, the patient was successfully weaned from V-V ECMO. Hence, in patients in contact with companion animals who present with respiratory failure and pseudomembrane formation, C. ulcerans pneumonia should be suspected and treated with antitoxin. C. ulcerans pneumonia may result in an inability to ventilate due to pseudomembrane formation. Therefore, treatment strategies including V-V ECMO should be considered in such cases. [ABSTRACT FROM AUTHOR]