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Do Ventilator Bundles Reduce Ventilator-Associated Pneumonia? A Meta-Analysis of Randomized Controlled Trials Reski Anugrah Zuandra; Irvan Medison; Russilawati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i3.1233

Background: Ventilator-associated pneumonia (VAP) is a serious complication in mechanically ventilated patients, leading to increased morbidity, mortality, and healthcare costs. Ventilator bundles are evidence-based practices aimed at preventing VAP. This meta-analysis evaluated the effectiveness of ventilator bundles in reducing VAP incidence in critically ill adults. Methods: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted from January 2013 to December 2024. Randomized controlled trials (RCTs) comparing ventilator bundles to standard care in adult patients receiving mechanical ventilation were included. The primary outcome was the incidence of VAP. Secondary outcomes included mortality, length of intensive care unit (ICU) stay, and duration of mechanical ventilation. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Results: Nine RCTs involving 2,850 patients met the inclusion criteria. The implementation of ventilator bundles was associated with a significant reduction in VAP incidence (RR 0.68, 95% CI 0.55-0.84, p=0.0002). Mortality (RR 0.89, 95% CI 0.75-1.05, p=0.16) and duration of mechanical ventilation (mean difference -1.2 days, 95% CI -2.8 to 0.4, p=0.13) did not significantly differ between groups. However, a significant reduction in ICU length of stay was observed in the ventilator bundle group (mean difference -2.1 days, 95% CI -3.5 to -0.7, p=0.004). Conclusion: This meta-analysis demonstrates that ventilator bundles are effective in reducing VAP incidence in critically ill adults. While no significant impact on mortality was observed, ventilator bundles were associated with a shorter ICU length of stay. These findings reinforce the importance of implementing ventilator bundles as a standard of care in ICUs to improve patient outcomes.

Massive Hemoptysis: A Meta-Analysis of Urgent Interventional Approaches Bambang Rojullun Taufik; Russilawati; Dewi Wahyu Fitrina
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 5 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i5.1272

Background: Massive hemoptysis is a life-threatening medical emergency requiring immediate intervention. This meta-analysis evaluated the efficacy and safety of urgent interventional approaches for managing massive hemoptysis. Methods: A systematic search of electronic databases (PubMed, Embase, Scopus) was conducted from January 2013 to February 2024. Studies comparing different urgent interventional approaches (bronchial artery embolization [BAE], bronchoscopic interventions, surgery) in adults with massive hemoptysis were included. The primary outcome was treatment success (cessation of bleeding). Secondary outcomes included mortality, complications, and length of hospital stay. Results: Nine studies (n=1145 patients) were included. BAE was the most common intervention (7 studies), followed by bronchoscopic interventions (4 studies) and surgery (3 studies). Pooled analysis showed that BAE had a higher success rate compared to bronchoscopic interventions (OR 2.15, 95% CI 1.32-3.51, p=0.002) and surgery (OR 1.88, 95% CI 1.15-3.08, p=0.01). BAE was associated with a lower mortality rate compared to surgery (OR 0.43, 95% CI 0.21-0.88, p=0.02) but not bronchoscopic interventions (OR 0.78, 95% CI 0.45-1.35, p=0.37). Complication rates were similar across all interventions. Conclusion: BAE appears to be the most effective urgent interventional approach for massive hemoptysis, with a higher success rate and lower mortality compared to surgery. Bronchoscopic interventions may be considered in selected cases. Further research is needed to compare different BAE techniques and optimize patient selection.

Nebulized Heparin for Inhalation Injury in Burn Patients: An Updated Systematic Review and Meta-Analysis of Efficacy and Safety Outcomes Haikal Basyar; Russilawati; Masrul Basyar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i7.1335

Background: Inhalation injury significantly increases morbidity and mortality in burn patients, primarily through airway obstruction, inflammation, and impaired gas exchange. Nebulized heparin has been investigated as a potential therapy to counteract local pulmonary coagulopathy and fibrin cast formation. However, evidence regarding its clinical efficacy and safety remains conflicting. This systematic review and meta-analysis aimed to synthesize updated evidence on the efficacy and safety outcomes of nebulized heparin in burn patients with inhalation injury. Methods: A systematic literature search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science for studies published between January 2014 and December 2024. We included randomized controlled trials (RCTs) and comparative cohort studies evaluating nebulized heparin versus placebo or standard care in adult and pediatric burn patients with inhalation injury. Primary efficacy outcomes included mortality and ventilator-free days (VFDs) at 28 days. Secondary outcomes included duration of mechanical ventilation (DoMV), hospital length of stay (LOS), changes in PaO2/FiO2 ratio, incidence of pneumonia, and safety outcomes (bleeding events). Data were synthesized, and a random-effects meta-analysis was planned to estimate pooled effect sizes (Risk Ratios [RR] or Standardized Mean Differences [SMD]). Study quality was assessed using appropriate tools. Results: The search strategy yielded seven studies (3 RCTs, 4 cohort studies) meeting the inclusion criteria, encompassing a total of 950 patients. Study quality varied. The meta-analysis suggested a potential reduction in mortality associated with nebulized heparin compared to control groups (Risk Ratio [RR]: 0.79; 95% CI: 0.64-0.97, P=0.02; I²=45%). A trend towards increased VFDs (Standardized Mean Difference [SMD]: 0.35; 95% CI: -0.05 to 0.75, P=0.08; I²=60%) and reduced DoMV (SMD: -0.50; 95% CI: -0.85 to -0.15, P=0.005; I²=55%) was observed. Effects on hospital LOS and PaO2/FiO2 ratio were less consistent across studies. There was no significant difference in the incidence of pneumonia (RR: 0.95; 95% CI: 0.80-1.13, P=0.55; I²=20%). Safety analysis indicated no significant increase in major bleeding events (RR: 1.15; 95% CI: 0.88-1.50, P=0.30; I²=10%), although minor bleeding, like blood-stained sputum, was noted in some studies. Substantial heterogeneity was present for some outcomes. Conclusion: Based on this updated systematic review and meta-analysis, nebulized heparin may be associated with reduced mortality and duration of mechanical ventilation in burn patients with inhalation injury, without a significantly increased risk of major bleeding. However, considerable uncertainty remains due to study heterogeneity and methodological limitations in the available literature. Its effect on pneumonia incidence appears negligible. Large-scale, high-quality RCTs are still needed to confirm these findings and establish optimal treatment protocols.

Massive Hemoptysis: A Meta-Analysis of Urgent Interventional Approaches Bambang Rojullun Taufik; Russilawati; Dewi Wahyu Fitrina
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 5 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i5.1272

Background: Massive hemoptysis is a life-threatening medical emergency requiring immediate intervention. This meta-analysis evaluated the efficacy and safety of urgent interventional approaches for managing massive hemoptysis. Methods: A systematic search of electronic databases (PubMed, Embase, Scopus) was conducted from January 2013 to February 2024. Studies comparing different urgent interventional approaches (bronchial artery embolization [BAE], bronchoscopic interventions, surgery) in adults with massive hemoptysis were included. The primary outcome was treatment success (cessation of bleeding). Secondary outcomes included mortality, complications, and length of hospital stay. Results: Nine studies (n=1145 patients) were included. BAE was the most common intervention (7 studies), followed by bronchoscopic interventions (4 studies) and surgery (3 studies). Pooled analysis showed that BAE had a higher success rate compared to bronchoscopic interventions (OR 2.15, 95% CI 1.32-3.51, p=0.002) and surgery (OR 1.88, 95% CI 1.15-3.08, p=0.01). BAE was associated with a lower mortality rate compared to surgery (OR 0.43, 95% CI 0.21-0.88, p=0.02) but not bronchoscopic interventions (OR 0.78, 95% CI 0.45-1.35, p=0.37). Complication rates were similar across all interventions. Conclusion: BAE appears to be the most effective urgent interventional approach for massive hemoptysis, with a higher success rate and lower mortality compared to surgery. Bronchoscopic interventions may be considered in selected cases. Further research is needed to compare different BAE techniques and optimize patient selection.

Nebulized Heparin for Inhalation Injury in Burn Patients: An Updated Systematic Review and Meta-Analysis of Efficacy and Safety Outcomes Haikal Basyar; Russilawati; Masrul Basyar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i7.1335

Background: Inhalation injury significantly increases morbidity and mortality in burn patients, primarily through airway obstruction, inflammation, and impaired gas exchange. Nebulized heparin has been investigated as a potential therapy to counteract local pulmonary coagulopathy and fibrin cast formation. However, evidence regarding its clinical efficacy and safety remains conflicting. This systematic review and meta-analysis aimed to synthesize updated evidence on the efficacy and safety outcomes of nebulized heparin in burn patients with inhalation injury. Methods: A systematic literature search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science for studies published between January 2014 and December 2024. We included randomized controlled trials (RCTs) and comparative cohort studies evaluating nebulized heparin versus placebo or standard care in adult and pediatric burn patients with inhalation injury. Primary efficacy outcomes included mortality and ventilator-free days (VFDs) at 28 days. Secondary outcomes included duration of mechanical ventilation (DoMV), hospital length of stay (LOS), changes in PaO2/FiO2 ratio, incidence of pneumonia, and safety outcomes (bleeding events). Data were synthesized, and a random-effects meta-analysis was planned to estimate pooled effect sizes (Risk Ratios [RR] or Standardized Mean Differences [SMD]). Study quality was assessed using appropriate tools. Results: The search strategy yielded seven studies (3 RCTs, 4 cohort studies) meeting the inclusion criteria, encompassing a total of 950 patients. Study quality varied. The meta-analysis suggested a potential reduction in mortality associated with nebulized heparin compared to control groups (Risk Ratio [RR]: 0.79; 95% CI: 0.64-0.97, P=0.02; I²=45%). A trend towards increased VFDs (Standardized Mean Difference [SMD]: 0.35; 95% CI: -0.05 to 0.75, P=0.08; I²=60%) and reduced DoMV (SMD: -0.50; 95% CI: -0.85 to -0.15, P=0.005; I²=55%) was observed. Effects on hospital LOS and PaO2/FiO2 ratio were less consistent across studies. There was no significant difference in the incidence of pneumonia (RR: 0.95; 95% CI: 0.80-1.13, P=0.55; I²=20%). Safety analysis indicated no significant increase in major bleeding events (RR: 1.15; 95% CI: 0.88-1.50, P=0.30; I²=10%), although minor bleeding, like blood-stained sputum, was noted in some studies. Substantial heterogeneity was present for some outcomes. Conclusion: Based on this updated systematic review and meta-analysis, nebulized heparin may be associated with reduced mortality and duration of mechanical ventilation in burn patients with inhalation injury, without a significantly increased risk of major bleeding. However, considerable uncertainty remains due to study heterogeneity and methodological limitations in the available literature. Its effect on pneumonia incidence appears negligible. Large-scale, high-quality RCTs are still needed to confirm these findings and establish optimal treatment protocols.

Do Ventilator Bundles Reduce Ventilator-Associated Pneumonia? A Meta-Analysis of Randomized Controlled Trials Reski Anugrah Zuandra; Irvan Medison; Russilawati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i3.1233

Background: Ventilator-associated pneumonia (VAP) is a serious complication in mechanically ventilated patients, leading to increased morbidity, mortality, and healthcare costs. Ventilator bundles are evidence-based practices aimed at preventing VAP. This meta-analysis evaluated the effectiveness of ventilator bundles in reducing VAP incidence in critically ill adults. Methods: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted from January 2013 to December 2024. Randomized controlled trials (RCTs) comparing ventilator bundles to standard care in adult patients receiving mechanical ventilation were included. The primary outcome was the incidence of VAP. Secondary outcomes included mortality, length of intensive care unit (ICU) stay, and duration of mechanical ventilation. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Results: Nine RCTs involving 2,850 patients met the inclusion criteria. The implementation of ventilator bundles was associated with a significant reduction in VAP incidence (RR 0.68, 95% CI 0.55-0.84, p=0.0002). Mortality (RR 0.89, 95% CI 0.75-1.05, p=0.16) and duration of mechanical ventilation (mean difference -1.2 days, 95% CI -2.8 to 0.4, p=0.13) did not significantly differ between groups. However, a significant reduction in ICU length of stay was observed in the ventilator bundle group (mean difference -2.1 days, 95% CI -3.5 to -0.7, p=0.004). Conclusion: This meta-analysis demonstrates that ventilator bundles are effective in reducing VAP incidence in critically ill adults. While no significant impact on mortality was observed, ventilator bundles were associated with a shorter ICU length of stay. These findings reinforce the importance of implementing ventilator bundles as a standard of care in ICUs to improve patient outcomes.

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