TY  - JOUR
A1  - Schmid, Benedikt
A1  - Griesel, Mirko
A1  - Fischer, Anna-Lena
A1  - Romero, Carolina S.
A1  - Metzendorf, Maria-Inti
A1  - Weibel, Stephanie
A1  - Fichtner, Falk
T1  - Awake prone positioning, high-flow nasal oxygen and non-invasive ventilation as non-invasive respiratory strategies in COVID-19 acute respiratory failure: a systematic review and meta-analysis
JF  - Journal of Clinical Medicine
N2  - Background: Acute respiratory failure is the most important organ dysfunction of COVID-19 patients. While non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) oxygen are frequently used, efficacy and safety remain uncertain. Benefits and harms of awake prone positioning (APP) in COVID-19 patients are unknown. Methods: We searched for randomized controlled trials (RCTs) comparing HFNC vs. NIV and APP vs. standard care. We meta-analyzed data for mortality, intubation rate, and safety. Results: Five RCTs (2182 patients) were identified. While it remains uncertain whether HFNC compared to NIV alters mortality (RR: 0.92, 95% CI 0.65–1.33), HFNC may increase rate of intubation or death (composite endpoint; RR 1.22, 1.03–1.45). We do not know if HFNC alters risk for harm. APP compared to standard care probably decreases intubation rate (RR 0.83, 0.71–0.96) but may have little or no effect on mortality (RR: 1.08, 0.51–2.31). Conclusions: Certainty of evidence is moderate to very low. There is no compelling evidence for either HFNC or NIV, but both carry substantial risk for harm. The use of APP probably has benefits although mortality appears unaffected.
KW  - respiratory failure
KW  - non-invasive ventilation
KW  - high-flow nasal cannula
KW  - awake prone positioning
KW  - COVID-19
KW  - systematic review
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-255225
SN  - 2077-0383
VL  - 11
IS  - 2
ER  - 
TY  - JOUR
A1  - Janson, Patrick
A1  - Willeke, Kristina
A1  - Zaibert, Lisa
A1  - Budnick, Andrea
A1  - Berghöfer, Anne
A1  - Kittel-Schneider, Sarah
A1  - Heuschmann, Peter U.
A1  - Zapf, Andreas
A1  - Wildner, Manfred
A1  - Stupp, Carolin
A1  - Keil, Thomas
T1  - Mortality, morbidity and health-related outcomes in informal caregivers compared to non-caregivers: a systematic review
JF  - International Journal of Environmental Research and Public Health
N2  - A systematic overview of mental and physical disorders of informal caregivers based on population-based studies with good methodological quality is lacking. Therefore, our aim was to systematically summarize mortality, incidence, and prevalence estimates of chronic diseases in informal caregivers compared to non-caregivers. Following PRISMA recommendations, we searched major healthcare databases (CINAHL, MEDLINE and Web of Science) systematically for relevant studies published in the last 10 years (without language restrictions) (PROSPERO registration number: CRD42020200314). We included only observational cross-sectional and cohort studies with low risk of bias (risk scores 0–2 out of max 8) that reported the prevalence, incidence, odds ratio (OR), hazard ratio (HR), mean- or sum-scores for health-related outcomes in informal caregivers and non-caregivers. For a thorough methodological quality assessment, we used a validated checklist. The synthesis of the results was conducted by grouping outcomes. We included 22 studies, which came predominately from the USA and Europe. Informal caregivers had a significantly lower mortality than non-caregivers. Regarding chronic morbidity outcomes, the results from a large longitudinal German health-insurance evaluation showed increased and statistically significant incidences of severe stress, adjustment disorders, depression, diseases of the spine and pain conditions among informal caregivers compared to non-caregivers. In cross-sectional evaluations, informal caregiving seemed to be associated with a higher occurrence of depression and of anxiety (ranging from 4 to 51% and 2 to 38%, respectively), pain, hypertension, diabetes and reduced quality of life. Results from our systematic review suggest that informal caregiving may be associated with several mental and physical disorders. However, these results need to be interpreted with caution, as the cross-sectional studies cannot determine temporal relationships. The lower mortality rates compared to non-caregivers may be due to a healthy-carer bias in longitudinal observational studies; however, these and other potential benefits of informal caregiving deserve further attention by researchers.
KW  - cohort studies
KW  - longitudinal studies
KW  - cross-sectional studies
KW  - family caregivers
KW  - informal caregiving
KW  - mental health
KW  - physical health
KW  - population-based studies
KW  - systematic review
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-275219
SN  - 1660-4601
VL  - 19
IS  - 10
ER  -