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Published on: August 2, 2019
Remote ischemic preconditioning and clinical outcomes after pediatric cardiac surgery: a systematic review and
Jianwen Li1, Xiwen Wang2, Wengui Liu1
1Departments of Anesthesiology, DongGuan SongShan Lake Tungwah Hospital, DongGuan, China.
Insights
Remote ischemia preconditioning (RIPreC) did not significantly reduce mechanical ventilation duration in pediatric cardiac surgery patients. However, RIPreC did shorten intensive care unit (ICU) stays, particularly in patients not receiving propofol anesthesia.
Area of Science:
- Cardiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- The efficacy of remote ischemia preconditioning (RIPreC) in pediatric cardiac surgery remains uncertain.
- This systematic review and meta-analysis aimed to evaluate RIPreC's impact on mechanical ventilation duration and ICU length of stay post-pediatric cardiac surgery.
Approach:
- Searched PubMed, EMBASE, and Cochrane Library up to December 31, 2022, for randomized controlled trials.
- Included 13 trials with 1,352 children, assessing risk of bias and performing random-effects meta-analysis.
- Conducted sensitivity analysis to evaluate the influence of intraoperative propofol use on outcomes.
Key Points:
- Overall, RIPreC did not reduce mechanical ventilation duration (WMD -5.35 h) but did reduce ICU length of stay (WMD -11.48 h).
- In a subgroup analysis excluding propofol anesthesia, RIPreC significantly reduced both mechanical ventilation duration (WMD -2.16 h) and ICU length of stay (WMD -7.41 h).
- The quality of evidence was moderate to low, suggesting potential confounding factors.
Conclusions:
- RIPreC's effects on clinical outcomes in pediatric cardiac surgery are inconsistent.
- A potential interaction between RIPreC and propofol anesthesia was identified.
- Further high-quality studies, especially those avoiding intraoperative propofol, are necessary to clarify RIPreC's role.
Background:
The benefit of remote ischemia preconditioning (RIPreC) in pediatric cardiac surgery is unclear. The objective of this systematic review and meta-analysis was to examine the effectiveness of RIPreC in reducing the duration of mechanical ventilation and intensive care unit (ICU) length of stay after pediatric cardiac surgery.
Methods:
We searched PubMed, EMBASE and the Cochrane Library from inception to December 31, 2022. Randomized controlled trials comparing RIPreC versus control in children undergoing cardiac surgery were included. The risk of bias of included studies was assessed using the Risk of Bias 2 (RoB 2) tool. The outcomes of interest were postoperative duration of mechanical ventilation and ICU length of stay. We conducted random-effects meta-analysis to calculate weighted mean difference (WMD) with 95% confidence interval (CI) for the outcomes of interest. We performed sensitivity analysis to examine the influence of intraoperative propofol use.
Results:
Thirteen trials enrolling 1,352 children were included. Meta-analyses of all trials showed that RIPreC did not reduce postoperative duration of mechanical ventilation (WMD -5.35 h, 95% CI -12.12-1.42) but reduced postoperative ICU length of stay (WMD -11.48 h, 95% CI -20.96- -2.01). When only trials using propofol-free anesthesia were included, both mechanical ventilation duration (WMD -2.16 h, 95% CI -3.87- -0.45) and ICU length of stay (WMD -7.41 h, 95% CI -14.77- -0.05) were reduced by RIPreC. The overall quality of evidence was moderate to low.
Conclusions:
The effects of RIPreC on clinical outcomes after pediatric cardiac surgery were inconsistent, but both postoperative mechanical ventilation duration and ICU length of stay were reduced in the subgroup of children not exposed to propofol. These results suggested a possible interaction effect of propofol. More studies with adequate sample size and without intraoperative propofol use are needed to define the role of RIPreC in pediatric cardiac surgery.
