PeerJ Preprints: Emergency and Critical Carehttps://peerj.com/preprints/index.atom?journal=peerj&subject=4200Emergency and Critical Care articles published in PeerJ PreprintsSetting the scene for paramedics in general practice: What can we expect?https://peerj.com/preprints/159342018-01-152018-01-15Kamal MahtaniGeorgette EatonMatthew CatterallAlice Ridley
Primary care services in England may be reaching saturation point. Demands to see a GP or practice nurse have increased substantially. Clinical complexity has also increased; patients are living longer, but with more multimorbidity.(1) These demands are mirrored by a decline in the GP workforce, despite political pledges to reverse this.(2) New strategies are needed to tackle the current pressures in general practice and reduce the risks of harm to patients. The NHS England GP Forward View advocates investing and developing new models of care, including expansion of a multidisciplinary, integrated primary care team.(3) These recommendations reflect the findings of the Primary Care Workforce Commission, who highlighted the potential roles for clinical pharmacists, physician associates, and physiotherapists, all substituting into current GP care pathways.(4) The Commission also recommended that general practices should consider more opportunities to use the skills of paramedics in primary care. Specific roles may include running clinics, triaging and managing minor illnesses, as well as provide continuity for patients with complex health needs. Further roles may include assessment and management of requests for same-day urgent home visits, as well as regular visits to homebound patients with long-term conditions.The commision highlighted that these innovative roles should be subject to further evaluation. Nevertheless, historical and current perspectives allow us to model how the role could be fully used.
Primary care services in England may be reaching saturation point. Demands to see a GP or practice nurse have increased substantially. Clinical complexity has also increased; patients are living longer, but with more multimorbidity.(1) These demands are mirrored by a decline in the GP workforce, despite political pledges to reverse this.(2) New strategies are needed to tackle the current pressures in general practice and reduce the risks of harm to patients. The NHS England GP Forward View advocates investing and developing new models of care, including expansion of a multidisciplinary, integrated primary care team.(3) These recommendations reflect the findings of the Primary Care Workforce Commission, who highlighted the potential roles for clinical pharmacists, physician associates, and physiotherapists, all substituting into current GP care pathways.(4) The Commission also recommended that general practices should consider more opportunities to use the skills of paramedics in primary care. Specific roles may include running clinics, triaging and managing minor illnesses, as well as provide continuity for patients with complex health needs. Further roles may include assessment and management of requests for same-day urgent home visits, as well as regular visits to homebound patients with long-term conditions.The commision highlighted that these innovative roles should be subject to further evaluation. Nevertheless, historical and current perspectives allow us to model how the role could be fully used.The effects of cooling conditions on EDTA whole canine blood sampleshttps://peerj.com/preprints/23982016-08-282016-08-28Karen M TobiasLeslie SerranoXiaocun SunBente Flatland
Background. Preanalytic factors such as time and temperature can have significant effects on laboratory test results. For example, ammonium concentration will increase 31% in blood samples stored at room temperature for 30 minutes before centrifugation. To reduce preanalytic error, blood samples may be placed in precooled tubes and chilled on ice or in ice water baths; however, the effectiveness of these modalities in cooling blood samples has not been formally evaluated. The purpose of this study was to evaluate the effectiveness of various cooling modalities on reducing temperature of EDTA whole blood samples.
Methods. Pooled samples of canine EDTA whole blood were divided into two aliquots. Saline was added to one aliquot to produce a packed cell volume (PCV) of 40% and to the second aliquot to produce a PCV of 20% (simulated anemia). Thirty samples from each aliquot were warmed to 37.7°C and cooled in 2 ml allotments under one of three conditions: in ice, in ice after transfer to a precooled tube, or in an ice water bath. Temperature of each sample was recorded at one minute intervals for 15 minutes.
Results. Within treatment conditions, sample PCV had no significant effect on cooling. Cooling in ice water was significantly faster than cooling in ice only or transferring the sample to a precooled tube and cooling it on ice. Mean temperature of samples cooled in ice water was significantly lower at 15 minutes than mean temperatures of those cooled in ice, whether or not the tube was precooled. By 4 minutes, samples cooled in an ice water bath had reached mean temperatures less than 4°C (refrigeration temperature), while samples cooled in other conditions remained above 4.0°C for at least 11 minutes. For samples with a PCV of 40%, precooling the tube had no significant effect on rate of cooling on ice. For samples with a PCV of 20%, transfer to a precooled tube resulted in a significantly faster rate of cooling than direct placement of the warmed tube onto ice.
Discussion. Canine EDTA whole blood samples cool most rapidly and to a greater degree when placed in an ice-water bath rather than in ice. Samples stored on ice water can rapidly drop below normal refrigeration temperatures; this should be taken into consideration when using this cooling modality.
Background. Preanalytic factors such as time and temperature can have significant effects on laboratory test results. For example, ammonium concentration will increase 31% in blood samples stored at room temperature for 30 minutes before centrifugation. To reduce preanalytic error, blood samples may be placed in precooled tubes and chilled on ice or in ice water baths; however, the effectiveness of these modalities in cooling blood samples has not been formally evaluated. The purpose of this study was to evaluate the effectiveness of various cooling modalities on reducing temperature of EDTA whole blood samples.Methods. Pooled samples of canine EDTA whole blood were divided into two aliquots. Saline was added to one aliquot to produce a packed cell volume (PCV) of 40% and to the second aliquot to produce a PCV of 20% (simulated anemia). Thirty samples from each aliquot were warmed to 37.7°C and cooled in 2 ml allotments under one of three conditions: in ice, in ice after transfer to a precooled tube, or in an ice water bath. Temperature of each sample was recorded at one minute intervals for 15 minutes.Results. Within treatment conditions, sample PCV had no significant effect on cooling. Cooling in ice water was significantly faster than cooling in ice only or transferring the sample to a precooled tube and cooling it on ice. Mean temperature of samples cooled in ice water was significantly lower at 15 minutes than mean temperatures of those cooled in ice, whether or not the tube was precooled. By 4 minutes, samples cooled in an ice water bath had reached mean temperatures less than 4°C (refrigeration temperature), while samples cooled in other conditions remained above 4.0°C for at least 11 minutes. For samples with a PCV of 40%, precooling the tube had no significant effect on rate of cooling on ice. For samples with a PCV of 20%, transfer to a precooled tube resulted in a significantly faster rate of cooling than direct placement of the warmed tube onto ice. Discussion. Canine EDTA whole blood samples cool most rapidly and to a greater degree when placed in an ice-water bath rather than in ice. Samples stored on ice water can rapidly drop below normal refrigeration temperatures; this should be taken into consideration when using this cooling modality.Augmenting caregiver in-home safety practices via mHealth: A randomized controlled trialhttps://peerj.com/preprints/23302016-08-032016-08-03Michael L. WilsonHamisi A. Kigwangalla
Unintentional injuries among under-fives represent an important cause of preventable morbidity in Dar es Salaam, Tanzania. In-home interventions targeting caregiver safety practices currently show promise in reducing household injury risks. Mobile health (mHealth) is emerging as a potentially cost effective platform for the delivery of critical health information in resource poor settings. The goal of this project is to introduce an mHealth intervention targeting risk factors for child burn injuries in Dar es Salaam.
Unintentional injuries among under-fives represent an important cause of preventable morbidity in Dar es Salaam, Tanzania. In-home interventions targeting caregiver safety practices currently show promise in reducing household injury risks. Mobile health (mHealth) is emerging as a potentially cost effective platform for the delivery of critical health information in resource poor settings. The goal of this project is to introduce an mHealth intervention targeting risk factors for child burn injuries in Dar es Salaam.Suspected anaphylaxis from intravenous cefazolin during general anaesthesia in a doghttps://peerj.com/preprints/22752016-07-112016-07-11Melanie PrebbleDaniel SJ Pang
A 6-year-old female Shetland Sheepdog with a history of cardiorespiratory compromise during general anaesthesia was referred for ovariohysterectomy surgery. Clinical examination was unremarkable at presentation and physiologic parameters under general anaesthesia were within expected ranges during preparation for surgery. Shortly after completion of an intravenous injection of cefazolin, the audible signal from the Doppler ultrasound unit stopped. A rapid survey of the patient revealed tachycardia with weak femoral pulses, tachypnoea, hyperpnoea and substantially increased resistance to manual positive pressure ventilation. Stopping inhalant anaesthesia, administering salbutamol, corticosteroids and diphenhydramine were associated with resolution of clinical signs. However, marked hypotension and resistance to ventilation recurred approximately 25 minutes later. Low dose intravenous epinephrine (5 mcg/kg) was effective at increasing arterial blood pressure and reversing respiratory dysfunction. Surgery was completed and the patient recovered uneventfully. Initial reliance on second line therapy and delay in administering epinephrine, the recommended treatment for anaphylaxis, may have slowed resolution of clinical signs.
A 6-year-old female Shetland Sheepdog with a history of cardiorespiratory compromise during general anaesthesia was referred for ovariohysterectomy surgery. Clinical examination was unremarkable at presentation and physiologic parameters under general anaesthesia were within expected ranges during preparation for surgery. Shortly after completion of an intravenous injection of cefazolin, the audible signal from the Doppler ultrasound unit stopped. A rapid survey of the patient revealed tachycardia with weak femoral pulses, tachypnoea, hyperpnoea and substantially increased resistance to manual positive pressure ventilation. Stopping inhalant anaesthesia, administering salbutamol, corticosteroids and diphenhydramine were associated with resolution of clinical signs. However, marked hypotension and resistance to ventilation recurred approximately 25 minutes later. Low dose intravenous epinephrine (5 mcg/kg) was effective at increasing arterial blood pressure and reversing respiratory dysfunction. Surgery was completed and the patient recovered uneventfully. Initial reliance on second line therapy and delay in administering epinephrine, the recommended treatment for anaphylaxis, may have slowed resolution of clinical signs.Predictive analytics in practice: A novel simulation application for addressing patient flow challenges in today's emergency departmentshttps://peerj.com/preprints/18912016-03-252016-03-25Joshua E HurwitzKenneth K LopianoThomas F BohrmannWendy SwanMichael FalgianiJ Adrian Tyndall
Objectives: To develop a flexible software application that uses predictive analytics to enable emergency department (ED) decision-makers in virtually any environment to predict the effects of operational interventions and enhance continual process improvement efforts. To demonstrate the ability of the application's core simulation model to recreate and predict site-specific patient flow in two very different EDs: a large academic center and a freestanding ED. To describe how the application was used by a freestanding ED medical director to match ED resources to patient demand.
Methods: The application was developed through a public-private partnership between University of Florida Health and Roundtable Analytics, Inc., supported by a National Science Foundation Small Business Technology Transfer (STTR) grant. The core simulation technology was designed to be quickly adaptable to any ED using data routinely collected by most electronic health record systems. To demonstrate model accuracy, Monte Carlo studies were performed to predict the effects of management interventions in two distinct ED settings. At one ED, the medical director conducted simulation studies to evaluate the sustainability of the current staffing strategy and inform his decision to implement specific interventions that better match ED resources to patient demand. After implementation of one intervention, the fidelity of the model's predictions was evaluated.
Results: A flexible, cloud-based software application enabling ED decision-makers to predict the effects of operational decisions was developed and deployed at two qualitatively distinct EDs. The application accurately recreated each ED's throughput and faithfully predicted the effects of specific management interventions. At one site, the application was used to identify when increasing arrivals will dictate that the current staffing strategy will be less effective than an alternative strategy. As actual arrivals approached this point, decision-makers used the application to simulate a variety different interventions; this directly informed their decision to implement a new strategy. The observed outcomes resulting from this intervention fell within the range of predictions from the model.
Conclusion: This application overcomes technical barriers that have made simulation modeling inaccessible to key decision-makers in emergency departments. Using this technology, ED managers with no programming experience can conduct customized simulation studies regardless of their ED's volume and complexity. In two very different case studies, the fidelity of the application was established and the application was shown to have a direct positive effect on patient flow. The effective use of simulation modeling promises to replace inefficient trial-and-error approaches and become a useful and accessible tool for hea
Objectives: To develop a flexible software application that uses predictive analytics to enable emergency department (ED) decision-makers in virtually any environment to predict the effects of operational interventions and enhance continual process improvement efforts. To demonstrate the ability of the application's core simulation model to recreate and predict site-specific patient flow in two very different EDs: a large academic center and a freestanding ED. To describe how the application was used by a freestanding ED medical director to match ED resources to patient demand.Methods: The application was developed through a public-private partnership between University of Florida Health and Roundtable Analytics, Inc., supported by a National Science Foundation Small Business Technology Transfer (STTR) grant. The core simulation technology was designed to be quickly adaptable to any ED using data routinely collected by most electronic health record systems. To demonstrate model accuracy, Monte Carlo studies were performed to predict the effects of management interventions in two distinct ED settings. At one ED, the medical director conducted simulation studies to evaluate the sustainability of the current staffing strategy and inform his decision to implement specific interventions that better match ED resources to patient demand. After implementation of one intervention, the fidelity of the model's predictions was evaluated.Results: A flexible, cloud-based software application enabling ED decision-makers to predict the effects of operational decisions was developed and deployed at two qualitatively distinct EDs. The application accurately recreated each ED's throughput and faithfully predicted the effects of specific management interventions. At one site, the application was used to identify when increasing arrivals will dictate that the current staffing strategy will be less effective than an alternative strategy. As actual arrivals approached this point, decision-makers used the application to simulate a variety different interventions; this directly informed their decision to implement a new strategy. The observed outcomes resulting from this intervention fell within the range of predictions from the model.Conclusion: This application overcomes technical barriers that have made simulation modeling inaccessible to key decision-makers in emergency departments. Using this technology, ED managers with no programming experience can conduct customized simulation studies regardless of their ED's volume and complexity. In two very different case studies, the fidelity of the application was established and the application was shown to have a direct positive effect on patient flow. The effective use of simulation modeling promises to replace inefficient trial-and-error approaches and become a useful and accessible tool for heaCertified Family Service Coordinator: A model for professional practice and recognitionhttps://peerj.com/preprints/16172015-12-302015-12-30Donald B. Stouder
The use of the Family Service Coordinator is still a relative newcomer to the organ procurement/transplantation field. Since no comprehensive training and recognition program exists, Lifesharing, A Donate Life Organization, decided to develop a Certified Family Service Coordinator program. We defined the goals of the program as 1) to improve the care we provide to our families and increase consent for organ donation; 2) to streamline and standardize our best practices; 3) to learn new skills and improve individual understanding and practice; 4) to share our own wealth of experience; and 5) to provide professional certification and recognition. In addition, given the limitations of time and resources that affect most organ procurement organizations, we wanted to see if a comprehensive training program could be developed using resources that were easily and inexpensively acquired on the Internet.
The use of the Family Service Coordinator is still a relative newcomer to the organ procurement/transplantation field. Since no comprehensive training and recognition program exists, Lifesharing, A Donate Life Organization, decided to develop a Certified Family Service Coordinator program. We defined the goals of the program as 1) to improve the care we provide to our families and increase consent for organ donation; 2) to streamline and standardize our best practices; 3) to learn new skills and improve individual understanding and practice; 4) to share our own wealth of experience; and 5) to provide professional certification and recognition. In addition, given the limitations of time and resources that affect most organ procurement organizations, we wanted to see if a comprehensive training program could be developed using resources that were easily and inexpensively acquired on the Internet.Characteristics of frequent presenters: An analysis of 1 year of data from an Irish Emergency Departmenthttps://peerj.com/preprints/10002015-07-012015-07-01Philip A WalkerNiamh CumminsNiamh Collins
Introduction: Frequent presenters (FPs) to the Emergency Department (ED) have been studied heavily in international literature. Many studies suggest that maintaining services for this cohort of patients is wasteful and detracts from the needs of nonfrequent presenters. In this study we aim to describe the characteristics of FPs to the ED. We review data pertaining to frequent ED use, demographics of FPs, their preferred methods of arrival to the ED and their social living arrangements. FP's tend to rely heavily on other services as well as the ED and primary care. Methods: A systematic retrospective review of FPs attendance was performed. Results: FPs accounted for 3.9% (n=1231) of total ED attendance. The age of the FP population ranged from 19- 94 (Median = 45.5, SD 18.422). Increased ED attendance was positively associated with younger age groups. The age category accounting for the highest ED attendance was those aged between 19-35 years. From the 152 (100%) FPs, 50.7% (n=77) were males and 49.3% (n=75) were female. When the living arrangements of FPs were examined, 40.1% (n=61) lived with family, 37.5% (n=57) lived alone, 12.5% (n=19) resided in residential care while data on 9.9% (n=15) FPs was unknown. A Chi-squared analysis was computed to determine if age showed any significant correlation with living arrangements. The findings were not significant as X2 =2.148 (df3, p=0.542). Conclusions: FP's are positively associated with being young and often present with true medical needs. Many believe that frequent presentation is positively associated with free health care and living alone this is not the case. FP's are more likely to live with family and up to 17% of FP attendances have been as a result of primary care referral. FPs also present frequently to the ambulance service with almost 50% utilising the service for transport to the ED.
Introduction: Frequent presenters (FPs) to the Emergency Department (ED) have been studied heavily in international literature. Many studies suggest that maintaining services for this cohort of patients is wasteful and detracts from the needs of nonfrequent presenters. In this study we aim to describe the characteristics of FPs to the ED. We review data pertaining to frequent ED use, demographics of FPs, their preferred methods of arrival to the ED and their social living arrangements. FP's tend to rely heavily on other services as well as the ED and primary care. Methods: A systematic retrospective review of FPs attendance was performed. Results: FPs accounted for 3.9% (n=1231) of total ED attendance. The age of the FP population ranged from 19- 94 (Median = 45.5, SD 18.422). Increased ED attendance was positively associated with younger age groups. The age category accounting for the highest ED attendance was those aged between 19-35 years. From the 152 (100%) FPs, 50.7% (n=77) were males and 49.3% (n=75) were female. When the living arrangements of FPs were examined, 40.1% (n=61) lived with family, 37.5% (n=57) lived alone, 12.5% (n=19) resided in residential care while data on 9.9% (n=15) FPs was unknown. A Chi-squared analysis was computed to determine if age showed any significant correlation with living arrangements. The findings were not significant as X2 =2.148 (df3, p=0.542). Conclusions: FP's are positively associated with being young and often present with true medical needs. Many believe that frequent presentation is positively associated with free health care and living alone this is not the case. FP's are more likely to live with family and up to 17% of FP attendances have been as a result of primary care referral. FPs also present frequently to the ambulance service with almost 50% utilising the service for transport to the ED.Prior CT imaging history for patients who undergo PAN CT for acute traumatic injuryhttps://peerj.com/preprints/10102015-04-272015-04-27Jeremy KenterOsbert BlowScott P KrallAlbert L GestCynthia SmithPeter Richman
OBJECTIVE: A single PAN scan may provide more radiation to a patient than is felt to be safe within a one-year period. Our objective was to determine how many patients admitted to the trauma service following a PAN scan had prior CT imaging within our six-hospital system. METHODS: We performed a secondary analysis of a prospectively collected trauma registry. The study was based at a level-two trauma center and five affiliated hospitals, which comprise 70.6% of all Emergency Department visits within a twelve county region of southern Texas. Electronic medical records were reviewed dating from the point of trauma evaluation back to December 5, 2005 to determine evidence of prior CT imaging. RESULTS: There were 867 patients were admitted to the trauma service between January 1, 2012 and December 31, 2012. 460 (53%) received a PAN scan and were included in the study group. The mean age of the study group was 37.7 +/- 1.54 years old, 24.8% were female, and the mean ISS score was 13.4 +/- 1.07. The most common mechanism of injury was motor vehicle collision (47%). 65 (14%; 95% CI = 11-18%) of the patients had at least one prior CT. The most common prior studies performed were: CT head (29%; 19-42%), CT Face (29%; 19-42%) and CT Abdomen and Pelvis (18%; 11-30%). CONCLUSION: Within our trauma registry, 14% of patients had prior CT imaging within our hospital system before their traumatic event and PAN scan.
OBJECTIVE: A single PAN scan may provide more radiation to a patient than is felt to be safe within a one-year period. Our objective was to determine how many patients admitted to the trauma service following a PAN scan had prior CT imaging within our six-hospital system. METHODS: We performed a secondary analysis of a prospectively collected trauma registry. The study was based at a level-two trauma center and five affiliated hospitals, which comprise 70.6% of all Emergency Department visits within a twelve county region of southern Texas. Electronic medical records were reviewed dating from the point of trauma evaluation back to December 5, 2005 to determine evidence of prior CT imaging. RESULTS: There were 867 patients were admitted to the trauma service between January 1, 2012 and December 31, 2012. 460 (53%) received a PAN scan and were included in the study group. The mean age of the study group was 37.7 +/- 1.54 years old, 24.8% were female, and the mean ISS score was 13.4 +/- 1.07. The most common mechanism of injury was motor vehicle collision (47%). 65 (14%; 95% CI = 11-18%) of the patients had at least one prior CT. The most common prior studies performed were: CT head (29%; 19-42%), CT Face (29%; 19-42%) and CT Abdomen and Pelvis (18%; 11-30%). CONCLUSION: Within our trauma registry, 14% of patients had prior CT imaging within our hospital system before their traumatic event and PAN scan.Patient understanding of radiation risk from medical computed tomography - A comparison of Hispanic vs. Non-Hispanic Emergency Department populationshttps://peerj.com/preprints/9932015-04-212015-04-21Afton McNierney-MooreCynthia SmithJose H. GuardiolaK Tom XuPeter Richman
Background: Cultural differences and language barriers may adversely impact patients with respect to understanding the risks/benefits of medical testing. Objective: We hypothesized that there would be no difference in Hispanic vs. non-Hispanic patients’ knowledge of radiation risk that results from CT of the abdomen/pelvis (CTAP). Methods: We enrolled a convenience sample of adults at an inner-city ED. Patients provided written answers to rate agreement on a 10-point scale for two correct statements comparing radiation exposure equality between: CTAP and 5 years of background radiation (question 1); CTAP and 200 chest x-rays (question 3). Patients also rated their agreement that multiple CT scans increase the lifetime cancer risk (question 2). Scores of > 8 were considered good knowledge. Multivariate logistic regression analyses were performed to estimate the independent effect of the Hispanic variable. Results: 600 patients in the study group; 63% Hispanic, mean age 39.2 +/- 13.9 years. Hispanics and non-Hispanics whites were similar with respect to good knowledge-level answers to question 1 (17.3 vs 15.1%; OR=1.2; 95 % CI=0.74- 2.0), question 2 (31.2 vs. 39.3%; OR=0.76; 95% CI=0.54 - 1.1), and question 3 (15.2 vs. 16.5%; OR =1.1; 95% CI= 0.66 - 1.8). Compared to patients who earned < $20,000, patients with income > $40,000 were more likely to answer question 2 with good knowledge (OR =1.96; 95% CI=1.2 – 3.1). Conclusion: The study group’s overall knowledge of radiation risk was poor, but we did not find significant differences between Hispanic vs. non-Hispanic patients.
Background: Cultural differences and language barriers may adversely impact patients with respect to understanding the risks/benefits of medical testing. Objective: We hypothesized that there would be no difference in Hispanic vs. non-Hispanic patients’ knowledge of radiation risk that results from CT of the abdomen/pelvis (CTAP). Methods: We enrolled a convenience sample of adults at an inner-city ED. Patients provided written answers to rate agreement on a 10-point scale for two correct statements comparing radiation exposure equality between: CTAP and 5 years of background radiation (question 1); CTAP and 200 chest x-rays (question 3). Patients also rated their agreement that multiple CT scans increase the lifetime cancer risk (question 2). Scores of > 8 were considered good knowledge. Multivariate logistic regression analyses were performed to estimate the independent effect of the Hispanic variable. Results: 600 patients in the study group; 63% Hispanic, mean age 39.2 +/- 13.9 years. Hispanics and non-Hispanics whites were similar with respect to good knowledge-level answers to question 1 (17.3 vs 15.1%; OR=1.2; 95 % CI=0.74- 2.0), question 2 (31.2 vs. 39.3%; OR=0.76; 95% CI=0.54 - 1.1), and question 3 (15.2 vs. 16.5%; OR =1.1; 95% CI= 0.66 - 1.8). Compared to patients who earned < $20,000, patients with income > $40,000 were more likely to answer question 2 with good knowledge (OR =1.96; 95% CI=1.2 – 3.1). Conclusion: The study group’s overall knowledge of radiation risk was poor, but we did not find significant differences between Hispanic vs. non-Hispanic patients.Cigarette smoking as a risk factor for acute respiratory distress syndrome: a systematic review and meta-analysishttps://peerj.com/preprints/574v12014-11-012014-11-01Zhongheng Zhang
Background and objectives: Numerous experimental studies have linked cigarette smoking to lung injury. However, it is still debated on whether cigarette smoking is a risk factor for the development of acute lung injury/acute respiratory distress syndrome (ALI/ARDS). The study aimed to solve the controversy by performing systematic review and meta-analysis. Methods: Electronic databases including Pubmed, Google scholar, Embase and Scopus were searched from inception to April 2014. Studies investigated the association of cigarette smoking and ALI/ARDS were included. Non-randomized studies were assessment for their methodological quality by using Newcastle-Ottawa scale. Meta-analysis was performed by using random effects model and subgroup analyses were performed to address the clinical heterogeneity. Publication bias was assessed by using Egger’s test. Main result: Of the 17 studies included in our analysis, 15 provided data on effect size and were meta-analyzable. Component studies involved heterogeneous populations including major surgery, trauma, septic shock, general population, influenza A infection and transfusion. The combined results showed that cigarette smoking was not a risk factor for the development of ALI/ARDS (OR: 1.00, 95% CI: 0.99-1.01). In subgroup analysis, the same result was obtained in general population (OR: 2.03, 95% CI: 0.06-4.01), patients with major surgery or trauma (OR: 1.20, 95% CI: 0.48-1.93) and patients with other risks of ALI/ARDS (OR: 1.00, 95% CI: 0.99-1.01). Conclusion: Our study demonstrates that cigarette smoking is not associated with increased risk of ALI/ARDS in critically ill patients. However, the relationship in general population is still controversial and requires further confirmation.
Background and objectives: Numerous experimental studies have linked cigarette smoking to lung injury. However, it is still debated on whether cigarette smoking is a risk factor for the development of acute lung injury/acute respiratory distress syndrome (ALI/ARDS). The study aimed to solve the controversy by performing systematic review and meta-analysis. Methods: Electronic databases including Pubmed, Google scholar, Embase and Scopus were searched from inception to April 2014. Studies investigated the association of cigarette smoking and ALI/ARDS were included. Non-randomized studies were assessment for their methodological quality by using Newcastle-Ottawa scale. Meta-analysis was performed by using random effects model and subgroup analyses were performed to address the clinical heterogeneity. Publication bias was assessed by using Egger’s test. Main result: Of the 17 studies included in our analysis, 15 provided data on effect size and were meta-analyzable. Component studies involved heterogeneous populations including major surgery, trauma, septic shock, general population, influenza A infection and transfusion. The combined results showed that cigarette smoking was not a risk factor for the development of ALI/ARDS (OR: 1.00, 95% CI: 0.99-1.01). In subgroup analysis, the same result was obtained in general population (OR: 2.03, 95% CI: 0.06-4.01), patients with major surgery or trauma (OR: 1.20, 95% CI: 0.48-1.93) and patients with other risks of ALI/ARDS (OR: 1.00, 95% CI: 0.99-1.01). Conclusion: Our study demonstrates that cigarette smoking is not associated with increased risk of ALI/ARDS in critically ill patients. However, the relationship in general population is still controversial and requires further confirmation.