BackgroundAlthough small randomised controlled trials (RCTs) and observational studies have examined helmet non-invasive ventilation (NIV), uncertainty remains regarding its role. We conducted a systematic review and meta-analysis to examine the effect of helmet NIV compared to facemask NIV or high flow nasal cannula (HFNC) in acute respiratory failure.MethodsWe searched multiple databases to identify RCTs and observational studies reporting on at least one of mortality, intubation, ICU length of stay, NIV duration, complications, or comfort with NIV therapy. We assessed study risk of bias (ROB) using the Cochrane ROB tool for RCTs and the Ottawa-Newcastle scale for observational studies and rated certainty of pooled evidence using GRADE.ResultsWe separately pooled data from 16 RCTs (n=949) and 8 observational studies (n=396). Compared to facemask NIV, based on low certainty evidence, helmet NIV may reduce mortality (relative risk (RR) 0.56, 95% confidence interval (CI) (0.33 to 0.95)), and intubation (RR 0.35, 95% CI (0.22 to 0.56)) in both hypoxic and hypercapnic respiratory failure but may have no effect on duration of NIV. There was an uncertain effect of helmet on ICU length of stay and development of pressure sores. Data from observational studies was consistent with the foregoing findings but of lower certainty. Based on low and very low certainty data, helmet NIV may reduce intubation compared to HFNC, but its effect on mortality is uncertain.ConclusionCompared to facemask NIV, helmet NIV may reduce mortality and intubation; however, the effect of helmet compared to HFNC remains uncertain.

No abstract

No abstract

Background: New-onset atrial fibrillation (NOAF) is a common complication after transcatheter aortic valve replacement (TAVR), though estimates of the precise incidence are variable. We sought to quantify the incidence of NOAF after TAVR, explore the associated outcomes and identify predictors for this complication. Methods: Using a broad strategy, we searched Medline, EMBASE and the Cochrane database from 2015-2020 for articles that reported any outcomes of TAVR. We extracted data for studies published prior to 2015 from a previous systematic review (22 studies in total). Reviewers performed screening and data extraction in duplicate. We pooled data using a random effects model with Mantel-Haenszel weighting. Results: We identified 183 studies with 296,986 total participants that reported NOAF from 2008 to 2020. The pooled incidence of NOAF after TAVR was 9.9% (95%CI 8.1-12%). NOAF after TAVR was associated with longer index hospitalization (MD 2.66 days, 95% CI 1.05-4.27), higher risk of stroke (RR 1.65, 95% CI 1.09-2.5) and 30-day mortality (RR 1.76, 95%CI 1.12-2.76). NOAF after TAVR was also associated with increased risk of major or life-threatening bleeding (RR 1.60, 95%CI 1.39-1.84) and new permanent pacemaker implantation (RR 1.12, 95%CI 1.05-1.18). Risk factors for the development of NOAF after TAVR included trans-apical access, pulmonary hypertension, chronic kidney disease, peripheral vascular disease, and severe mitral regurgitation. Conclusions: NOAF is common after TAVR and associated with a longer hospital stay, a higher risk of stroke, major bleeding, mortality and permanent pacemaker implantation. Whether this risk is modifiable requires further study.