European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Multicenter Study
Effect of chest ultrasound on diagnostic workup in elderly patients with acute respiratory failure in the emergency department: a prospective study.
We carried out a prospective study performed in our ED, included patients older than 75 years presenting with acute respiratory failure. Noninclusion criteria were documented palliative care or the need for immediate intensive care. After informed consent approval and routine diagnostic procedure (clinical, radiological and laboratory tests), the ED physician established the first diagnosis. Chest ultrasound was then performed, and a second diagnosis was established. An adjudication committee also established a diagnosis. The unweighted Cohen's kappa (κ) coefficient was used to measure the strength of agreement between routine diagnostic approach, chest ultrasound and adjudication committee diagnosis. ⋯ In our study, chest ultrasound add-on investigation to standard approach improved diagnosis performance in elderly patients presenting to the ED with acute respiratory failure. Further multicenter randomized trials are warranted to confirm this finding.
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Meta Analysis
Effect of oxygen supply on mortality in acute ST-elevation myocardial infarction: systematic review and meta-analysis.
Previous studies stated that high oxygen supply in patients with myocardial infarction (MI) was not associated with improved outcomes. However, the particularities of ST-elevation myocardial infarction (STEMI) and the results of a recent trial raised the question if this subgroup of patients benefits from high oxygen supply. This study aims to evaluate the clinical effect of high oxygen supply in patients with STEMI using a systematic review of the available literature. ⋯ Recurrent MI presented a contradictory result, favouring the lower oxygen protocol (RR 1.47; 95% CI, 0.84-2.56; I2 = 0%). The GRADE analysis was very low. High oxygen supply may be associated with a decrease in short-term mortality in STEMI patients, but the pooled data are not robust enough to allow definitive conclusions.