PubMed · 16250536
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Pre-eclampsia.. https://pubmed.ncbi.nlm.nih.gov/16250536/
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INTRODUCTION: Nosocomial pneumonia is the most important infectious complication in patients admitted to intensive care units. Kinetic bed therapy may reduce the incidence of nosocomial pneumonia in mechanically ventilated patients. The objective of this study was to investigate whether kinetic bed therapy reduces the incidence of nosocomial pneumonia and improves outcomes in critically ill mechanically ventilated patients. METHODS: We searched Medline, EMBASE, CINAHL, CENTRAL, and AMED for studies, as well as reviewed abstracts of conference proceedings, bibliographies of included studies and review articles and contacted the manufacturers of medical beds. Studies included were randomized or pseudo-randomized clinical trials of kinetic bed therapy compared to standard manual turning in critically ill mechanically ventilated adult patients. Two reviewers independently applied the study selection criteria and extracted data regarding study validity, type of bed used, intensity of kinetic therapy, and population under investigation. Outcomes assessed included the incidence of nosocomial pneumonia, mortality, duration of ventilation, and intensive care unit and hospital length of stay. RESULTS: Fifteen prospective clinical trials were identified, which included a total of 1,169 participants. No trial met all the validity criteria. There was a significant reduction in the incidence of nosocomial pneumonia (pooled odds ratio (OR) 0.38, 95% confidence interval (CI) 0.28 to 0.53), but no reduction in mortality (pooled OR 0.96, 95%CI 0.66 to 1.14), duration of mechanical ventilation (pooled standardized mean difference (SMD) -0.14 days, 95%CI, -0.29 to 0.02), duration of intensive care unit stay (pooled SMD -0.064 days, 95% CI, -0.21 to 0.086) or duration of hospital stay (pooled SMD 0.05 days, 95% CI -0.18 to 0.27). CONCLUSION: While kinetic bed therapy has been purported to reduce the incidence of nosocomial pneumonia in mechanically ventilated patients, the overall body of evidence is insufficient to support this conclusion. There appears to be a reduction in the incidence of nosocomial pneumonia, but no effect on mortality, duration of mechanical ventilation, or intensive care or hospital length of stay. Given the lack of consistent benefit and the poor methodological quality of the trials included in this analysis, definitive recommendations regarding the use of this therapy cannot be made at this time.
BACKGROUND: Women at risk of pre-eclampsia or gestational hypertension are sometimes advised to rest. Whether this, overall, does more good than harm is unclear. OBJECTIVES: To assess the effects of rest or advice to reduce physical activity during pregnancy for preventing pre-eclampsia and its complications in women with normal blood pressure. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2005), and EMBASE (2002 to August 2005). SELECTION CRITERIA: Studies were included if they were randomised trials evaluating the effects of rest or advise to reduce physical activity for preventing pre-eclampsia and its complications in women with normal blood pressure. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion and extracted data. Data were double checked for accuracy. MAIN RESULTS: Two small trials (106 women) of uncertain quality were included. Both recruited women with a singleton pregnancy at moderate risk of pre-eclampsia from 28 to 32 weeks' gestation. There was a statistically significant reduction in the relative risk of pre-eclampsia with four to six hours rest per day (one trial, 32 women; relative risk (RR) 0.05, 95% confidence interval (CI) 0.00 to 0.83), but not of gestational hypertension (RR 0.25, 95% CI 0.03 to 2.00), compared to normal activity. Rest of 30 minutes per day plus nutritional supplementation was associated with a reduction in the risk of pre-eclampsia (one trial, 74 women; RR 0.13, 95% CI 0.03 to 0.51) and also of gestational hypertension (RR 0.15, 95% CI 0.04 to 0.63). The effect on caesarean section was unclear (RR 0.82, 95% CI 0.48 to 1.41). No other outcomes were reported. AUTHORS' CONCLUSIONS: Daily rest, with or without nutrient supplementation, may reduce the risk of pre-eclampsia for women with normal blood pressure, although the reported effect may reflect bias and/or random error rather than a true effect. There is no information about outcomes such as perinatal mortality and morbidity, maternal morbidity, women's views, adverse effects, and costs. Current evidence is insufficient to support recommending rest or reduced activity to women for preventing pre-eclampsia and its complications. Whether women rest during pregnancy should therefore be a matter of personal choice.
Data is now more than ever available to inform couples at risk of second trimester miscarriage or preterm delivery. We are able to give customized information according to the obstetrical history and to the evolution of the cervix during the second trimester although the level of scientific evidence is limited or poor. Elective cerclage can be proposed to patients with a history of at least 3 second trimester miscarriages or preterm deliveries. There is no clear consensus on which patients could benefit from therapeutic cerclage. Indications would have to be motivated by a short cervix on ultrasound measurements and the cerclage performed before 24 weeks of gestation.