Heparin-bonded catheters for prolonging the patency of central venous catheters in children
Notice bibliographique
Résumé
BACKGROUND: Central venous catheters (CVCs) are a mainstay in the management of critically ill children. However, these catheters are associated with mechanical and infectious complications which reduce their life span. Heparin bonding of catheters has shown promise in animal studies and in adults. This is the first update of a review published in 2007. OBJECTIVES: The primary objective was to determine the effect of heparin-bonded CVCs on the duration of catheter patency in children. Secondary objectives were to determine the effects of heparin-bonded catheters on catheter-related thrombosis, occlusion, blood stream infection and side effects. SEARCH METHODS: For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched August 2013) and CENTRAL (2013, Issue 7). The authors searched MEDLINE (1946 to week 3 August 2013). SELECTION CRITERIA: We included randomized and quasi-randomized controlled trials of heparin-bonded catheters versus non-heparin bonded catheters or antibiotic-impregnated catheters that reported on any of the prespecified outcomes, without language restriction. DATA COLLECTION AND ANALYSIS: We assessed the methodological quality of the trials using the information provided in the studies and by contacting authors. We extracted data and estimated the effect size reported as risk ratio (RR), risk difference (RD) or number needed to treat (NNT), as appropriate. MAIN RESULTS: We included two eligible studies with a total of 287 participants; both had good methodological quality. There was no difference in the duration of catheter patency between heparin-bonded and non-heparin bonded catheters (median duration seven days versus six days) reported in one study. There was no difference in the risk of catheter-related thrombosis (two studies, RR 0.34, 95% CI 0.01 to 7.68; I(2) = 80%; RD -0.06, 95% CI -0.17 to 0.06). Data from one study revealed a statistically significant reduction in the risk of catheter occlusion (RR 0.06, 95% CI 0.00 to 1.07; RD -0.08, 95% CI -0.13 to -0.02; NNT 13, 95% CI 8 to 50), catheter-related blood stream infections (RR 0.06, 95% CI 0.01 to 0.41; RD -0.17, 95% CI -0.25 to -0.10; NNT 6, 95% CI 4 to 10) and catheter colonization (RR 0.21, 95% CI 0.06 to 0.71; RD -0.11, 95% CI -0.19 to -0.04; NNT 9, 95% CI 5 to 25) in the heparin-bonded catheter group. The second study did not report on these outcomes. There was no significant difference in risk of thrombocytopenia after catheter placement (RR 0.73, 95% CI 0.38 to 1.39; RD -0.02, 95% CI -0.10 to 0.07). AUTHORS' CONCLUSIONS: Two eligible studies on the use of heparin-bonded catheters versus placebo in children were identified. Meta-analysis of the two studies revealed no reduction in catheter-related thrombosis with heparin-bonded catheters. One study reported a reduction in catheter-related blood stream infection and colonization following the use of heparin-bonded catheters. The strength of evidence is low and further well-designed multicenter randomized controlled trials are warranted.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,011 | 0,002 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».