急性心血管性肺腫における非侵襲的換気:体系的なレビューとメタ解析
Josep Masip1, Marta Roque, Bernat Sánchez
1ICU Department, Hospital Dos de Maig Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain. jmasip@ub.edu
JAMA
|December 29, 2005
まとめ
非侵襲的換気は,急性心血管性肺腫患者の死亡率と挿管の必要性を大幅に減少させます. 継続的正気圧 (CPAP) と双レベル非侵襲的圧力サポート換気 (NIPSV) は効果的であり,両者間の結果には大きな違いはありません.
科学分野:
- 心臓病学 心臓病学
- 肺内科 肺内科 肺内科
- クリティカルケア・メディシン
背景:
- 急性心血管性肺腫 (ACPE) の管理には,挿管率を減らすために非侵襲的換気 (NIV) がしばしば含まれます.
- しかし,NIVが死亡率に与える影響と,異なるNIV技術の比較効果は不明である.
研究 の 目的:
- ACPE患者におけるNIVの短期的な臨床アウトカムを体系的にレビューし,定量的に合成する.
主な方法:
- MEDLINE,EMBASE,およびコクランデータベース (2005年10月まで) の包括的な検索により,関連するランダム化対照試験および系統的レビューが特定されました.
- 研究では,ACPE患者の従来の酸素療法とNIV (CPAPまたはNIPSV) を比較した.
- 死亡率と挿管率に関するデータを合成するためにメタアナリシスが行われました.
主要な成果:
- ACPEに対するNIVを含む15件の試験を分析した.
- NIVは,従来の治療と比較して,死亡率を約45% (RR,0.55;95%CI,0.40-0.78) 減少させた.
- CPAPとNIPSVの両方が,挿管の必要性を有意に減少させました (RR,0.43;95%CI,NIVを併せて0.32-0.57).
結論:
- NIVは,ACPE患者の死亡率と挿管の必要性を減らすのに有効です.
- CPAPの証拠はより強力であるが,CPAPとNIPSVの臨床結果において有意な差異は観察されなかった.
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