在重症COVID-19患者的早期和晚期气管切除术之间
Agnieszka Szafran1, Karolina Dahms1, Kelly Ansems1
1Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany.
The Cochrane database of systematic reviews
|November 20, 2023
概括
早期的气管切除术在重症COVID-19患者的死亡率或通风释放率上几乎没有差异. 需要进一步的研究来确定对特定患者群体的益处.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 呼吸系统医学 呼吸系统医学
背景情况:
- 早期气管切除术在重症COVID-19患者中的作用尚不清楚.
- 关于早期气管管切除术的好处,存在相互矛盾的流行前证据.
- COVID-19患者经常经历长时间的重症监护停留和通风持续时间.
研究的目的:
- 评估早期与晚期气管切除术在重症COVID-19患者中的益处和危害.
- 评估对死亡率,临床状况和ICU停留时间的影响.
主要方法:
- 搜索了多个数据库,包括Cochrane,PubMed,Embase和ClinicalTrials.gov,截至2022年6月14日.
- 包括随机对照试验 (RCT) 和非随机干预研究 (NRSI).
- 使用Cochrane RoB 2和ROBINS-I工具评估偏差风险,以及使用GRADE的证据确定性.
主要成果:
- 一个RCT (150名参与者) 显示了低确定性证据,表明死亡率,通风释放,不良事件或ICU逗留几乎没有差异.
- 24个NRSI (6372名参与者) 提供了非常低的确定性证据,死亡率和通风持续时间的不确定性.
- 根据NRSI数据,关于早期气管切除术对不良事件和ICU停留时间的影响存在不确定性.
结论:
- 低确定性证据表明,早期气管切除术对重症COVID-19患者的死亡率或通风释放几乎没有影响.
- 对于其他结果,如不良事件和ICU停留,存在很高的不确定性,特别是来自NRSI数据.
- 未来需要高质量的RCT和未来注册的NRSI,以澄清特定患者亚组的益处和危害.
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