在小儿心脏外科手术后防止重新输管的非侵入性呼吸支 - 一个系统性审查
Ilari Kuitunen1,2, Mikko Uimonen3
1University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland.
Paediatric anaesthesia
|December 2, 2023
概括
这次系统性审查没有发现明确的证据支持任何特定的非侵入性通风策略,用于儿童心脏外科手术患者的输出管术后. 需要更多高质量的研究来确定最佳的后化呼吸支.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 心胸外科手术是一项心胸手术.
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 儿科心脏手术患者通常需要术后的机械通风.
- 输出管后最佳的呼吸支对于预防并发症和改善结果至关重要.
- 非侵入性呼吸支策略越来越多地被使用,但证据证明它们在这个人群中的有效性有限.
研究的目的:
- 系统地审查和分析在儿科心脏手术患者的最佳 postextubation 呼吸支.
- 为了比较各种非侵入性呼吸辅助方法的有效性.
主要方法:
- 随机对照试验 (RCT) 的系统审查.
- 包括专注于接受心脏手术并需要术后侵入性通风的儿科患者 (16岁以下) 的研究.
- 干预包括高流量鼻腔管 (HFNC),常规氧气治疗 (COT),非侵入性正压通风 (NIPPV),持续正压 (CPAP) 和非侵入性高频振荡通风 (NHFOV).
主要成果:
- 在查167.7后,包括了6项研究. 偏见的风险在各个研究中各不相同.
- 在HFNC和COT之间没有发现重灌率的显著差异 (RR 0.10;95% CI 0.02-0.40).
- 由于研究的局限性,小样本大小和高不准确性,证据确定性被评估为非常低.
结论:
- 目前的证据并不清楚地支持一个非侵入性通风策略,而不是另一个在儿科心脏外科手术中进行术后支持的策略.
- 高质量的研究对于建立最佳的呼吸辅助方案至关重要.
- 需要进一步的研究来指导临床决策在这个脆弱的患者群体.
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