对于急性呼吸困难综合征的更高PEEP:对随机临床试验的贝叶斯元分析
Ary Serpa Neto1,2,3,4, George Tomlinson5,6,7, Sarina K Sahetya8
1Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
对于急性呼吸困扰综合征 (ARDS) 的较高的阳性末尾呼吸压力 (PEEP) 仍然存在争议. 有证据表明,在中度至重度的ARDS中可能有好处,但需要更多的研究.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统生理学 呼吸系统生理学
- 临床试验方法论 临床试验方法论
背景情况:
- 对急性呼吸困扰综合征 (ARDS) 的最佳正极端呼吸压力 (PEEP) 策略进行了辩论.
- 较高的PEEP水平可能会改善氧化,但也可能导致巴罗创伤.
研究的目的:
- 评估高PEEP水平对ARDS成年患者的益处或危害.
- 对随机临床试验进行贝叶斯元分析,比较高与低PEEP策略.
主要方法:
- 8个高质量的随机临床试验的系统综述和贝叶斯元分析.
- 包括3703名成年ARDS患者,两只手臂都有低潮量通风.
- 分析总体数据,使用最少信息的先前数据.
主要成果:
- 总体而言,较高PEEP的后续受益概率为65%.
- 在中度至重度的ARDS中,益处的概率增加到77%.
- 使用最大招聘策略的折扣研究将收益概率提高到92%.
结论:
- 关于在ARDS中常规使用更高的PEEP,仍然存在很大的不确定性,受益概率在27%至86%之间.
- 在中度至重度的ARDS中,更高的PEEP可能是有益的,特别是如果仔细考虑最大招聘策略.
- 进一步进行强大的随机临床试验至关重要,以证实这些发现.
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