连续与间歇控制袖口压力预防风扇相关肺炎:一个更新的元分析
Yanshuo Wu1, Yanan Li1, Meirong Sun1
1Department of Critical Care Medicine, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
连续控制袖口压力 (CCCP) 显著降低了呼吸机相关肺炎 (VAP) 的发生率和机械通风的持续时间在重症患者. 结合CCCP与下喉分泌液排水 (SSD),可以改善VAP的预防.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统疗法 呼吸系统疗法
- 预防传染病 预防传染病
背景情况:
- 呼吸机相关肺炎 (VAP) 是需要机械呼吸的重症患者的一个重大问题.
- 保持足够的内管袖口压力对于预防VAP至关重要.
- 目前的做法涉及间歇或连续控制袖口压力,效率各不相同.
研究的目的:
- 为了比较连续控制袖口压力 (CCCP) 与间歇控制袖口压力 (ICCP) 在预防VAP方面的有效性.
- 评估CCCP对机械通风持续时间和其他相关结果的影响.
- 评估下分泌排水 (SSD) 与CCCP一起用于VAP预防的作用.
主要方法:
- 一项对14项随机对照试验的元分析,涉及2080名重症患者.
- 在主要数据库 (PubMed,Embase,Web of Science等) 进行文献搜索. 在2022年9月之前.
- 使用RevMan 5.3和试验序列分析0.9进行统计分析,并使用GRADE框架进行证据评估.
主要成果:
- 与ICCP相比,CCCP显著降低了VAP发生率 (RR=0.52,P<0.001),具有中度的GRADE证据.
- 结合CCCP和下囊分泌液排水 (SSD) 显示了更明显的VAP降低 (RR=0.39,P<0.001).
- CCCP显著缩短了机械通风的持续时间 (MD=2.42天,P=0.04) 并改善了袖口压力管理,但没有显著影响ICU停留时间或死亡率.
结论:
- CCCP,特别是与SSD相结合时,是一种有效的策略,可以减少重症患者的VAP发病率.
- CCCP有助于缩短机械通风的持续时间和更好的袖口压力控制.
- 这些发现支持实施CCCP与SSD用于VAP预防协议.
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