在急诊室的呼吸器支:系统性审查和元分析
Jane O'Donnell1, Alison Pirret2, Karen Hoare2
1Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Worldviews on evidence-based nursing
|March 22, 2024
概括
鼻腔高流量 (NHF) 治疗比常规氧气疗法 (COT) 更有效,减少了急诊室升级呼吸支 (RS) 的需要. 然而,对于这种结果,NHF的效果低于非侵入性通风 (NIV).
科学领域:
- 紧急医疗 紧急医疗
- 呼吸系统护理 呼吸系统护理
- 临床试验 临床试验
背景情况:
- 大约20%的急诊室 (ED) 患者需要呼吸辅助 (RS).
- 鼻高流 (NHF) 疗法越来越多地被认为具有降低升级RS的需求的潜力.
研究的目的:
- 在成年ED患者中,系统地审查和元分析随机对照试验 (RCT),将NHF与常规氧气治疗 (COT) 或非侵入性通风 (NIV) 进行比较.
- 评估NHF对需要升级护理,死亡率和不良事件的影响.
主要方法:
- 系统审查和元分析遵循柯克伦协作方法.
- 包括18个RCT与1874名参与者,在ED环境中将NHF与COT或NIV进行比较.
- 对三个主要结果的分析:护理升级,死亡率和不良事件.
主要成果:
- 与COT相比,NHF显著降低了升级的风险 (RR 0.55;95% CI [0.33,0.92]),治疗所需数 (NNT) 为32.
- 与NIV相比,NHF与升级风险显著增加有关 (RR 1.60;95% CI [1.10,2.33]).
- 在将NHF与COT或NIV进行比较时,没有发现死亡率或不良事件的统计学上显著差异.
结论:
- 在ED中,NHF是COT的优质替代品,用于呼吸支,减少了对升级护理的需求.
- 在预防ED患者呼吸支升级方面,NIV表现出比NHF更高的疗效.
- 需要进一步的研究来澄清NHF与NIV的比较有效性,特别是考虑到在NIV输送中观察到的临床异质性.
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