从手术室的机械通风中断奶:一个系统的审查
Megan Abbott1, Sergio M Pereira2, Noah Sanders3
1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.
British journal of anaesthesia
|May 30, 2024
概括
使用压力支通风 (PSV),个性化正极呼气压 (PEEP) 和低分量吸入氧气 (FiO2) 的术后机械通风 (MV) 的断奶可以减少术后肺部并发症. 由于证据质量不佳,需要进行进一步的研究.
科学领域:
- 麻醉学和重症监护医学
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 手术后肺部并发症 (PPC) 增加死亡率和住院时间.
- 术内机械通风 (MV) 是PPCs的一个已知的风险因素.
- 从手术内MV中断奶 strategies 的研究不足.
研究的目的:
- 系统地评估从手术内MV中断奶的策略.
- 评估这些策略对术后肺部结局的影响.
主要方法:
- 随机对照试验和观察性研究的系统审查和元分析.
- 包括14个RCT,其中1719名成年患者接受了手术内MV.
- 评估偏差风险 (科克莱恩RoB2) 和证据质量 (GRADE).
主要成果:
- 结合压力支通风 (PSV),正极呼气压 (PEEP) 和低比例吸入氧气 (FiO2) 的策略,改善了输氧,氧化和肺体积.
- 低FiO2的个性化PEEP显示了减少PPC的潜力.
- 低的FiO2单独改善了脱和氧化.
- 固定的PEEP策略并没有改善结果.
结论:
- 有限的研究存在于手术内MV断奶策略.
- 低质量的证据表明PSV,个性化PEEP和低FiO2可能会减少PPCs.
- 需要进一步进行高质量的研究.
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