对儿童急性喘进行非侵入性正压通风
Steven Kwasi Korang1,2, Matthew Baker3, Joshua Feinberg1
1Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
The Cochrane database of systematic reviews
|October 2, 2024
概括
非侵入性正压通风 (NPPV) 可能改善喘症状并降低儿童的输管率. 然而,目前关于NPPV在急性儿科喘中的证据非常不确定,需要更大,高质量的试验.
科学领域:
- 儿科肺病学 儿科肺病学
- 关键护理医学 关键护理医学
- 呼吸系统疗法 呼吸系统疗法
背景情况:
- 喘是儿童住院的首要原因,造成重大成本并影响生活质量.
- 非侵入性正压通风 (NPPV) 越来越多地用于急性儿科喘,但其有效性的证据有限.
- 临床指南目前不建议常规NPPV治疗急性儿科喘,因为证据不足.
研究的目的:
- 评估NPPV的益处和危害,作为急性喘儿童常规护理的辅助.
- 综合随机临床试验 (RCT) 关于NPPV在急性喘恶化住院儿童的疗效的证据.
主要方法:
- 系统地搜索主要数据库 (科克兰航空集团,CENTRAL,MEDLINE,Embase) 和临床试验注册表,直到2023年3月.
- 包括三项涉及120名患有中度至重度急性喘的儿童 (60名NPPV,60名对照) 的RCT.
- 主要结局包括死亡率,严重不良事件和喘症状得分;次要结局涵盖了各种临床和资源利用指标.
主要成果:
- 两项试验表明,NPPV (双级阳性气道压力 - BiPAP) 降低了喘症状得分,尽管证据确定性非常低.
- 一项试验表明,BiPAP可能会降低输管率 (风险比率为0.47),但证据确定性非常低.
- 后期分析表明,小儿重症监护室 (PICU) 住院时间可能略有减少,而且确定性很低.
结论:
- 目前关于急性儿科喘NPPV的证据非常不确定,因为包括的研究中存在高风险的偏见和不准确性.
- 虽然NPPV可能有好处,例如改善症状得分,减少输管率和缩短PICU停留时间,但这些发现需要确认.
- 具有较低偏差风险的较大,设计良好的RCT对于确定NPPV在该患者群体中的真正有效性和安全性至关重要.
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