在接受侵入性机械呼吸的患者中确定最佳的阳性末尾呼气压力的方法:范围审查
Stefan Edginton1, Natalia Kruger1, Henry T Stelfox1,2,3
1Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
Canadian journal of anaesthesia = Journal canadien d'anesthesie
|November 20, 2024
概括
在机械通风患者中确定最佳的阳性末尾呼气压 (PEEP) 有许多方法,但缺乏证据. 本综述确定了研究的PEEP方法,并突出了未来机械通风研究的差距.
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
- 机械通风机械通风机械通风
背景情况:
- 在侵入性机械通风中,正极呼气压 (PEEP) 应用有显著的差异.
- 现有的指导方针缺乏具体的方法建议,原因是平衡和缺乏高质量的证据.
- 进行了范围审查,以绘制PEEP定位方法的景观.
研究的目的:
- 识别和分类用于在接受侵入性机械通风的成年人中确定最佳PEEP的方法.
- 评估各种PEEP定位技术的现有证据基础.
- 确定有关PEEP确定方法的文献上的差距.
主要方法:
- 对五个数据库进行了全面的搜索,以查找初级研究报告.
- 研究的重点是接受侵入性机械通风的成年人.
- 抽象的数据包括滴定方法,研究环境,设计,人口和结果.
主要成果:
- 有271项涉及17205名患者的研究符合纳入标准,其中包括73项随机对照试验 (RCT).
- 确定了22种不同的PEEP确定方法,其中合规性,成像和PEEP-FIO2表最常被研究.
- 大多数研究是在重症监护室进行的,通常涉及急性呼吸困扰综合征患者;很少有人评估了方法的可行性.
结论:
- 虽然研究了许多PEEP确定方法,但仍然存在显著的证据差距.
- 需要对特定人群 (例如,正常的肺,断奶患者) 和替代结果 (例如,可行性,无呼吸器日) 进行进一步的研究.
- 这些发现的差距代表了未来临床试验和证据生成的机会.
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