在急性喘恶化中进行非侵入性通风:系统性审查
Collin Homer-Bouthiette1, Kevin C Wilson1
1Pulmonary Center, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
非侵入性通风 (NIV) 可能会降低急性喘恶化的输管和入院率. 虽然证据质量较低,但NIV对患有严重喘发作的患者显示了潜在的临床益处.
科学领域:
- 肺部病理学 肺部病理学
- 关键护理医学 关键护理医学
- 呼吸系统医学 呼吸系统医学
背景情况:
- 由于证据有限,临床实践指南缺乏关于急性喘恶化非侵入性通风 (NIV) 的强有力的建议.
- 现有的证据综合已经过时,需要通过最近的随机对照试验 (RCT) 和观察性研究进行更新.
研究的目的:
- 在急性喘恶化中更新非侵入性通风 (NIV) 的证据综合.
- 为了澄清NIV与单独标准医学治疗相比的影响.
主要方法:
- 在Medline,Embase和Cochrane图书馆进行系统的文献搜索.
- 对8项RCT和5项观察性研究的元分析,比较NIV加标准治疗与单独标准治疗.
- 使用推,评估,开发和评估 (GRADE) 方法对证据进行评估.
主要成果:
- 非侵入性通风 (NIV) 与降低的输管率 (RCTs:RR=0.46;观察性:RR=0.55) 和入院率 (RR=0.57) 相关.
- NIV显著减少了辅助肌肉使用改善的时间 (MD=-1.13小时).
- 其他结果,如呼吸障碍和螺旋测量措施有利于NIV,但缺乏统计意义;证据质量低至非常低.
结论:
- 统计学意义上的结果有利于NIV加上急性喘恶化标准医学治疗.
- 鉴于其与死亡率的关联,NIV可能会降低输管率,这是潜在的临床重要效应.
- 除了标准的医疗治疗之外,NIV的试验可能会使急性喘恶化患者受益.
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