在患有肥胖症的重症成年人中,输出后的非侵入性呼吸支:系统性审查和网络元分析
Joris Pensier1,2, Arthur Naudet-Lasserre1, Clément Monet1,2
1Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier, CEDEX 5, France.
EClinicalMedicine
|January 10, 2025
概括
与传统氧气疗法或单独使用HFNC相比,非侵入性通风 (NIV) 或使用高流量鼻腔管 (HFNC) 的NIV显著降低了重症肥胖患者在脱口后的再输管和死亡率.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统疗法 呼吸系统疗法
- 肥胖医学 肥胖医学
背景情况:
- 患有肥胖症的重症患者面临着输出管失败的高风险.
- 关于非侵入性通风 (NIV),高流量鼻腔管 (HFNC) 和常规氧气疗法 (COT) 的先前研究已经产生了相互矛盾的结果,以防止这个人群的输出失败.
研究的目的:
- 系统地比较NIV,HFNC和COT在预防肥胖严重病情的成年人输出管失败方面的疗效.
- 评估这些干预措施对再化率和28天死亡率的影响.
主要方法:
- 1998年至2024年间发表的随机对照试验 (RCT) 的系统审查和网络元分析.
- 在 MEDLINE,Cochrane 和 Web of Science 搜索了评估 NIV,HFNC,COT 和结合 NIV + HFNC 的实验室.
- 主要结局是在第7天重新灌输;次要结局是28天死亡率.
主要成果:
- 与COT相比,NIV + HFNC (RR 0.36) 和NIV (RR 0.45) 在第7天显著减少了再灌输.
- 与COT相比,单独的HFNC并没有显著降低再灌输 (RR 0.79).
- 与HFNC相比,NIV + HFNC (RR 0.46) 和NIV (RR 0.31) 均降低了28天死亡率,两者治疗所需人数为15.
结论:
- 单独使用NIV或与HFNC结合使用,可以有效地降低重症肥胖患者在输管术后的再输管率.
- 与HFNC相比,基于NIV的策略也显示了28天死亡率的显著降低.
- 这些发现支持使用NIV来缓解输出失败并改善这一高风险患者群体的生存率.
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