烧伤患者消化道的选择性去污染:通过元分析进行系统性审查
Emma Atsuko Tsuchiya1, Jacob Jensen-Abbew1, Mette Krag1
1Department of Anesthesiology, Surgery and Trauma Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
消化道的选择性去污染 (SDD) 显示了非常低的确定性证据,以改善烧伤患者的结果. 需要更多的研究来确认这种独特人群的益处.
科学领域:
- 临界护理医学 临界护理医学
- 预防传染病 预防传染病
- 烧伤患者管理管理
背景情况:
- 消化道的选择性消毒 (SDD) 减少了感染,并改善了机械通风ICU患者的存活率.
- 烧伤患者具有高感染风险和独特的临床特征,因此需要对该组SDD疗效进行评估.
研究的目的:
- 系统地审查SDD在烧伤患者中对患者重要的可取和不可取影响.
- 评估SDD对烧伤患者死亡率,不良事件和感染率的影响.
主要方法:
- 随机临床试验 (RCT) 的系统审查和元分析,将SDD与安慰剂或没有SDD进行比较.
- 搜索了主要的数据库,遵守柯克兰和PRISMA指南.
- 使用推评估,开发和评价 (GRADE) 方法评估证据的确定性.
主要成果:
- 包括4个RCT与457个烧伤患者;所有人都有"一些担忧"或"高风险"的偏见.
- 所有结局的证据,包括30天死亡率 (RR 0.62,95% CI 0.22-1.78),肺炎和血液感染,确定性非常低.
- 数据不足阻止了对几个次要结果的元分析和试验顺序分析.
结论:
- 关于SDD对烧伤患者患者重要结果的影响的证据的确定性非常低.
- 从一般机械通风ICU患者的数据中推断,可以考虑在等待在烧伤人群中进行进一步的RCT.
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