在输管患者中进行口腔关干预以预防呼吸机相关肺炎:系统性审查和多变体网络元分析评估药理学剂
Kannan Sridharan1, Gowri Sivaramakrishnan2, Ghazi Abdulrahman Alotaibi3,4
1Department of Pharmacology & Therapeutics, College of Medicine & Health Sciences, Arabian Gulf University, Manama 26671, Bahrain.
这一网络分析发现,虽然各种口腔干预措施可以预防呼吸机相关肺炎 (VAP),但它们的有效性因结果而异. 最佳的VAP预防可能不会减少死亡率或资源使用.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 肺部医学 肺部医学
背景情况:
- 呼吸机相关肺炎 (VAP) 是机械通风 (MV) 的严重并发症,导致死亡率增加和医疗费用增加.
- 现有的口腔关干预缺乏关键结果的直接比较疗效数据.
- 关于不同局部口服干预措施在VAP预防方面的比较有效性存在不确定性.
研究的目的:
- 进行系统性审查和网络元分析 (NMA),比较在直管患者中预防VAP的局部口服干预措施.
- 评估这些干预措施对VAP发病率,ICU死亡率,MV持续时间和ICU停留时间 (LOS) 的比较有效性.
- 评估每项干预措施的证据确定性.
主要方法:
- 在2025年9月之前对随机和非随机研究进行系统审查和NMA.
- 搜索了MEDLINE,EMBASE和Cochrane CENTRAL的研究,比较了直管患者的局部口腔干预措施.
- 分析了VAP发病率,ICU死亡率,MV持续时间和ICU LOS使用对对和网络元分析;评估了使用GRADE的证据确定性.
主要成果:
- 96项研究 (20,650名患者) 评估了44项干预措施.
- 与对照组相比,抗微生物组合,波维-和赫西丁在VAP预防方面表现优越.
- 赫西丁加牙刷是唯一能显著降低死亡率的干预措施 (OR:0.74,95% CI:0.58-0.93);抗菌药物组合减少了MV持续时间和ICU LOS.
结论:
- 多次口腔关干预有效地预防VAP,但好处是结果具体的.
- 选择的干预措施应与临床优先事项保持一致,因为VAP预防的有效性不能保证减少死亡率或资源利用率.
- 这些发现支持制定标准化,多方面的ICU口腔护理协议的指导方针.
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