在ICU外的高流量鼻:系统性审查和元分析
Andrea Boccatonda1, Alice Brighenti1, Damiano D'Ardes2
1Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, via Massarenti n 9, 40138 Bologna, Italy.
高流量鼻腔管 (HFNC) 的使用扩展到ICU以外,但结果因护理环境而异. 在一般病房中,HFNC是可行的,但与较高的死亡率和ICU转移有关,与步进单位不同.
科学领域:
- 临界护理医学 临界护理医学
- 呼吸系统疗法 呼吸系统疗法
- 医疗保健服务研究 医疗服务研究
背景情况:
- 高流量鼻腔管 (HFNC) 的使用已经超出了重症监护室 (ICU) 的范围,进入了普通和升级呼吸病房.
- 在非ICU环境中HFNC的安全性和有效性仍在调查中,特别是在流行病后.
- 现有的证据有限,需要对其在各种医院环境中的应用进行全面审查.
研究的目的:
- 系统地审查和元分析非ICU环境中启动的HFNC的安全性和有效性.
- 为了比较HFNC的结果,包括死亡率和ICU转移率,在不同的非ICU环境中 (一般病房与步进单位).
- 评估HFNC与常规氧气疗法 (COT) 在无输入 (DNI) 患者队列中的差异.
主要方法:
- 对非ICU病房中使用HFNC启动的成人患者的观察性研究和试验进行系统审查和元分析.
- 评估的主要结局是住院或28天死亡率和ICU转移.
- 随机效应模型用于合成,并使用ROBINS-I/RoB 2和GRADE标准评估偏差风险和证据确定性.
主要成果:
- 在所有非ICU病房中,聚合死亡率为14.0%,ICU转移为20.0%.
- 与升级单位 (22.0%的转移) 相比,内科/呼吸病房的综合死亡率 (19.8%) 和ICU转移率 (31.2%) 较高.
- 关键结果的证据确定性非常低,这是由于研究设计,不一致性和不准确性.
结论:
- 在ICU之外,HFNC是可行的,但与显著的死亡率和升级有关,特别是在一般病房.
- 步进单位 (IMCU/HDU) 显示出更一致的HFNC结果,表明结果取决于环境.
- 鉴于证据的确定性较低,机构应为病房的HFNC实施协议化的重新评估和快速响应系统.
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