Prophylactic Antibiotics in Adults With Acute Brain Injury Who Are Invasively Ventilated in the ICU: A Systematic Review and Meta-Analysis.

IF 9.5 1区医学 Q1 CRITICAL CARE MEDICINE

Chest Pub Date : 2025-04-01 Epub Date: 2024-10-28 DOI:10.1016/j.chest.2024.10.031

Kathryn Hadley-Brown, Laura Hailstone, Roisin Devane, Tak Chan, Anthony Devaux, Joshua S Davis, Naomi Hammond, Qiang Li, Edward Litton, John Myburgh, Alexis Poole, Joseph Santos, Ian Seppelt, Steven Y C Tong, Andrew Udy, Balasubramanian Venkatesh, Paul J Young, Anthony P Delaney

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引用次数: 0

Abstract

Background: Lower respiratory tract infections are common in patients receiving invasive mechanical ventilation in an ICU after an acute brain injury and may have deleterious consequences.

Research question: In adults with acute brain injury receiving invasive mechanical ventilation in an ICU, is the administration of prophylactic parenteral antibiotics, compared with placebo or usual care, associated with reduced mortality?

Study design and methods: We conducted a systematic review and meta-analysis. We searched for randomized clinical trials in electronic databases, as well as unpublished trials. The primary outcome was hospital mortality, and secondary outcomes included the incidence of ventilator-associated pneumonia, ICU length of stay, and duration of mechanical ventilation. We used a random effects model to estimate the pooled risk ratio (RR) with corresponding 95% CI for binary outcomes and the mean difference (MD) with 95% CI for continuous outcomes. Certainty of evidence was evaluated using Grading of Recommendations Assessment Development and Evaluation methods.

Results: One thousand seven hundred twenty-eight reports of studies were screened, with 7 randomized controlled trials recruiting 835 participants included. No trials were adjudicated as having a high risk of bias. The pooled estimated RR for mortality associated with the use of prophylactic antibiotics was 0.91 (95% CI, 0.70-1.17; P = .39; low certainty). The pooled estimated RR for ventilator-associated pneumonia was 0.56 (95% CI, 0.35-0.89; low certainty). The pooled estimated duration of mechanical ventilation for those allocated to prophylactic antibiotics compared with control participants (MD, -2.0 days; 95% CI, -6.1 to 2.1 days; very low certainty) and duration of ICU admission (MD, -2.2 days; 95% CI, -5.4 to 1.1 days; very low certainty) were similar.

Interpretation: Current evidence from randomized clinical trials does not provide definitive evidence regarding the effect of prophylactic antibiotics on mortality in patients receiving invasive mechanical ventilation in the ICU.

Clinical trial registry: International Prospective Register of Systematic Reviews; No.: CRD42023424732; URL: https://www.crd.york.ac.uk/prospero/.

查看原文本刊更多论文

成人急性脑损伤患者在重症监护病房进行侵入性通气时预防性使用抗生素：系统回顾和荟萃分析。

背景：下呼吸道感染是急性脑损伤后在重症监护病房（ICU）接受有创机械通气的患者的常见病，可能会造成不良后果：下呼吸道感染是急性脑损伤后在重症监护病房（ICU）接受有创机械通气的患者的常见病，可能会产生有害后果：研究问题：在重症监护室接受有创机械通气的急性脑损伤成人患者中，与安慰剂或常规护理相比，预防性肠外抗生素的应用是否与死亡率的降低有关？我们进行了系统回顾和荟萃分析。我们在电子数据库中搜索了随机临床试验（RCT）以及未发表的试验。主要结果是住院死亡率，次要结果包括呼吸机相关肺炎的发生率、重症监护室的住院时间和机械通气的持续时间。对于二元结局，我们使用随机效应模型估算了汇总风险比 (RR) 和相应的 95% 置信区间 (CI)；对于连续结局，我们估算了平均差 (MD) 和 95% 置信区间 (CI)。采用 GRADE 方法对证据的确定性进行了评估：结果：共筛选出 1728 份研究报告，其中包括 7 项招募了 835 名参与者的 RCT。没有一项试验被判定为存在高偏倚风险。与使用预防性抗生素相关的死亡率的汇总估计风险比（RR）为 0.91（95% CI 0.70 至 1.17，P=0.39，低确定性）。呼吸机相关肺炎的汇总估计RR为0.56（95% CI为0.35至0.89，确定性较低）。与对照组相比，被分配使用预防性抗生素的患者的机械通气持续时间（平均差异（MD）-2.0 天，95% CI -6.1-2.1，确定性极低）和入住 ICU 的持续时间（MD -2.2 天，95% CI -5.4-1.1天，确定性极低）的汇总估计值相似：目前来自随机临床试验的证据并未就预防性抗生素对在重症监护室接受有创机械通气患者死亡率的影响提供确切证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Chest 医学-呼吸系统

CiteScore

13.70

自引率

3.10%

发文量

3369

审稿时长

15 days

期刊介绍： At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.