[不同干预措施对重症患者机械通气时间和重症监护室住院时间的影响:网络 Meta 分析]。

Q3 Medicine
Ying Li, Xiangkun Li, Jie Zhang, Shuai Xu, Lei Gao, Xiaohan Meng, Xiaoan Chen
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引用次数: 0

摘要

目的采用网络 Meta 分析法评估不同干预措施对重症患者机械通气时间和重症监护室(ICU)住院时间的影响:在 PubMed、Embase、中国生物医学文献数据库、CNKI 等数据库中系统检索了不同干预措施对重症患者机械通气时间和重症监护病房(ICU)住院时间影响的随机对照试验(RCT)。检索时限为数据库建立后至 2023 年 11 月。文献筛选、质量评估和数据提取由两名研究人员独立完成。采用网络元分析法评估每种干预措施对机械通气时间和重症监护室住院时间的影响,并生成漏斗图:共纳入了 37 项 RCT,涉及 3 977 名重症患者,其中干预组 2 041 人,对照组 1 936 人。分析了 13 种干预方式,包括常规护理(UC)、早期活动(EA)、早期综合康复(ECR)、早期肺康复(EPR)、集群干预策略(CS)、镇静、镇痛和集群护理(SACN)、音乐治疗(MT)、神经肌肉电刺激(NMES)、改良教育和探视(MV)、虚拟现实(VR)、耳穴贴敷(APS)、穴位针灸(AA)和协同干预(COR)。网络 Meta 分析显示,在改善重症患者机械通气时间方面,MV 明显优于 COR [标准化平均差(SMD)=-2.35,95% 置信区间(95%CI)为-4.30 至-0.39]、EPR(SMD =-2.59,95%CI 为-4.81 至-0.37)和 UC(SMD =-4.10,95%CI 为-5.71 至-2.49)。在缩短重症监护室住院时间方面,COR明显优于UC(SMD=-5.72,95%CI为-10.07至-1.37)。疗效排名结果显示,在机械通气持续时间方面,MV(85.4%)和EA(85.4%)的累积排名曲线下表面积(SUCRA)最高,其次是AA(74.9%)、NMES(63.1%)、ECR(51.7%)、CS(48.8%)、SACN(34.3%)、COR(29.4%)、EPR(26.1%)和UC(0.7%)。在重症监护室住院时间方面,COR 的 SUCRA 最高(82.3%),其次是 APS(79.7%)、MV(77.7%)、EPR(68.0%)、NMES(57.6%)、CS(54.4%)、ECR(51.1%)、SACN(41.9%)、MT(39.8%)、EA(39.3%)、AA(33.0%)、VR(15.4%)和 UC(9.8%)。ICU住院时间的漏斗图结果显示,研究之间的发表偏倚相对较小:MV和COR似乎是减少重症患者机械通气时间和ICU住院时间的有效干预措施。然而,由于纳入研究的数量和质量问题,这些发现需要通过更多高质量的研究来证实。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Effect of different intervention measures on duration of mechanical ventilation and the length of ICU stay in critically ill patients: a network Meta-analysis].

Objective: To evaluate the effects of different intervention measures on duration of mechanical ventilation and the length of intensive care unit (ICU) stay in critically ill patients using network Meta-analysis.

Methods: Randomized controlled trial (RCT) on the effects of different intervention measures on duration of mechanical ventilation and the length of ICU stay in critically ill patients were systematically searched in PubMed, Embase, China Biomedical Literature Database, CNKI, and other databases. The search time limit was from the establishment of the database to November 2023. Literature screening, quality assessment, and data extraction were independently conducted by two researchers. Network Meta-analysis was employed to assess the effects of each intervention on duration of mechanical ventilation and the length of ICU stay, and funnel plots were generated.

Results: A total of 37 RCTs were included, involving 3 977 severe patients, 2 041 in the intervention group and 1 936 in the control group. Thirteen types of interventions were analyzed, including usual care (UC), early activity (EA), early comprehensive rehabilitation (ECR), early pulmonary rehabilitation (EPR), cluster intervention strategy (CS), sedation, analgesia and cluster nursing (SACN), music therapy (MT), neuromuscular electrical stimulation (NMES), modified education and visitation (MV), virtual reality (VR), auricular point sticking (APS), acupoint acupuncture (AA), and concerted intervention (COR). Network Meta-analysis showed that MV significantly better than COR [standardized mean difference (SMD) = -2.35, 95% confidence interval (95%CI) was -4.30 to -0.39], EPR (SMD = -2.59, 95%CI was -4.81 to -0.37), and UC (SMD = -4.10, 95%CI was -5.71 to -2.49) in improving duration of mechanical ventilation in critically ill patients. COR was significantly better than UC in shortened length of ICU stay (SMD = -5.72, 95%CI was -10.07 to -1.37). The efficacy ranking results showed that for duration of mechanical ventilation, the surface under the cumulative ranking curve (SUCRA) was highest for MV (85.4%) and EA (85.4%), followed by AA (74.9%), NMES (63.1%), ECR (51.7%), CS (48.8%), SACN (34.3%), COR (29.4%), EPR (26.1%), and UC (0.7%). For the length of ICU stay, COR had the highest SUCRA (82.3%), followed by APS (79.7%), MV (77.7%), EPR (68.0%), NMES (57.6%), CS (54.4%), ECR (51.1%), SACN (41.9%), MT (39.8%), EA (39.3%), AA (33.0%), VR (15.4%), and UC (9.8%). The funnel plot results of ICU stay showed that the publication bias between studies were relatively small.

Conclusions: MV and COR appear to be effective interventions for reducing mechanical ventilation time and ICU stay in critically ill patients. However, due to the number and quality of included studies, these findings require confirmation through additional high-quality research.

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来源期刊
Zhonghua wei zhong bing ji jiu yi xue
Zhonghua wei zhong bing ji jiu yi xue Medicine-Critical Care and Intensive Care Medicine
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