机械通气危重患者胸腔积液的处理：系统回顾和指南。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-02-01 Epub Date: 2024-12-12 DOI:10.1016/j.amjsurg.2024.116144

William C Chiu, Nikolay Bugaev, Kaushik Mukherjee, John J Como, George Kasotakis, Rachel S Morris, Katherine D Downton, Vanessa P Ho, Christopher W Towe, Jeannette M Capella, Bryce R H Robinson

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引用次数: 0

摘要

背景：机械通气危重患者常发生胸腔积液，影响肺顺应性和肺扩张。本系统综述探讨危重患者胸膜积液的处理。方法:进行全面的文献检索。证据质量评级和建议发展采用建议评估、发展和评价分级（GRADE）方法。结果：完整检索检索到11965篇文章进行筛选，其中28篇研究最终符合纳入标准。有15项队列研究评估氧合结局，17项队列研究评估气胸结局。引流患者（n = 418）与预引流/未引流患者（n = 432）相比，PaO2/FiO2比值累计平均增加53 （P 2 = 0%）。引流组气胸合并发生率为124/5995（2.1%）。结论：对于机械通气的危重成人胸腔积液伴缺氧患者，我们有条件地推荐胸腔积液引流以改善氧合。P:F比500毫升是排水最有利的条件。

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Management of pleural effusion in mechanically ventilated critically ill patients: A systematic review and guideline.

Background: Mechanically ventilated critically ill patients often develop pleural effusions, which may impact lung compliance and expansion. This systematic review explores the management of pleural effusion in the critically ill population.

Methods: A comprehensive literature search was performed. Quality of evidence rating and recommendation development utilized Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

Results: The full search retrieved 11,965 articles for screening, of which 28 studies ultimately met inclusion criteria. There were 15 cohort studies assessing oxygenation outcome and 17 cohort studies assessing pneumothorax outcome. Patients with drainage (n = 418) had a pooled mean increase in PaO2/FiO2 ratio of 53 (P < 0.00001, 95 % CI: 43-64, I² = 0 %) compared to pre-drainage/no-drainage (n = 432). In patients with drainage, the combined incidence of pneumothorax was 124/5995 (2.1 %).

Conclusion: In mechanically ventilated critically ill adult patients with pleural effusion and hypoxia, we conditionally recommend drainage of pleural effusion to improve oxygenation. P:F ratio <200 and pleural effusion volume estimate >500 mL are conditions in which drainage would have most benefit.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.