气泡持续气道正压治疗1-59月龄儿童重症肺炎和低氧血症的有效性:随机对照试验的系统评价和荟萃分析

IF 1.7 4区 医学 Q2 PEDIATRICS
Indian pediatrics Pub Date : 2025-06-01 Epub Date: 2025-04-29 DOI:10.1007/s13312-025-00081-x
Mohammad Tanashat, AlMothana Manasrah, Omar Abdullah Bataineh, Ahmad Abdelrazek, Mohamed Abouzid
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引用次数: 0

摘要

目的:持续气道正压通气(CPAP)是中重度呼吸窘迫患儿的标准治疗方法;然而,发展中国家往往没有呼吸机。气泡CPAP (bCPAP)被认为是一种简单、成本效益高、侵入性小的CPAP替代方案,然而,直到最近才对其对肺炎儿童的疗效进行评估。本荟萃分析旨在比较bCPAP与低流量氧治疗儿童重症肺炎和低氧血症的有效性。方法:检索PubMed, EMBASE, Cochrane Library, Web of Science和CENTRAL,以确定截至2024年3月23日报道的符合条件的随机对照试验。使用Review Manager软件以风险比(rr)或平均差(MD)和置信区间(ci)报告结果。结果:纳入了3项研究,共纳入了2030例患者,结果显示bCPAP与对照组的总死亡率无显著差异[RR (95% CI) 0.46 (0.09, 2.32);住院期间死亡[0.48 (0.02,9.09),P = 0.619],综合主要结局[0.48 (0.12,1.97),P = 0.301],气胸[1.94 (0.16,23.11),P = 0.601],违背医嘱出院[0.63 (0.16,2.39),P = 0.489],住院时间[MD (95%CI) 0.15天(- 0.66,0.96),P = 0.706]。使用bCPAP的儿童发生严重低氧血症的事件显著减少[RR (95% CI) 0.22 (0.10, 0.49), P]结论:bCPAP在提高肺炎儿童生存率和缩短住院时间方面并不优于低流量氧,尽管机械通气的需要减少了。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effectiveness of Bubble Continuous Positive Airway Pressure for Treatment of Children Aged 1-59 Months with Severe Pneumonia and Hypoxemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objective: Continuous positive airway pressure (CPAP) is a standard treatment for children with moderate to severe respiratory distress; however, ventilators are often unavailable in developing countries. Bubble CPAP (bCPAP) is considered a simple, cost effective and less invasive alternative to CPAP, however, its efficacy has not been assessed for children with pneumonia until recently. This meta-analysis aims to compare the effectiveness of bCPAP with low-flow oxygen for treating severe pneumonia and hypoxemia in children.

Methods: PubMed, EMBASE, Cochrane Library, Web of Science, and CENTRAL were searched to identify eligible randomized controlled trials reported up to March 23, 2024. Outcomes were reported as risk ratios (RRs) or mean difference (MD) and confidence intervals (CIs) using Review Manager software. P value < 0.05 was considered statistically significant.

Results: Three studies with 2030 patients were included and revealed no significant difference between bCPAP and control in overall mortality [RR (95% CI) 0.46 (0.09, 2.32); P = 0.348], death during hospital stay [0.48 (0.02, 9.09), P = 0.619], composite primary outcome [0.48 (0.12, 1.97), P = 0.301], pneumothorax [1.94 (0.16, 23.11), P = 0.601], leaving hospital against medical advice [0.63 (0.16, 2.39), P = 0.489], and length of hospital stay [MD (95%CI) 0.15 days (- 0.66, 0.96), P = 0.706]. Children on bCPAP had significantly fewer events of severe hypoxemia [RR (95% CI) 0.22 (0.10, 0.49), P < 0.001], and less requirement for mechanical ventilation [RR (95% CI) 0.38 (0.15, 0.99), P = 0.048].

Conclusion: bCPAP is not superior to low-flow oxygen for improving survival and reducing hospital stay in children with pneumonia, albeit the need for mechanical ventilation decreases.

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来源期刊
Indian pediatrics
Indian pediatrics 医学-小儿科
CiteScore
3.30
自引率
8.70%
发文量
344
审稿时长
3-8 weeks
期刊介绍: The general objective of Indian Pediatrics is "To promote the science and practice of Pediatrics." An important guiding principle has been the simultaneous need to inform, educate and entertain the target audience. The specific key objectives are: -To publish original, relevant, well researched peer reviewed articles on issues related to child health. -To provide continuing education to support informed clinical decisions and research. -To foster responsible and balanced debate on controversial issues that affect child health, including non-clinical areas such as medical education, ethics, law, environment and economics. -To achieve the highest level of ethical medical journalism and to produce a publication that is timely, credible and enjoyable to read.
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