{"title":"无创脱离通气可降低死亡率、呼吸机相关性肺炎和插管成人的住院时间","authors":"Grant Willson","doi":"10.1016/S0004-9514(09)70083-2","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To review the evidence as to whether early extubation with immediate application of non-invasive ventilation reduces mortality and ventilator-associated pneumonia and improves other outcomes in criticallyill adults receiving invasive ventilation.</p></div><div><h3>Data sources</h3><p>Medline, Embase, CENTRAL, searched up to April, 2008. This search was supplemented by hand-searching of conference proceeding and citation tracking.</p></div><div><h3>Study selection</h3><p>Randomised and quasi-randomised controlled trials involving adults with respiratory failure who required invasive ventilation for at least 24 hours in which extubation with immediate application of noninvasive ventilation was compared to continued invasive weaning. Outcome measures were mortality, ventilatorassociated pneumonia, weaning failure, length of stay in intensive care or hospital, total duration of ventilation (invasive and non-invasive), duration of ventilation related to weaning (after randomisation), duration of invasive-only ventilation, adverse events (arrhythmia, reintubation, tracheostomy), and quality of life.</p></div><div><h3>Data extraction</h3><p>Two reviewers extracted data and discrepancies were resolved by consensus and arbitration. Methodological quality was assessed.</p></div><div><h3>Data synthesis</h3><p>Of 1368 studies identified by the initial search, 12 studies with a total of 530 patients met the selection criteria and were included in the review. All included studies were of moderate to high quality according to the reviewers’ criteria. Based on the quantitative pooling of the available data from these trials, there was a statistically significant difference in mortality in favour of non-invasive weaning, relative risk 0.55 (95% CI 0.38 to 0.79). Non-invasive weaning also significantly reduced ventilator-associated pneumonia (relative risk 0.29, 95% CI 0.19 to 0.45), length of stay in the intensive care unit (by 6 days, 95% CI 4 to 9) and in the hospital (by 7 days, 95% CI 4 to 11), total duration of ventilation (by 6 days, 95% CI 2 to 9), duration of invasive ventilation (by 8 days, 95% CI 4 to 11), and tracheostomy (relative risk 0.16, 95% CI 0.04 to 0.75). The remaining secondary outcomes did not differ significantly. None of the included studies measured quality of life.</p></div><div><h3>Conclusion</h3><p>Non-invasive ventilation facilitates weaning and has substantial clinical benefits in adults with respiratory failure who require invasive ventilation.</p></div>","PeriodicalId":50086,"journal":{"name":"Australian Journal of Physiotherapy","volume":"55 3","pages":"Page 207"},"PeriodicalIF":0.0000,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70083-2","citationCount":"2","resultStr":"{\"title\":\"Non-invasive weaning from ventilation reduces mortality, ventilator-associated pneumonia, and length of stay in intubated adults\",\"authors\":\"Grant Willson\",\"doi\":\"10.1016/S0004-9514(09)70083-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>To review the evidence as to whether early extubation with immediate application of non-invasive ventilation reduces mortality and ventilator-associated pneumonia and improves other outcomes in criticallyill adults receiving invasive ventilation.</p></div><div><h3>Data sources</h3><p>Medline, Embase, CENTRAL, searched up to April, 2008. This search was supplemented by hand-searching of conference proceeding and citation tracking.</p></div><div><h3>Study selection</h3><p>Randomised and quasi-randomised controlled trials involving adults with respiratory failure who required invasive ventilation for at least 24 hours in which extubation with immediate application of noninvasive ventilation was compared to continued invasive weaning. Outcome measures were mortality, ventilatorassociated pneumonia, weaning failure, length of stay in intensive care or hospital, total duration of ventilation (invasive and non-invasive), duration of ventilation related to weaning (after randomisation), duration of invasive-only ventilation, adverse events (arrhythmia, reintubation, tracheostomy), and quality of life.</p></div><div><h3>Data extraction</h3><p>Two reviewers extracted data and discrepancies were resolved by consensus and arbitration. Methodological quality was assessed.</p></div><div><h3>Data synthesis</h3><p>Of 1368 studies identified by the initial search, 12 studies with a total of 530 patients met the selection criteria and were included in the review. All included studies were of moderate to high quality according to the reviewers’ criteria. Based on the quantitative pooling of the available data from these trials, there was a statistically significant difference in mortality in favour of non-invasive weaning, relative risk 0.55 (95% CI 0.38 to 0.79). Non-invasive weaning also significantly reduced ventilator-associated pneumonia (relative risk 0.29, 95% CI 0.19 to 0.45), length of stay in the intensive care unit (by 6 days, 95% CI 4 to 9) and in the hospital (by 7 days, 95% CI 4 to 11), total duration of ventilation (by 6 days, 95% CI 2 to 9), duration of invasive ventilation (by 8 days, 95% CI 4 to 11), and tracheostomy (relative risk 0.16, 95% CI 0.04 to 0.75). The remaining secondary outcomes did not differ significantly. None of the included studies measured quality of life.</p></div><div><h3>Conclusion</h3><p>Non-invasive ventilation facilitates weaning and has substantial clinical benefits in adults with respiratory failure who require invasive ventilation.</p></div>\",\"PeriodicalId\":50086,\"journal\":{\"name\":\"Australian Journal of Physiotherapy\",\"volume\":\"55 3\",\"pages\":\"Page 207\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2009-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/S0004-9514(09)70083-2\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Australian Journal of Physiotherapy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0004951409700832\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Australian Journal of Physiotherapy","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0004951409700832","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 2
摘要
目的回顾早期拔管并立即应用无创通气是否能降低危重成人接受有创通气的死亡率和呼吸机相关性肺炎,并改善其他结局的证据。数据来源medline, Embase, CENTRAL,检索截止到2008年4月。该检索还辅以手工检索会议记录和引文跟踪。研究选择随机和准随机对照试验,涉及需要有创通气至少24小时的呼吸衰竭成人,其中拔管并立即应用无创通气与持续有创脱机进行比较。结局指标为死亡率、呼吸机相关肺炎、脱机失败、重症监护或住院时间、总通气时间(有创和无创)、脱机相关通气时间(随机化后)、仅有创通气持续时间、不良事件(心律失常、重新插管、气管切开术)和生活质量。数据提取两名审稿人提取数据,差异通过协商一致和仲裁解决。评估方法学质量。在最初检索确定的1368项研究中,有12项研究(共530例患者)符合选择标准,被纳入本综述。根据审稿人的标准,所有纳入的研究均为中等至高质量。基于这些试验中可用数据的定量汇总,非侵入性断奶的死亡率有统计学显著差异,相对危险度为0.55 (95% CI 0.38 ~ 0.79)。无创脱机也显著减少呼吸机相关肺炎(相对危险度0.29,95% CI 0.19 ~ 0.45)、重症监护病房住院时间(减少6天,95% CI 4 ~ 9)和住院时间(减少7天,95% CI 4 ~ 11)、总通气时间(减少6天,95% CI 2 ~ 9)、有创通气时间(减少8天,95% CI 4 ~ 11)和气管造口术(相对危险度0.16,95% CI 0.04 ~ 0.75)。其余次要结局无显著差异。纳入的研究都没有测量生活质量。结论无创通气对需要有创通气的成人呼吸衰竭患者脱机方便,临床获益显著。
Non-invasive weaning from ventilation reduces mortality, ventilator-associated pneumonia, and length of stay in intubated adults
Objective
To review the evidence as to whether early extubation with immediate application of non-invasive ventilation reduces mortality and ventilator-associated pneumonia and improves other outcomes in criticallyill adults receiving invasive ventilation.
Data sources
Medline, Embase, CENTRAL, searched up to April, 2008. This search was supplemented by hand-searching of conference proceeding and citation tracking.
Study selection
Randomised and quasi-randomised controlled trials involving adults with respiratory failure who required invasive ventilation for at least 24 hours in which extubation with immediate application of noninvasive ventilation was compared to continued invasive weaning. Outcome measures were mortality, ventilatorassociated pneumonia, weaning failure, length of stay in intensive care or hospital, total duration of ventilation (invasive and non-invasive), duration of ventilation related to weaning (after randomisation), duration of invasive-only ventilation, adverse events (arrhythmia, reintubation, tracheostomy), and quality of life.
Data extraction
Two reviewers extracted data and discrepancies were resolved by consensus and arbitration. Methodological quality was assessed.
Data synthesis
Of 1368 studies identified by the initial search, 12 studies with a total of 530 patients met the selection criteria and were included in the review. All included studies were of moderate to high quality according to the reviewers’ criteria. Based on the quantitative pooling of the available data from these trials, there was a statistically significant difference in mortality in favour of non-invasive weaning, relative risk 0.55 (95% CI 0.38 to 0.79). Non-invasive weaning also significantly reduced ventilator-associated pneumonia (relative risk 0.29, 95% CI 0.19 to 0.45), length of stay in the intensive care unit (by 6 days, 95% CI 4 to 9) and in the hospital (by 7 days, 95% CI 4 to 11), total duration of ventilation (by 6 days, 95% CI 2 to 9), duration of invasive ventilation (by 8 days, 95% CI 4 to 11), and tracheostomy (relative risk 0.16, 95% CI 0.04 to 0.75). The remaining secondary outcomes did not differ significantly. None of the included studies measured quality of life.
Conclusion
Non-invasive ventilation facilitates weaning and has substantial clinical benefits in adults with respiratory failure who require invasive ventilation.