PDF(Pubmed)
Abstract：
BACKGROUND: Acute respiratory distress syndrome (ARDS) is often a consequence of a dysregulated immune response; therefore, immunomodulation by extracorporeal cytokine removal has been increasingly used as an adjuvant therapy, but convincing data are still missing. The aim of this study was to investigate the effects of adjunctive hemoadsorption (HA) on clinical and laboratory outcomes in patients with ARDS.
METHODS: We performed a systematic literature search in PubMed, Embase, CENTRAL, Scopus, and Web of Science (PROSPERO: CRD42022292176). The population was patients receiving HA therapy for ARDS. The primary outcome was the change in PaO2/FiO2 before and after HA therapy. Secondary outcomes included the before and after values for C-reactive protein (CRP), lactate, interleukin-6 (IL-6), and norepinephrine (NE) doses.
RESULTS: We included 26 publications, with 243 patients (198 undergoing HA therapy and 45 controls). There was a significant improvement in PaO2/FiO2 ratio following HA therapy (MD = 68.93 [95%-CI: 28.79 to 109.06] mmHg, p = 0.005) and a reduction in CRP levels (MD = -45.02 [95%-CI: -82.64; -7.39] mg/dL, p = 0.026) and NE dose (MD = -0.24 [95%-CI: -0.44 to -0.04] μg/kg/min, p = 0.028).
CONCLUSIONS: Based on our findings, HA resulted in a significant improvement in oxygenation and a reduction in NE dose and CRP levels in patients treated with ARDS. Properly designed RCTs are still needed.
METHODS: We performed a systematic literature search in PubMed, Embase, CENTRAL, Scopus, and Web of Science (PROSPERO: CRD42022292176). The population was patients receiving HA therapy for ARDS. The primary outcome was the change in PaO2/FiO2 before and after HA therapy. Secondary outcomes included the before and after values for C-reactive protein (CRP), lactate, interleukin-6 (IL-6), and norepinephrine (NE) doses.
RESULTS: We included 26 publications, with 243 patients (198 undergoing HA therapy and 45 controls). There was a significant improvement in PaO2/FiO2 ratio following HA therapy (MD = 68.93 [95%-CI: 28.79 to 109.06] mmHg, p = 0.005) and a reduction in CRP levels (MD = -45.02 [95%-CI: -82.64; -7.39] mg/dL, p = 0.026) and NE dose (MD = -0.24 [95%-CI: -0.44 to -0.04] μg/kg/min, p = 0.028).
CONCLUSIONS: Based on our findings, HA resulted in a significant improvement in oxygenation and a reduction in NE dose and CRP levels in patients treated with ARDS. Properly designed RCTs are still needed.
摘要：
背景：急性呼吸窘迫综合征（ARDS）通常是免疫反应失调的结果；因此，通过体外细胞因子去除进行免疫调节已越来越多地用作辅助治疗，但令人信服的数据仍然缺失。这项研究的目的是研究辅助血液吸收（HA）对ARDS患者临床和实验室结果的影响。
方法：我们在PubMed，Embase,中部,Scopus,和WebofScience(PROSPERO：CRD42022292176)。人群是接受HA治疗的ARDS患者。主要结果是HA治疗前后PaO2/FiO2的变化。次要结果包括C反应蛋白（CRP）的前后值，乳酸，白细胞介素-6（IL-6），和去甲肾上腺素（NE）剂量。
结果：我们包括26种出版物，243名患者(198名接受HA治疗，45名对照)。HA治疗后PaO2/FiO2比值有显著改善(MD=68.93[95%-CI:28.79至109.06]mmHg,p=0.005）和CRP水平降低（MD=-45.02[95％-CI：-82.64；-7.39]mg/dL，p=0.026）和NE剂量（MD=-0.24[95％-CI：-0.44至-0.04]μg/kg/min，p=0.028)。
结论：根据我们的发现，在接受ARDS治疗的患者中，HA导致氧合的显着改善以及NE剂量和CRP水平的降低。仍然需要适当设计的RCT。
方法：我们在PubMed，Embase,中部,Scopus,和WebofScience(PROSPERO：CRD42022292176)。人群是接受HA治疗的ARDS患者。主要结果是HA治疗前后PaO2/FiO2的变化。次要结果包括C反应蛋白（CRP）的前后值，乳酸，白细胞介素-6（IL-6），和去甲肾上腺素（NE）剂量。
结果：我们包括26种出版物，243名患者(198名接受HA治疗，45名对照)。HA治疗后PaO2/FiO2比值有显著改善(MD=68.93[95%-CI:28.79至109.06]mmHg,p=0.005）和CRP水平降低（MD=-45.02[95％-CI：-82.64；-7.39]mg/dL，p=0.026）和NE剂量（MD=-0.24[95％-CI：-0.44至-0.04]μg/kg/min，p=0.028)。
结论：根据我们的发现，在接受ARDS治疗的患者中，HA导致氧合的显着改善以及NE剂量和CRP水平的降低。仍然需要适当设计的RCT。
