背景:在重症监护病房(ICU)中,机械通气(MV)是一种典型的呼吸支持方式。疾病的严重程度增加了需要MV的患者死亡的可能性。在埃塞俄比亚进行了几项研究;然而,他们的死亡率不同。本系统评价和荟萃分析的目的是提供在埃塞俄比亚医院接受MV的ICU住院患者中死亡率和相关因素的汇总患病率。
方法:我们使用系统评价和荟萃分析的首选报告项目(PRISMA)2020标准在本研究中进行了全面的系统评价和荟萃分析。我们搜索了PubMed/Medline,Scopus,Embase,Hinari,和WebofScience,发现了22篇符合我们纳入标准的文章。我们使用了随机效应模型。为了确定纳入研究中的异质性,使用meta回归和亚组分析。我们采用Egger回归检验和漏斗图评估发表偏倚。STATA版本17.0软件用于所有统计分析。
结果:在本系统综述和荟萃分析中,来自22篇文章的7507名ICU住院患者的合并死亡率,接受MV的患者估计为54.74%[95%CI=47.93,61.55]。在按地区分组分析中,南方国家,国籍,和人民(SNNP)亚组(64.28%,95%CI=51.19,77.37)的患病率最高。COVID-19患者死亡率最高(75.80%,95%CI=51.10,0.00)。脓毒症(OR=6.85,95CI=3.24,14.46),格拉斯哥昏迷评分(GCS)评分<8(OR=6.58,95CI=1.96,22.11),住院病例(OR=4.12,95CI=2.00,8.48),多器官功能障碍综合征(MODS)(OR=2.70,95CI=4.11,12.62),和血管加压药治疗(OR=19.06,95CI=9.34,38.88)均与死亡率相关.
结论:我们的综述发现,与美国(US)的类似研究相比,埃塞俄比亚机械通气ICU住院患者的合并死亡率相当高。中国,和其他国家。脓毒症,GCS<8,医疗病例,MODS,血管加压药的使用与死亡率有统计学关联.临床医生在对ICU住院患者进行机械通气时应谨慎。然而,应该指出的是,通过这种荟萃分析无法确定确切的因果关系,因为现有证据不充分。因此,将需要更多使用前瞻性方法的研究。
BACKGROUND: In the intensive care unit (ICU), mechanical ventilation (MV) is a typical way of respiratory support. The severity of the illness raises the likelihood of death in patients who require MV. Several studies have been done in Ethiopia; however, the mortality rate differs among them. The objective of this systematic
review and meta-analysis is to provide a pooled prevalence of mortality and associated factors among ICU-admitted patients receiving MV in Ethiopian hospitals.
METHODS: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria to conduct a comprehensive systematic
review and meta-analysis in this study. We searched PubMed/Medline, SCOPUS, Embase, Hinari, and Web of Science and found 22 articles that met our inclusion criteria. We used a random-effects model. To identify heterogeneity within the included studies, meta-regression and subgroup analysis were used. We employed Egger\'s regression test and funnel plots for assessing publication bias. STATA version 17.0 software was used for all statistical analyses.
RESULTS: In this systematic
review and meta-analysis, the pooled prevalence of mortality among 7507 ICU-admitted patients from 22 articles, who received MV was estimated to be 54.74% [95% CI = 47.93, 61.55]. In the subgroup analysis by region, the Southern Nations, Nationalities, and Peoples (SNNP) subgroup (64.28%, 95% CI = 51.19, 77.37) had the highest prevalence. Patients with COVID-19 have the highest mortality rate (75.80%, 95% CI = 51.10, 100.00). Sepsis (OR = 6.85, 95%CI = 3.24, 14.46), Glasgow Coma Scale (GCS) score<8 (OR = 6.58, 95%CI = 1.96, 22.11), admission with medical cases (OR = 4.12, 95%CI = 2.00, 8.48), Multi Organ Dysfunction Syndrome (MODS) (OR = 2.70, 95%CI = 4.11, 12.62), and vasopressor treatment (OR = 19.06, 95%CI = 9.34, 38.88) were all statistically associated with mortality.
CONCLUSIONS: Our
review found that the pooled prevalence of mortality among mechanically ventilated ICU-admitted patients in Ethiopia was considerably high compared to similar studies in the United States (US), China, and other countries. Sepsis, GCS<8, medical cases, MODS, and use of vasopressors were statistically associated with mortality. Clinicians should exercise caution while mechanically ventilating ICU-admitted patients with these factors. However, it should be noted that the exact cause and effect relationship could not be established with this meta-analysis, as the available evidence is not sufficient. Thus, more studies using prospective methods will be required.