背景:俯卧位是急性呼吸窘迫综合征抢救治疗的一种选择。然而,创伤和手术患者的相关数据有限,体位改变后并发症的风险可能增加。这项研究旨在确定该患者亚组的益处和风险。
方法:遵循PRISMA2020,进行MEDLINE和EMBASE数据库搜索。还进行了相关主要文献和综述文章的额外搜索。使用随机效应模型来估计PF比率,死亡率,机械呼吸机天数,和使用ReviewManager5.4.1软件的重症监护病房住院时间。
结果:在1,128项研究中,本荟萃分析包括15篇文章。与仰卧位相比,俯卧位显着提高了PF比率(平均差,79.26;95%CI,53.38至105.13)。俯卧位组有统计学意义的死亡率获益(风险比[RR],0.48;95%CI,0.35至0.67)。虽然重症监护病房住院时间没有显著差异,俯卧位显着减少了机械呼吸机天数(-2.59;95%CI,-4.21至-0.97)。关于系统审查,轻微的并发症是常见的,尤其是面部水肿.局部伤口并发症无差异。
结论:俯卧位具有与仰卧位相当的并发症。由于其增加氧合和降低死亡率的好处,对于外伤和手术患者,可以考虑俯卧位。有必要进行前瞻性多中心研究。
BACKGROUND: Prone position is an option for rescue therapy for acute respiratory distress syndrome. However, there are limited relevant data among trauma and surgical patients, who may be at increased risk for complications following position changes. This study aimed to identify the benefits and risks of proning in this patient subgroup.
METHODS: Follow the PRISMA 2020, MEDLINE and EMBASE database searches were conducted. Additional search of relevant primary literature and
review articles was also performed. A random effects model was used to estimate the PF ratio, mortality rate, mechanical ventilator days, and intensive care unit length of stay using
Review Manager 5.4.1 software.
RESULTS: Of 1,128 studies, 15 articles were included in this meta-analysis. The prone position significantly improved the PF ratio compared with the supine position (mean difference, 79.26; 95% CI, 53.38 to 105.13). The prone position group had a statistically significant mortality benefit (risk ratio [RR], 0.48; 95% CI, 0.35 to 0.67). Although there was no significant difference in the intensive care unit length of stay, the prone position significantly decreased mechanical ventilator days (-2.59; 95% CI, -4.21 to -0.97). On systematic
review, minor complications were frequent, especially facial edema. There were no differences in local wound complications.
CONCLUSIONS: The prone position has comparable complications to the supine position. With its benefits of increased oxygenation and decreased mortality, the prone position can be considered for trauma and surgical patients. A prospective multicenter study is warranted.