背景:术后患者拔管后呼吸衰竭继发再次插管与患者发病率和死亡率增加相关。非侵入性呼吸支持(NRS)替代常规氧疗(COT),即,高流量鼻腔吸氧,持续气道正压通气,和无创通气(NIV),已被建议用于预防或治疗拔管后呼吸衰竭。本研究的目的是评估NRS应用的效果,与COT相比,关于重新插管率(主要结果),以及重新插管的时间,医院获得性肺炎的发病率,患者不适,重症监护病房(ICU)和住院时间,手术后拔管的成年患者的死亡率(次要结局)。
方法:对随机和非随机对照试验的系统评价和网络荟萃分析。Medline的搜索,Embase,Scopus,Cochrane中央控制试验登记册,和WebofScience从成立到2024年2月2日进行。
结果:纳入了33项研究(11,292例患者)。在所有NRS模式中,只有NIV降低了再插管率,与COT相比(比值比0.49,95%置信区间0.28;0.87,p=0.015,I2=60.5%,证据的确定性低)。特别是,在接受NIV治疗的患者中观察到这种效果,虽然不是为了预防,拔管后呼吸衰竭,在高的患者中,虽然不低,拔管后呼吸衰竭的风险。NIV降低了医院内肺炎的发生率,ICU住院时间,ICU,医院,和长期死亡率,而不会加重患者的不适。
结论:在拔管后接受NRS的术后患者中,NIV降低了再插管率,与COT相比,用于治疗拔管后呼吸衰竭和拔管后呼吸衰竭高危患者。
Re-intubation secondary to post-
extubation respiratory failure in post-operative patients is associated with increased patient morbidity and mortality. Non-invasive respiratory support (NRS) alternative to conventional oxygen therapy (COT), i.e., high-flow nasal oxygen, continuous positive airway pressure, and non-invasive ventilation (NIV), has been proposed to prevent or treat post-extubation respiratory failure. Aim of the present study is assessing the effects of NRS application, compared to COT, on the re-intubation rate (primary outcome), and time to re-intubation, incidence of nosocomial pneumonia, patient discomfort, intensive care unit (ICU) and hospital length of stay, and mortality (secondary outcomes) in adult patients extubated after surgery.
A systematic
review and network meta-analysis of randomized and non-randomized controlled trials. A search from Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from inception until February 2, 2024 was performed.
Thirty-three studies (11,292 patients) were included. Among all NRS modalities, only NIV reduced the re-intubation rate, compared to COT (odds ratio 0.49, 95% confidence interval 0.28; 0.87, p = 0.015, I2 = 60.5%, low certainty of evidence). In particular, this effect was observed in patients receiving NIV for treatment, while not for prevention, of post-extubation respiratory failure, and in patients at high, while not low, risk of post-
extubation respiratory failure. NIV reduced the rate of nosocomial pneumonia, ICU length of stay, and ICU, hospital, and long-term mortality, while not worsening patient discomfort.
In post-operative patients receiving NRS after
extubation, NIV reduced the rate of re-intubation, compared to COT, when used for treatment of post-
extubation respiratory failure and in patients at high risk of post-
extubation respiratory failure.