目的:调查重症监护病房(ICU)急性呼吸窘迫综合征(ARDS)俯卧位成人患者上肢周围神经损伤(PNI)的发生率。
方法:本系统综述采用荟萃分析,遵循流行病学观察性研究(MOOSE)报告指南的系统评价和荟萃分析(PRISMA)和荟萃分析的首选报告项目。包括PubMed在内的四个电子数据库,护理和相关健康文献累积指数(CINAHL),科克伦图书馆,和EMBASE从开始到2024年1月进行了搜索。根据JoannaBriggs研究所关键评估工具评估纳入研究的质量。进行了比例荟萃分析,以检查需要俯卧位的患者中上肢PNI的综合患病率。
结果:共8项研究(511名患者)纳入定量分析。所有研究在方法学质量上都有低或中等偏倚风险。上肢PNI患者的总体比例为13%(95CI:5%至29%),具有较大的研究间异质性(I2=84.6%,P<0.001)。在4项研究中描述了尺神经病和臂丛神经病变。
结论:在COVID-19大流行期间,俯卧定位已被广泛使用。ICU团队之间的不同方法和未经培训的工作人员的选择性报告可能是解释研究之间巨大差异的一个因素,以及本荟萃分析中发现的13%的上肢PNI患者比例。因此,在从ICU出院后和随后的随访评估中强调患者评估的重要性是至关重要的.
结论:专业培训对于确保安全的俯卧位至关重要,仔细考虑手臂和头部的放置,以减轻潜在的神经损伤。因此,医疗保健协议应纳入预防策略,由专家多学科团队进行的患者评估。
OBJECTIVE: To investigate the prevalence of upper limb peripheral nerve injuries (PNI) in adult patients admitted to the intensive care unit (ICU) with acute respiratory distress syndrome (ARDS) undergoing prone positioning.
METHODS: This systematic review with meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Four electronic databases including PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library, and EMBASE were searched from inception to January 2024. The quality of the included studies was evaluated according to the Joanna Briggs Institute Critical Appraisal Tools. A proportion meta-analysis was conducted to examine the combined prevalence of upper limb PNI among patients requiring prone positioning.
RESULTS: A total of 8 studies (511 patients) were pooled in the quantitative analysis. All studies had a low or moderate risk of bias in methodological quality. The overall proportion of patients with upper limb PNI was 13% (95%CI: 5% to 29%), with large between-study heterogeneity (I2 = 84.6%, P<0.001). Both ulnar neuropathy and brachial plexopathy were described in 4 studies.
CONCLUSIONS: During the COVID-19 pandemic, prone positioning has been used extensively. Different approaches among ICU teams and selective reporting by untrained staff may be a factor in interpreting the large variability between studies and the 13% proportion of patients with upper limb PNI found in the present meta-analysis. Therefore, it is paramount to stress the importance of patient assessment both after discharge from the ICU and during subsequent follow-up evaluations.
CONCLUSIONS: Specialized training is essential to ensure safe prone positioning, with careful consideration given to arms and head placement to mitigate potential nerve injuries. Therefore, healthcare protocols should incorporate preventive strategies, with patient assessments conducted by expert multidisciplinary teams.