背景:急性肺损伤或急性呼吸窘迫综合征(ARDS)是非致命性溺水最常见的并发症之一。尽管呼吸学会指南认可全身性皮质类固醇在ARDS中的作用,非致命性溺水所致ARDS患者全身使用皮质类固醇的证据有限.
方法:在Pubmed,OVID,和EuropePMC,使用纳入和排除标准评估临床问题。对选定的研究进行了严格评估,并对结果进行了总结。
结果:共选择并评估了六项回顾性研究,所有研究均显示有效性差,偏倚风险高.在六项研究中,只有4人告知我们类固醇给药对结局的影响.在两项研究中,与皮质类固醇相关的死亡率似乎更高.相反,一项研究发现,皮质类固醇组无死亡率,但对照组死亡率为100%.在另一项研究中,类固醇治疗似乎不影响住院时间或机械通气率.
结论:非致命性溺水的皮质类固醇给药及其对临床结局的影响仍然模棱两可。皮质类固醇的常规给药是不需要的,应该在个案的基础上进行。
BACKGROUND: Acute lung injury or acute respiratory distress syndrome (ARDS) is one of the most common complications of non-fatal drowning. Although respiratory societies\' guidelines endorse the role of systemic corticosteroids in ARDS, the evidence for systemic corticosteroid use in ARDS due to non-fatal drowning is limited.
METHODS: A search was conducted on Pubmed, OVID, and EuropePMC, assessing the clinical question using inclusion and exclusion criteria. The selected studies were critically appraised, and the results were summarized.
RESULTS: A total of six retrospective studies were selected and assessed, all studies showed poor validity and a high risk of bias. Out of six studies, only four informed us of steroid administration\'s effect on outcomes. In two studies, mortality associated with corticosteroid administration seemed to be higher. On the contrary, one study found no mortality in the corticosteroid group, but 100% mortality was observed in the control group. In another study, steroid therapy seemed to not affect hospital length of stay or mechanical ventilation rates.
CONCLUSIONS: Corticosteroid administration for non-fatal drowning and its impact on clinical outcomes remains equivocal. Routine administration of corticosteroids is not indicated and should be done on a case-by-case basis.