背景:目前,有一个初步的临床共识,即俯卧位通气(PPV)有利于治疗急性呼吸窘迫综合征(ARDS),对治疗细节和患者获益的进一步研究将有助于评估其有效性和安全性。
目的:为了评估时机,功效,不同机械通气位置(MVP)治疗ARDS的安全性。
方法:通过网络荟萃分析直接或间接比较临床试验的结果,以比较不同MVP的效果。
方法:两位作者独立搜索了发表在PubMed上的论文,Embase,科克伦图书馆,中国知识基础设施(CNKI),中国生物医学光盘(CBM),万方,和VIP数据库从2000年1月到2022年8月。结果指标是氧合指数,机械通气时间,ICU住院时间,住院死亡率,和不良事件的发生率。两位作者独立筛选了文献,评估了研究的质量,并完成了数据的提取。Stata14.0用于进行网络Meta分析,并根据累积排序曲线(SUCRA)下的表面对干预措施进行排序。绘制漏斗图以评估发表偏倚。
结果:根据纳入和排除标准,最终纳入75项研究(包括6333例患者数据)。根据分析结果,PPV对改善氧合指数最好。机械通气时间的SUCRA值,ICU住院时间,院内死亡率排序为PPV>侧卧位通气(LPV)>仰卧位通气(SuPV)>半靠位通气(SePV)。不良事件发生率的SUCRA值排序为LPV>PPV>SuPV>SePV。所有结果指标均具有良好的一致性和较低的统计异质性。漏斗图分析表明,论文报告的机械通气时间在三天内,超过五天的机械通气时间,住院死亡率更可能存在发表偏倚.
结论:PPV对改善氧合指数效果最好,减少机械通气时间,缩短ICU住院时间,降低住院死亡率。早期和长期使用PPV改善肺通气功能将是提高ARDS患者生存和生活质量的关键。
结论:PPV显著影响ARDS患者,缩短治疗时间,降低住院费用。在治疗过程中,应加强护理观察,防止不良事件发生。
At present, there is a preliminary clinical consensus that prone position ventilation (PPV) is beneficial to the treatment of acute respiratory distress syndrome (ARDS), and further research on the details of treatment and patients\' benefits will help to assess its effectiveness and safety.
To evaluate the timing, efficacy, and safety of different mechanical ventilation positions (MVP) in treating ARDS.
The results of clinical trials were directly or indirectly compared by network meta-analysis to compare the effects of different MVP. Two authors independently searched the papers published in PubMed, Embase, Cochrane Library, China Knowledge Infrastructure (CNKI), China Biomedical Discs (CBM), WanFang, and VIP database from January 2000 to August 2022. The outcome indicators were oxygenation index, mechanical ventilation time, ICU hospitalization time, in-hospital mortality, and incidence of adverse events. Two authors independently screened the literature, evaluated the quality of the studies, and completed the data extraction. Stata 14.0 was used to conduct a network Meta-analysis, and the intervention measures were ranked according to the surface under the cumulative ranking curve (SUCRA). Funnel plots were drawn to evaluate publication bias.
According to the inclusion and exclusion criteria, 75 studies (including 6333 patient data) were finally included. According to the analysis results, PPV was the best for improving the oxygenation index. The SUCRA values of mechanical ventilation time, ICU hospitalization time, and in-hospital mortality were ranked as PPV > lateral position ventilation (LPV) > supine position ventilation (SuPV) > semireclining position ventilation (SePV). The SUCRA values in the incidence of adverse events were ranked as LPV > PPV > SuPV > SePV. All outcome measures had good consistency and low statistical heterogeneity. Funnel plot analysis shows that papers reported within three days of mechanical ventilation time, over five days of mechanical ventilation time, and in-hospital mortality were more likely to have publication bias.
PPV has the best effect on improving the oxygenation index, reducing mechanical ventilation time, shortening ICU hospitalization time, and reducing in-hospital mortality. Early and long-term use of PPV to improve pulmonary ventilatory function will be the key to improving patients\' survival and quality of life with ARDS.
PPV significantly affects patients with ARDS, which can shorten the treatment time and reduce hospital costs. During the treatment, nursing observation should be strengthened to prevent adverse events.