背景:这项PICO指导的系统评价评估了机械通气危重患者的连续侧向旋转治疗(CLRT)与常规位置变化,评估死亡率,重症监护病房(ICU)和住院时间作为主要结果,和呼吸功能,机械通气持续时间,肺部并发症,和不良事件,作为次要结果。方法:系统评价遵循PRISMA标准(PROSPEROCRD420223384258)。搜索跨数据库:MEDLINE/PubMed,EMBASE,Scopus,ScienceDirect,科克伦,CINAHL和WebofScience,没有语言或出版年份的限制。纳入标准涉及随机(RCT)和半随机试验,比较CLRT(干预)与常规位置变化(对照)。使用Cochrane协作和GRADE工具评估随机对照试验的偏倚风险和证据质量。对于准随机试验,使用了ROBINS-I工具。结果:在18项研究中,1.466名参与者(干预,n=700,47.7%;对照,n=766,52.2%),CLRT主要用于预防目的,协议从10到24小时/天不等。荟萃分析(16项RCTs)有利于CLRT减少机械通气持续时间(SMD-0.17天,CI-0.29至-0.04,p=0.008)和较低的医院内肺炎发生率(OR0.39,CI0.29至0.52,p<0.00001)。CLRT对死亡率无显著影响(OR1.04,CI0.80至1.34,p=0.77),ICU住院(SMD-0.11天,CI-0.25至0.02,p=0.11),住院时间(SMD-0.10天,CI-0.31至0.11,p=0.33)和压疮发生率(OR0.73,CI0,34至1.60,p=0.44)。结论:CLRT在主要结局中没有显着差异(死亡率,ICU,和住院时间),但显示次要结局存在显着差异(持续减少医院内肺炎,对MV持续时间影响较小),由适度的确定性支持。其他结果的确定性非常低,这凸显了目前在不同临床环境和方案中进行研究以评估CLRT有效性的必要性。
Background: This PICO-guided systematic review assessed continuous lateral rotation therapy (CLRT) versus conventional position changes in mechanically ventilated critically ill adults, evaluating mortality, intensive care unit (ICU) and hospital stay duration as primary outcomes, and respiratory function,
mechanical ventilation duration, pulmonary complications, and adverse events, as secondary outcomes. Methods: A systematic review followed PRISMA criteria (PROSPERO CRD42022384258). Searches spanned databases: MEDLINE/PubMed, EMBASE, Scopus, ScienceDirect, Cochrane, CINAHL and Web of Science, without language or publication year restrictions. Inclusion criteria involved randomized (RCT) and quasi-randomized trials, comparing CLRT (intervention) with conventional position changes (control). Risk of bias and quality of evidence for RCTs were assessed using the Cochrane collaboration and GRADE tools. For the quasi-randomized trials, the ROBINS-I tool was used. Results: In 18 studies with 1.466 participants (intervention, n= 700, 47.7%; control, n= 766, 52.2%), CLRT was predominantly used for prophylactic purposes, with protocols varying from 10 to 24 hours/day. Meta-analysis (16 RCTs) favored CLRT for reduced
mechanical ventilation duration (SMD -0.17 days, CI -0.29 to -0.04, p=0.008) and lower nosocomial pneumonia incidence (OR 0.39, CI 0.29 to 0.52, p<0.00001). CLRT showed no significant impact on mortality (OR 1.04, CI 0.80 to 1.34, p= 0.77), ICU stay (SMD -0.11 days, CI -0.25 to 0.02, p= 0.11), hospital stay (SMD -0.10 days, CI -0.31 to 0.11, p= 0.33) and incidence of pressure ulcers (OR 0.73, CI 0,34 to 1.60, p= 0.44). Conclusions: CLRT showed no significant difference in primary outcomes (mortality, ICU, and hospital stay duration) but revealed significant differences in secondary outcomes (consistently reduced nosocomial pneumonia, with a minor effect on MV duration), supported by moderate certainty. Very low certainty for other outcomes highlights the need for current studies in diverse clinical settings and protocols to assess CLRT effectiveness.