Davison Caroline, Ventre Kathleen M, Luchetti Marco, Randolph Adrienne G
Department of Anaesthesia, St. George's Hospital, Tooting, London, UK.
Pediatr Crit Care Med. 2004 Sep;5(5):482-9. doi: 10.1097/01.pcc.0000128891.54799.67.
Viral bronchiolitis is the leading cause of respiratory failure among infants in the United States. Currently, the mainstay of treatment is supportive care. The effectiveness of treatments used for mechanically ventilated infants with bronchiolitis is unclear.
To evaluate the strength of the evidence supporting the use of currently available treatments for critically ill infants with bronchiolitis.
We searched PubMed, citations of relevant articles, personal files, and conference proceedings, and we contacted experts in the field.
Randomized, controlled trials evaluating any therapy for bronchiolitis that included children in an intensive care unit.
Two reviewers independently extracted data and assessed methodologic quality.
A total of 2,319 citations were screened, and 16 randomized, controlled trials were included. There were three trials of surfactant, three of ribavirin, three of immune globulin, three of systemic corticosteroids, and one each of vitamin A, interferon, erythropoietin, and heliox. A meta-analysis of the three surfactant studies showed a strong trend toward a decrease in duration of mechanical ventilation of 2.58 days (95% confidence interval, -5.34 to 0.18 days; p =.07) and a significant decrease of 3.3 intensive care unit days (95% confidence interval, -6.38 to -0.23 days; p =.04). A meta-analysis of the three systemic corticosteroid studies showed no overall effect on duration of mechanical ventilation when all three trials were combined (-0.62 day; 95% confidence interval, -2.78 to 1.53 days; p =.57). We identified one published meta-analysis of three ribavirin studies showing a significant decrease in ventilator days with ribavirin (-1.2 days; 95% confidence interval, -0.2 to -3.4 days; p =.2).
Currently, there are no clearly effective interventions available to improve the outcome of critically ill infants with bronchiolitis. Surfactant seems to be a promising intervention, and corticosteroids or ribavirin may also be beneficial.
在美国，病毒性细支气管炎是婴儿呼吸衰竭的主要原因。目前，治疗的主要手段是支持性护理。用于机械通气的细支气管炎婴儿的治疗效果尚不清楚。
评估支持使用现有治疗方法治疗重症细支气管炎婴儿的证据强度。
我们检索了PubMed、相关文章的参考文献、个人档案和会议记录，并联系了该领域的专家。
评估任何治疗细支气管炎方法的随机对照试验，试验对象包括重症监护病房的儿童。
两名审阅者独立提取数据并评估方法学质量。
共筛选了2319篇文献，纳入16项随机对照试验。其中有3项关于表面活性剂的试验、3项关于利巴韦林的试验、3项关于免疫球蛋白的试验、3项关于全身用皮质类固醇的试验，以及各1项关于维生素A、干扰素、促红细胞生成素和氦氧混合气的试验。对3项表面活性剂研究的荟萃分析显示，机械通气时间有显著缩短趋势，缩短2.58天（95%置信区间，-5.34至0.18天；p=0.07），重症监护病房住院天数显著减少3.3天（95%置信区间，-6.38至-0.23天；p=0.04）。对3项全身用皮质类固醇研究的荟萃分析显示，将所有3项试验合并后，对机械通气时间无总体影响（-0.62天；95%置信区间，-2.78至1.53天；p=0.57）。我们发现一项已发表的对3项利巴韦林研究的荟萃分析显示，利巴韦林可显著减少呼吸机使用天数（-1.2天；95%置信区间，-0.2至-3.4天；p=0.2）。
目前，尚无明确有效的干预措施可改善重症细支气管炎婴儿的预后。表面活性剂似乎是一种有前景的干预措施，皮质类固醇或利巴韦林可能也有益处。
