Siempos Ilias I, Vardakas Konstantinos Z, Kopterides Petros, Falagas Matthew E
Alfa Institute of Biomedical Sciences, Athens, Greece.
Crit Care Med. 2007 Dec;35(12):2843-51. doi: 10.1097/01.ccm.0000295302.67973.9a.
Previous meta-analyses reported advantages of passive (i.e., heat and moisture exchangers, or HMEs) compared with active (i.e., heated humidifiers, or HHs) humidifiers in reducing the incidence of ventilator-associated pneumonia, but they did not examine the effect of these devices on mortality, length of intensive care unit stay, and duration of mechanical ventilation. In addition, relevant data were recently published.
Meta-analysis of randomized controlled trials comparing HMEs with HHs for the management of mechanically ventilated patients to determine the impact of these devices on clinical outcomes of such patients.
We searched PubMed and the Cochrane Central Register of Controlled Trials as well as reference lists from publications, with no language restrictions. We estimated pooled odds ratios (ORs) and 95% confidence intervals (CIs), using a random effects model.
Thirteen randomized controlled trials, studying 2,580 patients, were included. There was no difference in incidence of ventilator-associated pneumonia among patients managed with HMEs and HHs (OR 0.85, 95% CI 0.62-1.16). There was no difference between the compared groups regarding mortality (OR 0.98, 95% CI 0.80-1.20), length of intensive care unit stay (weighted mean differences, -0.68 days, 95% CI -3.65 to 2.30), duration of mechanical ventilation (weighted mean differences, 0.11 days, 95% CI -0.90 to 1.12), or episodes of airway occlusion (OR 2.26, 95% CI 0.55-9.28). HMEs were cheaper than HHs in each of the randomized controlled trials.
The available evidence does not support the preferential performance of either passive or active humidifiers in mechanical ventilation patients in terms of ventilator-associated pneumonia incidence, mortality, or morbidity.
以往的荟萃分析报告称，在降低呼吸机相关性肺炎的发生率方面，被动式（即热湿交换器，或HMEs）加湿器相较于主动式（即加热加湿器，或HHs）加湿器具有优势，但未考察这些装置对死亡率、重症监护病房住院时长及机械通气持续时间的影响。此外，近期有相关数据发表。
对比较HMEs与HHs用于机械通气患者管理的随机对照试验进行荟萃分析，以确定这些装置对此类患者临床结局的影响。
我们检索了PubMed、Cochrane对照试验中央注册库以及出版物的参考文献列表，无语言限制。我们采用随机效应模型估计合并比值比（ORs）和95%置信区间（CIs）。
纳入了13项研究2580例患者的随机对照试验。使用HMEs和HHs管理的患者中，呼吸机相关性肺炎的发生率无差异（OR 0.85，95% CI 0.62 - 1.16）。在死亡率（OR 0.98，95% CI 0.80 - 1.20）、重症监护病房住院时长（加权平均差，-0.68天，95% CI -3.65至2.30）、机械通气持续时间（加权平均差，0.11天，95% CI -0.90至1.12）或气道阻塞发作次数（OR 2.26，95% CI 0.55 - 9.28）方面，比较组之间无差异。在每项随机对照试验中，HMEs比HHs更便宜。
现有证据不支持在机械通气患者中，被动式或主动式加湿器在呼吸机相关性肺炎发生率、死亡率或发病率方面具有更优表现。
