Rose Louise, Schultz Marcus J, Cardwell Chris R, Jouvet Philippe, McAuley Danny F, Blackwood Bronagh
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, Ontario, M5T IP8, Canada.
Crit Care. 2015 Feb 24;19(1):48. doi: 10.1186/s13054-015-0755-6.
Automated weaning systems may improve adaptation of mechanical support for a patient's ventilatory needs and facilitate systematic and early recognition of their ability to breathe spontaneously and the potential for discontinuation of ventilation. Our objective was to compare mechanical ventilator weaning duration for critically ill adults and children when managed with automated systems versus non-automated strategies. Secondary objectives were to determine differences in duration of ventilation, intensive care unit (ICU) and hospital length of stay (LOS), mortality, and adverse events.
Electronic databases were searched to 30 September 2013 without language restrictions. We also searched conference proceedings; trial registration websites; and article reference lists. Two authors independently extracted data and assessed risk of bias. We combined data using random-effects modelling.
We identified 21 eligible trials totalling 1,676 participants. Pooled data from 16 trials indicated that automated systems reduced the geometric mean weaning duration by 30% (95% confidence interval (CI) 13% to 45%), with substantial heterogeneity (I(2) = 87%, P <0.00001). Reduced weaning duration was found with mixed or medical ICU populations (42%, 95% CI 10% to 63%) and Smartcare/PS (28%, 95% CI 7% to 49%) but not with surgical populations or using other systems. Automated systems reduced ventilation duration with no heterogeneity (10%, 95% CI 3% to 16%) and ICU LOS (8%, 95% CI 0% to 15%). There was no strong evidence of effect on mortality, hospital LOS, reintubation, self-extubation and non-invasive ventilation following extubation. Automated systems reduced prolonged mechanical ventilation and tracheostomy. Overall quality of evidence was high.
Automated systems may reduce weaning and ventilation duration and ICU stay. Due to substantial trial heterogeneity an adequately powered, high quality, multi-centre randomized controlled trial is needed.
自动撤机系统可改善对患者通气需求的机械支持适应性，并有助于系统且早期地识别患者自主呼吸能力及停止通气的可能性。我们的目的是比较使用自动系统与非自动策略管理时，重症成人和儿童的机械通气撤机持续时间。次要目的是确定通气持续时间、重症监护病房（ICU）和住院时间（LOS）、死亡率及不良事件的差异。
检索电子数据库至2013年9月30日，无语言限制。我们还检索了会议论文集、试验注册网站及文章参考文献列表。两位作者独立提取数据并评估偏倚风险。我们使用随机效应模型合并数据。
我们确定了21项符合条件的试验，共1676名参与者。16项试验的汇总数据表明，自动系统将几何平均撤机持续时间缩短了30%（95%置信区间（CI）为13%至45%），存在显著异质性（I(2)=87%，P<0.00001）。在混合或医疗ICU人群（42%，95%CI为10%至63%）和Smartcare/PS（28%，95%CI为7%至49%）中发现撤机持续时间缩短，但在外科人群或使用其他系统时未发现。自动系统缩短了通气持续时间，无异质性（10%，95%CI为3%至16%）和ICU住院时间（8%，95%CI为0%至15%）。没有强有力的证据表明对死亡率、住院时间、再次插管、自行拔管及拔管后无创通气有影响。自动系统减少了长时间机械通气和气管切开术。总体证据质量较高。
自动系统可能会缩短撤机和通气持续时间以及ICU住院时间。由于试验存在显著异质性，需要进行一项样本量充足、高质量的多中心随机对照试验。
