Amado-Rodríguez Laura, Bernal Teresa, López-Alonso Inés, Blázquez-Prieto Jorge, García-Prieto Emilio, Albaiceta Guillermo M
1Área de Gestión Clínica de Medicina Intensiva, Hospital Valle del Nalón, Langreo, Spain. 2Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain. 3Servicio de Hematología, Hospital Universitario Central de Asturias, Oviedo, Spain. 4Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain. 5Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain.
Crit Care Med. 2016 Jul;44(7):1406-13. doi: 10.1097/CCM.0000000000001613.
Acute respiratory failure in hematological patients is related to a high mortality. Noninvasive mechanical ventilation may benefit a subset of these patients, but the overall effect on mortality and the risks derived from its failure are unclear. Our objective was to review the impact of initial ventilatory strategy on mortality and the risks related to noninvasive mechanical ventilation failure in this group of patients.
Data sources, including PubMed and conference proceedings, were searched from the year 2000 to January 2015.
We selected studies reporting mortality and the need for mechanical ventilation in hematological patients with acute respiratory failure.
Two trained reviewers independently conducted study selection, abstracted data, and assessed the risk of bias. Discrepancies between reviewers were resolved through discussion and consensus. The outcomes explored were all-cause mortality after mechanical ventilation and incidence of noninvasive mechanical ventilation failure.
A random-effects model was used in all the analysis. Thirteen studies, involving 2,380 patients, were included. Use of noninvasive mechanical ventilation was related to a better outcome than initial intubation (risk ratio, 0.74; 95% CI, 0.65-0.84). Failure of noninvasive mechanical ventilation did not increase the overall risk of death (risk ratio, 1.02; 95% CI, 0.93-1.13). There were signs of publication bias and substantial heterogeneity among the studies. Compensation of this bias by using the trim-and-fill method showed a significant risk of death after noninvasive mechanical ventilation failure (risk ratio, 1.07; 95% CI, 1.00-1.14). Meta-regression analysis showed that the predicted risk of death for the noninvasive mechanical ventilation group acted as a significant moderator, with a higher risk of death after noninvasive mechanical ventilation failure in those studies reporting lower predicted mortality.
Noninvasive mechanical ventilation is associated with a lower risk of death in hematological patients with respiratory failure. Noninvasive mechanical ventilation failure may worsen the prognosis, mainly in less severe patients.
血液学患者的急性呼吸衰竭与高死亡率相关。无创机械通气可能使部分此类患者获益，但对死亡率的总体影响以及其失败所带来的风险尚不清楚。我们的目的是回顾初始通气策略对该组患者死亡率的影响以及与无创机械通气失败相关的风险。
检索了2000年至2015年1月期间的数据源，包括PubMed和会议论文集。
我们选择了报告急性呼吸衰竭血液学患者死亡率和机械通气需求的研究。
两名经过培训的审阅者独立进行研究选择、提取数据并评估偏倚风险。审阅者之间的分歧通过讨论和达成共识来解决。所探讨的结局为机械通气后的全因死亡率和无创机械通气失败的发生率。
所有分析均采用随机效应模型。纳入了13项研究，涉及2380例患者。使用无创机械通气与比初始插管更好的结局相关（风险比，0.74；95%置信区间，0.65 - 0.84）。无创机械通气失败并未增加总体死亡风险（风险比，1.02；95%置信区间，0.93 - 1.13）。研究中存在发表偏倚的迹象和显著的异质性。使用修剪填充法校正此偏倚后显示无创机械通气失败后有显著的死亡风险（风险比，1.07；95%置信区间，1.00 - 1.14）。Meta回归分析表明，无创机械通气组的预测死亡风险是一个显著的调节因素，在那些报告较低预测死亡率的研究中，无创机械通气失败后的死亡风险更高。
无创机械通气与呼吸衰竭血液学患者较低的死亡风险相关。无创机械通气失败可能会使预后恶化，主要是在病情较轻的患者中。
