Xu Xiu-Ping, Zhang Xin-Chang, Hu Shu-Ling, Xu Jing-Yuan, Xie Jian-Feng, Liu Song-Qiao, Liu Ling, Huang Ying-Zi, Guo Feng-Mei, Yang Yi, Qiu Hai-Bo
1Department of Critical Care Medicine, Nanjing Zhong-da Hospital, School of Medicine, Southeast University, Nanjing, P. R. China.2Department of Pain Management, Subei People's Hospital of Jiangsu Province and Clinical Medical School, Yang Zhou University, Yangzhou, P. R. China.
Crit Care Med. 2017 Jul;45(7):e727-e733. doi: 10.1097/CCM.0000000000002361.
To evaluate the effectiveness of noninvasive ventilation in patients with acute hypoxemic nonhypercapnic respiratory failure unrelated to exacerbation of chronic obstructive pulmonary disease and cardiogenic pulmonary edema.
PubMed, EMBASE, Cochrane library, Web of Science, and bibliographies of articles were retrieved inception until June 2016.
Randomized controlled trials comparing application of noninvasive ventilation with standard oxygen therapy in adults with acute hypoxemic nonhypercapnic respiratory failure were included. Chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema patients were excluded. The primary outcome was intubation rate; ICU mortality and hospital mortality were secondary outcomes.
Demographic variables, noninvasive ventilation application, and outcomes were retrieved. Internal validity was assessed using the risk of bias tool. The strength of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation methodology.
Eleven studies (1,480 patients) met the inclusion criteria and were analyzed by using a random effects model. Compared with standard oxygen therapy, the pooled effect showed that noninvasive ventilation significantly reduced intubation rate with a summary risk ratio of 0.59 (95% CI, 0.44-0.79; p = 0.0004). Furthermore, hospital mortality was also significantly reduced (risk ratio, 0.46; 95% CI, 0.24-0.87; p = 0.02). Subgroup meta-analysis showed that the application of bilevel positive support ventilation (bilevel positive airway pressure) was associated with a reduction in ICU mortality (p = 0.007). Helmet noninvasive ventilation could reduce hospital mortality (p = 0.0004), whereas face/nasal mask noninvasive ventilation could not.
Noninvasive ventilation decreased endotracheal intubation rates and hospital mortality in acute hypoxemia nonhypercapnic respiratory failure excluding chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema patients. There is no sufficient scientific evidence to recommend bilevel positive airway pressure or helmet due to the limited number of trials available. Large rigorous randomized trials are needed to answer these questions definitely.
评估无创通气对与慢性阻塞性肺疾病加重和心源性肺水肿无关的急性低氧性非高碳酸血症呼吸衰竭患者的有效性。
检索了PubMed、EMBASE、Cochrane图书馆、科学网以及文章的参考文献，检索起始时间至2016年6月。
纳入比较无创通气与标准氧疗在急性低氧性非高碳酸血症呼吸衰竭成年患者中应用的随机对照试验。排除慢性阻塞性肺疾病加重和心源性肺水肿患者。主要结局为插管率；ICU死亡率和医院死亡率为次要结局。
检索人口统计学变量、无创通气应用情况及结局。使用偏倚风险工具评估内部效度。使用推荐分级评估、制定和评价方法评估证据强度。
11项研究（1480例患者）符合纳入标准，采用随机效应模型进行分析。与标准氧疗相比，汇总效应显示无创通气显著降低插管率，汇总风险比为0.59（95%CI，0.44 - 0.79；p = 0.0004）。此外，医院死亡率也显著降低（风险比，0.46；95%CI，0.24 - 0.87；p = 0.02）。亚组Meta分析显示，双水平正压支持通气（双水平气道正压）的应用与ICU死亡率降低相关（p = 0.007）。头盔式无创通气可降低医院死亡率（p = 0.0004），而面罩/鼻罩式无创通气则不能。
无创通气可降低排除慢性阻塞性肺疾病加重和心源性肺水肿患者的急性低氧性非高碳酸血症呼吸衰竭患者的气管插管率和医院死亡率。由于可用试验数量有限，尚无足够科学证据推荐双水平气道正压或头盔式无创通气。需要大型严谨的随机试验来明确回答这些问题。
