Charlesworth Michael, Lawton Tom, Fletcher Stephen
Department of Anaesthesia, Central Manchester University Hospitals, Manchester, UK.
Department of Critical Care, Bradford Royal Infirmary, Bradford, UK.
J Intensive Care Soc. 2015 Aug;16(3):215-221. doi: 10.1177/1751143715571698. Epub 2015 Feb 12.
To find, critically appraise and synthesise all published studies so as to determine the safety and spectrum of use of noninvasive positive pressure ventilation for acute respiratory failure following oesophagectomy.
Systematic review.
The MEDLINE and EMBASE databases were searched and the quality of the studies and any bias or confounding were rated according to established protocols. Outcomes extracted included re-intubation, anastomotic leakage, length of intensive care unit stay and mortality. The data were analysed quantitatively and qualitatively. Pooling of outcomes was considered if appropriate.
The search identified four papers, demonstrating the understudying/underreporting of the topic. Three were case-series and one was a conference abstract. The overall methodological quality was low. Design-specific biases and confounding were high. Despite this, the included studies conclude that noninvasive positive pressure ventilation is safe and effective and that re-intubation rates, intensive care unit length of stay, mortality and anastomotic dehiscence is lower when it is used. Meta-analysis was deemed to be inappropriate.
Despite the conclusions and consensus of the included studies, there is no evidence to definitively conclude that noninvasive positive pressure ventilation is either safe or dangerous following oesophagectomy and the current literary evidence is inadequate. Current practice varies and is based on opinion and consensus. As such, randomised controlled studies are urgently required as current practice may cause undue harm to patients. The incidence of anastomotic leakage with noninvasive positive pressure ventilation use needs to be determined.
查找、严格评估并综合所有已发表的研究，以确定无创正压通气用于食管切除术后急性呼吸衰竭的安全性和使用范围。
系统评价。
检索MEDLINE和EMBASE数据库，并根据既定方案对研究质量以及任何偏倚或混杂因素进行评级。提取的结果包括再次插管、吻合口漏、重症监护病房住院时间和死亡率。对数据进行定量和定性分析。若合适则考虑对结果进行合并。
检索确定了4篇论文，表明该主题研究不足/报道不足。3篇为病例系列研究，1篇为会议摘要。总体方法学质量较低。特定设计的偏倚和混杂因素较高。尽管如此，纳入的研究得出结论，无创正压通气是安全有效的，使用时再次插管率、重症监护病房住院时间、死亡率和吻合口裂开发生率较低。荟萃分析被认为不合适。
尽管纳入研究有相关结论和共识，但没有证据能明确得出无创正压通气在食管切除术后是安全还是危险的结论，目前的文献证据不足。当前的实践各不相同，基于观点和共识。因此，迫切需要进行随机对照研究，因为当前的实践可能会对患者造成不必要的伤害。需要确定使用无创正压通气时吻合口漏的发生率。
