对于急性呼吸窘迫综合征成年患者，与肺保护性通气策略相比，肺复张手法并不能带来任何死亡率方面的获益：一项对随机对照试验的荟萃分析和系统评价
Recruitment maneuver does not provide any mortality benefit over lung protective strategy ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis and systematic review of the randomized controlled trials.
作者信息
Bhattacharjee Sulagna, Soni Kapil D, Maitra Souvik
机构信息
1Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Room No. 5011, 5th Floor Teaching block, Ansari Nagar New Delhi, 110029 India.
2Department of Trauma Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute Medical Sciences, New Delhi, India.
出版信息
J Intensive Care. 2018 Jun 26;6:35. doi: 10.1186/s40560-018-0305-9. eCollection 2018.
BACKGROUND
Clinical benefits of recruitment maneuver in ARDS patients are controversial. A number of previous studies showed possible benefits; a large recent study reported that recruitment maneuver and PEEP titration may even be harmful. This meta-analysis was designed to compare the clinical utility of recruitment maneuver with low tidal volume ventilation in adult patients with ARDS.
METHODS
Randomized controlled trials comparing recruitment maneuver and lung protective ventilation strategy with lung protective strategy ventilation protocol alone in adult patients with ARDS has been included in this meta-analysis. PubMed and Cochrane Central Register of Controlled Trials were searched from inception to 10 November 2017 to identify potentially eligible trials. Pooled risk ratio (RR) and standardized mean difference (SMD) were calculated for binary and continuous variables respectively.
RESULTS
Data of 2480 patients from 7 randomized controlled trials have been included in this meta-analysis and systemic review. Reported mortality at the longest available follow-up [RR (95% CI) 0.93 (0.80, 1.08); = 0.33], ICU mortality [RR (95% CI) 0.91 (0.76, 1.10); = 0.33] and in-hospital mortality [RR (95% CI) 0.95 (0.83, 1.08); = 0.45] were similar between recruitment maneuver group and standard lung protective ventilation group. Duration of hospital stay [SMD (95% CI) 0.00 (- 0.09, 0.10); = 0.92] and duration of ICU stays [SMD (95% CI) 0.05 (- 0.09, 0.19); = 0.49] were also similar between recruitment maneuver group and standard lung protective ventilation group. Risk of barotrauma was also similar.
CONCLUSION
Use of recruitment maneuver along with co-interventions such as PEEP titration does not provide any benefit in terms of mortality, length of ICU, and hospital stay in ARDS patients.
背景
肺复张手法对急性呼吸窘迫综合征（ARDS）患者的临床益处存在争议。此前的多项研究显示可能有益；但近期一项大型研究报告称，肺复张手法和呼气末正压（PEEP）滴定甚至可能有害。本荟萃分析旨在比较肺复张手法与低潮气量通气在成年ARDS患者中的临床效用。
方法
本荟萃分析纳入了比较肺复张手法联合肺保护性通气策略与单纯肺保护性通气方案在成年ARDS患者中的随机对照试验。检索了PubMed和Cochrane对照试验中心注册库，时间范围从建库至2017年11月10日，以确定可能符合条件的试验。分别计算二分类变量和连续变量的合并风险比（RR）和标准化均数差（SMD）。
结果
本荟萃分析和系统评价纳入了7项随机对照试验中2480例患者的数据。在最长可获得的随访期，肺复张手法组与标准肺保护性通气组的报告死亡率[RR（95%CI）0.93（0.80，1.08）；P = 0.33]、重症监护病房（ICU）死亡率[RR（95%CI）0.91（0.76，1.10）；P = 0.33]和住院死亡率[RR（95%CI）0.95（0.83，1.08）；P = 0.45]相似。住院时间[SMD（95%CI）0.00（-0.09，0.10）；P = 0.92]和ICU住院时间[SMD（95%CI）0.05（-0.09，0.19）；P = 0.49]在肺复张手法组与标准肺保护性通气组之间也相似。气压伤风险也相似。
结论
在ARDS患者中，使用肺复张手法并联合诸如PEEP滴定等辅助干预措施，在死亡率、ICU住院时间和住院时间方面并无任何益处。
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