Kataoka Jun, Kuriyama Akira, Norisue Yasuhiro, Fujitani Shigeki
Department of Pulmonary and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, 2790001, Japan.
Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 7108602, Japan.
Ann Intensive Care. 2018 Dec 10;8(1):123. doi: 10.1186/s13613-018-0470-y.
Proportional modes (proportional assist ventilation, PAV, and neurally adjusted ventilatory assist, NAVA) could improve patient-ventilator interaction and consequently may be efficient as a weaning mode. The purpose of this systematic review is to examine whether proportional modes improved patient-ventilator interaction and whether they had an impact on the weaning success and length of mechanical ventilation, in comparison with PSV.
We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception through May 13, 2018. We included both parallel-group and crossover randomized studies that examined the efficacy of proportional modes in comparison with PSV in mechanically ventilated adults. The primary outcomes were (1) asynchrony index (AI), (2) weaning failure, and (3) duration of mechanical ventilation.
We included 15 studies (four evaluated PAV, ten evaluated NAVA, and one evaluated both modes). Although the use of proportional modes was not associated with a reduction in AI (WMD - 1.43; 95% CI - 3.11 to 0.25; p = 0.096; PAV-one study, and NAVA-seven studies), the use of proportional modes was associated with a reduction in patients with AI > 10% (RR 0.15; 95% CI 0.04-0.58; p = 0.006; PAV-two studies, and NAVA-five studies), compared with PSV. There was a significant heterogeneity among studies for AI, especially with NAVA. Compared with PSV, use of proportional modes was associated with a reduction in weaning failure (RR 0.44; 95% CI 0.26-0.75; p = 0.003; PAV-three studies) and duration of mechanical ventilation (WMD - 1.78 days; 95% CI - 3.24 to - 0.32; p = 0.017; PAV-three studies, and NAVA-two studies). Reduced duration of mechanical ventilation was found with PAV but not with NAVA.
The use of proportional modes was associated with a reduction in the incidence with AI > 10%, weaning failure and duration of mechanical ventilation, compared with PSV. However, reduced weaning failure and duration of mechanical ventilation were found with only PAV. Due to a significant heterogeneity among studies and an insufficient number of studies, further investigation seems warranted to better understand the impact of proportional modes. Clinical trial registration PROSPERO registration number, CRD42017059791. Registered 20 March 2017.
比例模式（比例辅助通气，PAV，以及神经调节通气辅助，NAVA）可改善患者与呼吸机的相互作用，因此作为撤机模式可能是有效的。本系统评价的目的是研究与压力支持通气（PSV）相比，比例模式是否改善了患者与呼吸机的相互作用，以及它们是否对撤机成功率和机械通气时间有影响。
我们检索了从创刊至2018年5月13日的PubMed、EMBASE和Cochrane对照试验中央注册库。我们纳入了平行组和交叉随机研究，这些研究比较了比例模式与PSV在机械通气成人中的疗效。主要结局为：（1）不同步指数（AI）；（2）撤机失败；（3）机械通气时间。
我们纳入了15项研究（4项评估PAV，10项评估NAVA，1项评估两种模式）。尽管使用比例模式与AI降低无关（加权均数差[WMD] -1.43；95%置信区间[CI] -3.11至0.25；p = 0.096；PAV - 1项研究，NAVA - 7项研究），但与PSV相比，使用比例模式与AI>10%的患者减少相关（风险比[RR] 0.15；95% CI 0.04 - 0.58；p = 0.006；PAV - 2项研究，NAVA - 5项研究）。各研究间AI存在显著异质性，尤其是NAVA。与PSV相比，使用比例模式与撤机失败减少（RR 0.44；95% CI 0.26 - 0.75；p = 0.003；PAV - 3项研究）和机械通气时间缩短（WMD -1.78天；95% CI -3.24至 -0.32；p = 0.017；PAV - 3项研究，NAVA - 2项研究）相关。发现PAV可缩短机械通气时间，但NAVA未显示此作用。
与PSV相比，使用比例模式与AI>10%的发生率、撤机失败及机械通气时间减少相关。然而，仅PAV可降低撤机失败率和缩短机械通气时间。由于各研究间存在显著异质性且研究数量不足，似乎有必要进行进一步研究以更好地了解比例模式的影响。临床试验注册PROSPERO注册号：CRD42017059791。于2017年3月20日注册。
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