Joint Programme of Nanchang University of London, Nanchang University, Nanchang, Jiangxi, China.
Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, Shangdong, China.
Am J Infect Control. 2019 Jul;47(7):755-760. doi: 10.1016/j.ajic.2018.12.015. Epub 2019 Jan 12.
Ventilator-associated pneumonia (VAP) remains a frequent and severe complication in mechanically ventilated patients. We undertook a meta-analysis to evaluate the efficacy of chest physiotherapy (CPT) for the prevention of VAP.
A systematic literature search of PubMed and Embase databases were searched up until November 25, 2018 for published studies of mechanically ventilated patients comparing CPT with controls and reporting on the occurrence of VAP. Two authors independently selected studies and abstracted data on study quality and outcomes. We pooled data using random-effects models.
A total of 6 randomized (n = 704) controlled trials were identified. CPT did not significantly reduce the incidence of VAP (risk ratio = 1.02; 95% confidence interval, 0.82-1.26; P = .87), but reduced hospital mortality (risk ratio = 0.68; 95% confidence interval, 0.48-0.95; P = .02). No significant differences were observed regarding intensive care unit mortality, length of intensive care unit stay, and duration of mechanical ventilation.
CPT may not significantly reduce the incidence of VAP and alter other important clinical outcomes in adult patients receiving mechanical ventilation. However, the results should be interpreted cautiously owing to the heterogeneity and the limited trials. Further large-scale, well-designed randomized controlled trials are needed.
呼吸机相关性肺炎（VAP）仍然是机械通气患者常见且严重的并发症。我们进行了一项荟萃分析，以评估胸部物理疗法（CPT）预防 VAP 的疗效。
对截至 2018 年 11 月 25 日在 PubMed 和 Embase 数据库中发表的比较 CPT 与对照组机械通气患者的研究进行了系统的文献检索，并报告了 VAP 的发生情况。两位作者独立选择研究并提取研究质量和结局的数据。我们使用随机效应模型汇总数据。
共确定了 6 项随机（n=704）对照试验。CPT 并未显著降低 VAP 的发生率（风险比=1.02；95%置信区间，0.82-1.26；P=0.87），但降低了医院死亡率（风险比=0.68；95%置信区间，0.48-0.95；P=0.02）。CPT 在 ICU 死亡率、ICU 住院时间和机械通气时间方面没有显著差异。
CPT 可能不会显著降低机械通气患者 VAP 的发生率，并改变其他重要的临床结局。然而，由于异质性和试验数量有限，结果应谨慎解释。需要进一步进行大规模、精心设计的随机对照试验。
