Huang Xu An, Du Yan Ping, Li Liu Xia, Wu Fang Fang, Hong Shao Qing, Tang Fang Xuan, Ye Zhang Qiang
Medical College of Xiamen University, Xiamen, China.
Department of Respiratory Medicine, Zhongshan Hospital Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China.
Clin Respir J. 2019 May;13(5):289-298. doi: 10.1111/crj.13009. Epub 2019 Mar 25.
Standard bi-level non-invasive ventilation with fixed-level pressure support (PS) delivery may not maintain ventilation during the changes in pulmonary mechanics that occur throughout day and night, so average volume-assured pressure support (AVAPS) modes that target a preset volume by adjustment of PS may be effective.
Our meta-analysis wants to compare AVAPS and pressure support non-invasive ventilation (PS-NIV) regarding arterial blood gases (ABGs), sleep efficiency and compliance.
Relevant publications indexed in PubMed, Cochrane Library, Embase, Web of Science, Wanfang Data, China National Knowledge Infrastructure and VIPI were identified. Appropriate articles identified from the reference lists of the above searches were also reviewed. We included randomized controlled trials involved the use of AVAPS and PS-NIV ventilation for chronic respiratory failure. Each included study weighted mean differences, and 95% confidence intervals (CI) were calculated for continuous outcomes. Statistical heterogeneity was assessed using the I value ≤ 50% were considered as no statistical heterogeneity and used fixed effects model. Otherwise, a random effects model was used.
Eight trials were eligible. No significant difference was observed between AVAPS and PS-NIV groups to compare PaCO (OR -0.97, CI-2.54-0.61, P = 0.23) and PaO (OR -1.81, CI-4.29-0.67, P = 0.15) in ABGs. There was no significant difference between the two groups with sleep efficiency (OR -3.31, CI-7.58-0.95, P = 0.13) and visual analog scale (OR 0.32, CI-6.97-7.61, P = 0.93).
The evidence shows there is no significant difference in clinical outcomes when comparing AVAPS and PS-NIV used for chronic respiratory failure patients.
采用固定水平压力支持（PS）输送的标准双水平无创通气在昼夜肺力学变化期间可能无法维持通气，因此通过调整PS以达到预设容量的平均容量保证压力支持（AVAPS）模式可能有效。
我们的荟萃分析旨在比较AVAPS和压力支持无创通气（PS-NIV）在动脉血气（ABG）、睡眠效率和依从性方面的差异。
检索了PubMed、Cochrane图书馆、Embase、Web of Science、万方数据、中国知网和维普资讯等数据库中索引的相关出版物。还对上述检索的参考文献列表中识别出的合适文章进行了审查。我们纳入了涉及使用AVAPS和PS-NIV通气治疗慢性呼吸衰竭的随机对照试验。对于连续性结局，计算每个纳入研究的加权平均差异和95%置信区间（CI）。使用I²值评估统计异质性，I²≤50%被认为无统计异质性，采用固定效应模型。否则，采用随机效应模型。
八项试验符合条件。在ABG中比较PaCO₂（OR -0.97，CI -2.54 - 0.61，P = 0.23）和PaO₂（OR -1.81，CI -4.29 - 0.67，P = 0.15）时，AVAPS组和PS-NIV组之间未观察到显著差异。两组在睡眠效率（OR -3.31，CI -7.58 - 0.95，P = 0.13）和视觉模拟评分（OR 0.32，CI -6.97 - 7.61，P = 0.93）方面也无显著差异。
证据表明，比较用于慢性呼吸衰竭患者的AVAPS和PS-NIV时，临床结局无显著差异。
