School of Advanced Studies, Saint Louis University, Baguio, Philippines.
Department of Nursing, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia.
Syst Rev. 2019 Jul 20;8(1):180. doi: 10.1186/s13643-019-1080-y.
An increasing number of studies have investigated the clinical epidemiology and outcomes of ventilator-associated pneumonia (VAP) in intensive care units. However, these findings have not been clearly defined in broad subgroups of mechanically ventilated adults. Hence, this protocol for a systematic review and meta-analysis is designed to better understand the clinical and epidemiological features of VAP in these patient populations by establishing its overall prognosis of and risk factors for morbidity and mortality and to determine the differences in clinical and economic outcomes between VAP and non-VAP patients.
This present review will systematically search available full-text articles without date and language restrictions and indexed in PubMed, CENTRAL, CINAHL, Web of Science, and EMBASE databases. In addition, reference lists and citations of retrieved articles and relevant medical and nursing journals will be manually reviewed. Supplementary search in other databases involving trials, reviews, and grey literatures, including conference proceedings, theses, and dissertations, will be performed. Study investigators will be contacted to clarify missing or unpublished data. All prognostic studies meeting the pre-defined eligibility criteria will be included. The study selection, risk of bias assessment, data extraction, and grading of the quality of evidence will be carried out in duplicate, involving independent evaluation by two investigators with consensus or a third-party adjudication. The degree of inter-rater agreement will be calculated using the kappa statistic. For meta-analysis, dichotomous and continuous outcome measures will be pooled using odds ratios and standardized mean differences with 95% confidence intervals, respectively. The Mantel-Haenszel or inverse variance methods with random effects model will be used as a guide for analysis. The heterogeneity of each outcome measure will be assessed using both X and I statistics. In addition, sensitivity and subgroup analyses will be performed to ensure consistency of pooled results. The review protocol described herein is in accordance with the PRISMA-P standards.
The investigation of the epidemiological profiles, prognostic factors, and outcomes associated with VAP is critical for the identification of high-risk groups of mechanically ventilated patients and evaluation of possible clinical endpoints. This may provide substantial links for improved VAP prevention practices targeting modifiable risk factors. Implications for future research directions are discussed.
PROSPERO CRD42017048158.
越来越多的研究调查了重症监护病房（ICU）呼吸机相关性肺炎（VAP）的临床流行病学和结局。然而，这些发现并未在广泛的机械通气成人亚组中明确界定。因此，本系统评价和荟萃分析的方案旨在通过确定其发病率和死亡率的总体预后以及确定 VAP 和非 VAP 患者之间临床和经济结局的差异，更好地了解这些患者人群中 VAP 的临床和流行病学特征。
本综述将系统地搜索没有日期和语言限制的可用全文文章，并在 PubMed、CENTRAL、CINAHL、Web of Science 和 EMBASE 数据库中进行索引。此外，还将手动审查检索文章和相关医学和护理期刊的参考文献列表和引文。将在其他涉及试验、综述和灰色文献的数据库中进行补充搜索，包括会议记录、论文和学位论文。将联系研究人员以澄清缺失或未发表的数据。所有符合预先确定的纳入标准的预后研究都将被纳入。研究选择、偏倚风险评估、数据提取和证据质量分级将由两名独立评估者进行重复评估，以达成共识或由第三方裁决。将使用 Kappa 统计量计算两位评估者之间的一致性程度。对于荟萃分析，二分类和连续结局指标将分别使用优势比和标准化均数差值及其 95%置信区间进行汇总。分析将以 Mantel-Haenszel 或倒数方差法和随机效应模型为指导。将使用 X 和 I 统计量评估每个结局指标的异质性。此外，还将进行敏感性和亚组分析，以确保汇总结果的一致性。本研究描述的综述方案符合 PRISMA-P 标准。
调查与 VAP 相关的流行病学特征、预后因素和结局对于确定机械通气患者的高危人群和评估可能的临床终点至关重要。这可能为针对可改变的危险因素的 VAP 预防措施提供重要依据。讨论了对未来研究方向的影响。
PROSPERO CRD42017048158。
