比较不同通气模式以促进机械通气撤机：系统评价和网络荟萃分析方案。
Comparison of ventilatory modes to facilitate liberation from mechanical ventilation: protocol for a systematic review and network meta-analysis.
机构信息
Medicine, McMaster University, Hamilton, Ontario, Canada.
Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
出版信息
BMJ Open. 2019 Sep 5;9(9):e030407. doi: 10.1136/bmjopen-2019-030407.
INTRODUCTION
Timely liberation from invasive mechanical ventilation is important to reduce the risk of ventilator-associated complications. Once a patient is deemed ready to tolerate a mode of partial ventilator assist, clinicians can use one of multiple ventilatory modes. Despite multiple trials, controversy regarding the optimal ventilator mode to facilitate liberation remains. Herein, we report the protocol for a systematic review and network meta-analysis comparing modes of ventilation to facilitate the liberation of a patient from invasive mechanical ventilation.
METHODS AND ANALYSIS
We will search MEDLINE, EMBASE, PubMed, the Cochrane Library from inception to April 2019 for randomised trials that report on critically ill adults who have undergone invasive mechanical ventilation for at least 24 hours and have received any mode of assisted invasive mechanical ventilation compared with an alternative mode of assisted ventilation. Outcomes of interest will include: mortality, weaning success, weaning duration, duration of mechanical ventilation, duration of stay in the acute care setting and adverse events. Two reviewers will independently screen in two stages, first titles and abstracts, and then full texts, to identify eligible studies. Independently and in duplicate, two investigators will extract all data, and assess risk of bias in all eligible studies using the Modified Cochrane Risk of Bias tool. Reviewers will resolve disagreement by discussion and consultation with a third reviewer as necessary. Using a frequentist framework, we will perform random-effect network meta-analysis, including all ventilator modes in the same model. We will calculate direct and indirect estimates of treatment effect using a node-splitting procedure and report effect estimates using OR and 95% CI. We will assess certainty in effect estimates using Grading of Recommendations Assessment, Development and Evaluation methodology.
ETHICS AND DISSEMINATION
Research ethics board approval is not necessary. The results will be disseminated through publication in a peer-reviewed journals.
PROSPERO REGISTRATION NUMBER
CRD42019137786.
简介
及时从有创机械通气中解脱出来，对于降低呼吸机相关并发症的风险非常重要。一旦患者被认为能够耐受部分呼吸机辅助模式，临床医生就可以使用多种通气模式中的一种。尽管进行了多项试验，但对于促进患者从有创机械通气中解脱出来的最佳通气模式仍存在争议。在此，我们报告了一项系统评价和网络荟萃分析的方案，比较了各种通气模式，以促进患者从有创机械通气中解脱出来。
方法和分析
我们将从建库到 2019 年 4 月，在 MEDLINE、EMBASE、PubMed 和 Cochrane 图书馆中搜索随机试验，这些试验报告了接受至少 24 小时有创机械通气且接受过任何辅助有创机械通气模式的危重症成人，并与替代辅助通气模式进行比较。感兴趣的结局包括：死亡率、撤机成功、撤机时间、机械通气时间、急性护理设置停留时间和不良事件。两名评审员将独立分两个阶段筛选，首先是标题和摘要，然后是全文，以确定合格的研究。两名调查员将独立地、重复地提取所有数据，并使用修改后的 Cochrane 偏倚风险工具评估所有合格研究的偏倚风险。评审员将通过讨论和必要时与第三名评审员协商来解决分歧。我们将使用贝叶斯框架进行随机效应网络荟萃分析，将所有通气模式纳入同一模型。我们将使用节点分割程序计算治疗效果的直接和间接估计，并使用 OR 和 95%CI 报告效果估计。我们将使用推荐评估、制定和评价方法评估效果估计的确定性。
伦理和传播
不需要研究伦理委员会的批准。研究结果将通过发表在同行评议的期刊上进行传播。
PROSPERO 注册号：CRD42019137786。
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