Patterson Timothy J, Currie Peter, Williams Michael, Shevlin Claire
From the Department of Acute Critical Care Services, Craigavon Area Hospital, Portadown, Craigavon, United Kingdom.
From the Department of Acute Critical Care Services, Craigavon Area Hospital, Portadown, Craigavon, United Kingdom.
Am J Ophthalmol. 2021 Jul;227:66-73. doi: 10.1016/j.ajo.2021.02.019. Epub 2021 Mar 3.
Prone positioning during the COVID-19 pandemic has become increasingly used as an adjunct to increase oxygenation in critical care patients. It is associated with an adverse event profile. This study sought to investigate the occurrence of ocular injuries reported in prone versus supine groups in adult critical care.
Systematic review and meta-analysis.
A systematic review and meta-analysis were carried out in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, SCOPUS, and the Cochrane Library were searched. The search period was January 1, 1990, to July 1, 2020.
Eleven randomized controlled trials were included, with 2,247 patients. Twenty-eight events were recorded in 3 trials (174 patients) and no events in the other 8 trials (2,073 patients). The rates of eye injury were 5 events in 1,158 patients (1.30%) and 13 events in 1,089 patients (1.19%) in the prone and supine groups, respectively, which were reduced to 2 of 1,158 patients (0.17%) and 2 of 1,089 patients (0.18%), respectively, when reports of eye or eyelid edema were removed. Meta-analysis demonstrated no significant differences between groups with (an OR of 1.40 (95% CI: 0.37-5.27) and without (OR: 0.78; 95% CI: 0.11-5.73) reported edema.
This meta-analysis showed no significant difference in the rate of reported ocular injury between prone and supine critical care groups. These rates remain higher than the incidence reported during general anesthesia. There is a need for studies in critical care settings in which ocular injury is an end-point and which include extended patient follow-up.
在新冠疫情期间，俯卧位通气越来越多地被用作提高重症监护患者氧合的辅助手段。它与不良事件谱相关。本研究旨在调查成人重症监护中俯卧位组与仰卧位组报告的眼部损伤发生率。
系统评价和荟萃分析。
按照PRISMA（系统评价和荟萃分析的首选报告项目）指南进行系统评价和荟萃分析。检索了PubMed、SCOPUS和Cochrane图书馆。检索期为1990年1月1日至2020年7月1日。
纳入11项随机对照试验，共2247例患者。3项试验（174例患者）记录了28起事件，其他8项试验（2073例患者）未记录事件。俯卧位组和仰卧位组的眼损伤发生率分别为1158例患者中有5起事件（1.30%）和1089例患者中有13起事件（1.19%），去除眼部或眼睑水肿报告后，分别降至1158例患者中有2起事件（0.17%）和1089例患者中有2起事件（0.18%）。荟萃分析表明，有（优势比为1.40（95%置信区间：0.37 - 5.27））和无（优势比：0.78；95%置信区间：0.11 - 5.73）报告水肿的组间无显著差异。
这项荟萃分析表明，俯卧位和仰卧位重症监护组报告的眼部损伤发生率无显著差异。这些发生率仍高于全身麻醉期间报告的发生率。需要在以眼部损伤为终点且包括延长患者随访时间的重症监护环境中进行研究。
