Intensive Care National Audit and Research Centre (ICNARC), 24 High Holborn, London, WC1V 6AZ, UK.
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Crit Care. 2021 Jul 21;25(1):257. doi: 10.1186/s13054-021-03684-5.
New-onset atrial fibrillation (NOAF) in patients treated on an intensive care unit (ICU) is common and associated with significant morbidity and mortality. We undertook a systematic scoping review to summarise comparative evidence to inform NOAF management for patients admitted to ICU.
We searched MEDLINE, EMBASE, CINAHL, Web of Science, OpenGrey, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, ISRCTN, ClinicalTrials.gov, EU Clinical Trials register, additional WHO ICTRP trial databases, and NIHR Clinical Trials Gateway in March 2019. We included studies evaluating treatment or prevention strategies for NOAF or acute anticoagulation in general medical, surgical or mixed adult ICUs. We extracted study details, population characteristics, intervention and comparator(s), methods addressing confounding, results, and recommendations for future research onto study-specific forms.
Of 3,651 citations, 42 articles were eligible: 25 primary studies, 12 review articles and 5 surveys/opinion papers. Definitions of NOAF varied between NOAF lasting 30 s to NOAF lasting > 24 h. Only one comparative study investigated effects of anticoagulation. Evidence from small RCTs suggests calcium channel blockers (CCBs) result in slower rhythm control than beta blockers (1 study), and more cardiovascular instability than amiodarone (1 study). Evidence from 4 non-randomised studies suggests beta blocker and amiodarone therapy may be equivalent in respect to rhythm control. Beta blockers may be associated with improved survival compared to amiodarone, CCBs, and digoxin, though supporting evidence is subject to confounding. Currently, the limited evidence does not support therapeutic anticoagulation during ICU admission.
From the limited evidence available beta blockers or amiodarone may be superior to CCBs as first line therapy in undifferentiated patients in ICU. The little evidence available does not support therapeutic anticoagulation for NOAF whilst patients are critically ill. Consensus definitions for NOAF, rate and rhythm control are needed.
在重症监护病房（ICU）接受治疗的患者新发心房颤动（NOAF）很常见，并且与显著的发病率和死亡率相关。我们进行了系统的范围界定审查，以总结比较证据，为入住 ICU 的患者的 NOAF 管理提供信息。
我们于 2019 年 3 月在 MEDLINE、EMBASE、CINAHL、Web of Science、OpenGrey、Cochrane 系统评价数据库、Cochrane 对照试验中心注册库、疗效评价文摘数据库、ISRCTN、ClinicalTrials.gov、欧盟临床试验注册库、额外的世界卫生组织 ICTRP 试验数据库以及英国国家卫生与保健优化研究所临床试验注册库中进行了检索。我们纳入了评估一般内科、外科或混合成人 ICU 中 NOAF 或急性抗凝治疗的治疗或预防策略的研究。我们将研究细节、人群特征、干预措施和比较项、处理混杂因素的方法、结果以及对未来研究的建议提取到研究特定的表格中。
在 3651 条引文中有 42 篇文章符合纳入标准：25 项原始研究、12 项综述文章和 5 项调查/观点论文。NOAF 的定义在持续 30 秒至持续时间超过 24 小时的 NOAF 之间有所不同。只有一项比较研究调查了抗凝治疗的效果。来自小型 RCT 的证据表明钙通道阻滞剂（CCBs）的节律控制效果比β受体阻滞剂（1 项研究）差，且心血管稳定性比胺碘酮（1 项研究）差。来自 4 项非随机研究的证据表明，β受体阻滞剂和胺碘酮治疗在节律控制方面可能等效。与胺碘酮、CCBs 和地高辛相比，β受体阻滞剂可能与生存改善相关，尽管支持证据受到混杂因素的影响。目前，有限的证据并不支持 ICU 住院期间的治疗性抗凝。
根据现有有限的证据，β受体阻滞剂或胺碘酮可能优于 CCBs，成为 ICU 中未分化患者的一线治疗药物。现有关于 NOAF 的证据很少，不支持对危重患者进行治疗性抗凝。需要对 NOAF、速率和节律控制的共识定义进行研究。
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