Douma Matthew J, Handley Anthony J, MacKenzie Ella, Raitt James, Orkin Aaron, Berry David, Bendall Jason, O'Dochartaigh Domhnall, Picard Christopher, Carlson Jestin N, Djärv Therese, Zideman David A, Singletary Eunice M
Department of Critical Care Medicine, University of Alberta and School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland.
Cambridge, United Kingdom, United Kingdom.
Resusc Plus. 2022 Apr 29;10:100236. doi: 10.1016/j.resplu.2022.100236. eCollection 2022 Jun.
To conduct a systematic review of the use of the recovery position in adults and children with non-traumatic decreased levels of responsiveness changes outcomes in comparison with other positioning strategies.
We searched Medline (Ovid), Embase, Cochrane Library, CINAHL, medRxiv and Google Scholar from inception to 15 March 2021 for studies involving adults and children in an out-of-hospital, first aid setting who had reduced levels of responsiveness of non-traumatic aetiology but did not require resuscitative interventions. We used the ROBINS-I tool to assess risk of bias and GRADE methodology to determine the certainty of evidence.
Of 17,947 citations retrieved, three prospective observational studies and four case series were included. The prone and semi-recumbent positions were associated with a decreased rate of suspected aspiration pneumonia in acute poisoning. Use of the recovery position in paediatric patients with decreased levels of responsiveness was associated with a deceased admission rate and the prone position was the position most commonly associated with sudden unexpected death in epilepsy. High risk of bias, imprecision and indirectness of evidence limited our ability to perform pooled analyses.
We identified a limited number of observational studies and case series comparing outcomes following use of the recovery position with outcomes when other patient positions were used. There was limited evidence to support or revise existing first aid guidance; however, greater emphasis on the initial assessment of responsiveness and need for CPR, as well as the detection and management of patient deterioration of a person identified with decreased responsiveness, is recommended.
对非创伤性反应水平降低的成人和儿童使用恢复体位与其他体位策略相比是否会改变结局进行系统评价。
我们检索了从创刊至2021年3月15日的Medline（Ovid）、Embase、Cochrane图书馆、CINAHL、medRxiv和谷歌学术，以查找在院外急救环境中涉及非创伤性病因导致反应水平降低但不需要复苏干预的成人和儿童的研究。我们使用ROBINS-I工具评估偏倚风险，并使用GRADE方法确定证据的确定性。
在检索到的17947条文献中，纳入了三项前瞻性观察性研究和四个病例系列。俯卧位和半卧位与急性中毒时疑似吸入性肺炎的发生率降低有关。反应水平降低的儿科患者使用恢复体位与入院率降低有关，俯卧位是癫痫患者最常与意外猝死相关的体位。证据的高偏倚风险、不精确性和间接性限制了我们进行汇总分析的能力。
我们发现了数量有限的观察性研究和病例系列，比较了使用恢复体位后的结局与使用其他患者体位后的结局。支持或修订现有急救指南的证据有限；然而，建议更加强调对反应性的初始评估以及心肺复苏的必要性，以及对反应性降低的患者病情恶化的检测和管理。
