成人急性低氧性呼吸衰竭的呼吸支持策略：一项系统评价和网状荟萃分析

Respiratory support strategy in adults with acute hypoxemic respiratory failure: a systematic review and network meta-analysis.

作者信息

Okano Hiromu, Sakuraya Masaaki, Masuyama Tomoyuki, Kimata Shunsuke, Hokari Satoshi

机构信息

Department of Critical Care and Emergency Medicine, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama-shi, Kanagawa, 245-8575, Japan.

International University of Health and Welfare Graduate School of Public Health, 4-1-26 Akasaka, Minato City, Tokyo, 107-8402, Japan.

出版信息

JA Clin Rep. 2022 May 6;8(1):34. doi: 10.1186/s40981-022-00525-4.

DOI:10.1186/s40981-022-00525-4

PMID:35522380

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9072760/

Abstract

INTRODUCTION

Network meta-analyses (NMAs) of respiratory management strategies for acute hypoxemic respiratory failure (AHRF) have been reported, but no previous study has compared noninvasive ventilation (NIV), high-flow nasal oxygen (HFNO), standard oxygenation therapy (SOT), and invasive mechanical ventilation (IMV) for de novo AHRF. Therefore, we conducted an NMA to assess the effectiveness of these four respiratory strategies in patients with de novo AHRF.

METHODS

The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults aged ≥18 years with AHRF and RCTs that compared two different oxygenation techniques (SOT, NIV, HFNO, or IMV) were selected. A frequentist-based approach with multivariate random-effects meta-analysis was used. The outcomes were mortality and intubation rates.

RESULTS

Among the 14,263 records initially identified, 25 studies (3302 patients) were included. In the analysis of mortality, compared to SOT, NIV (risk ratio [RR], 0.76; 95% confidence interval [CI], 0.61-0.95) reduced mortality; however, IMV (RR, 1.01; 95% CI, 0.57-1.78) and HFNO (RR, 0.89; 95% CI, 0.66-1.20) did not. For assessments of the intubation incidence, compared to SOT, NIV use (RR, 0.63; 95% CI, 0.51-0.79) was associated with a reduction in intubation, but HFNO (RR, 0.82; 95% CI, 0.61-1.11) was not significant.

CONCLUSIONS

Our NMA demonstrated that only NIV showed clinical benefits compared with SOT as an initial respiratory strategy for de novo AHRF. Further investigation, especially comparison with HFNO, is warranted.

TRIAL REGISTRATION

PROSPERO (registration number: CRD42020213948 , 11/11/2020).

摘要

引言

已有关于急性低氧性呼吸衰竭（AHRF）呼吸管理策略的网状Meta分析（NMA）报道，但此前尚无研究比较无创通气（NIV）、高流量鼻导管吸氧（HFNO）、标准氧疗（SOT）和有创机械通气（IMV）用于新发AHRF的效果。因此，我们进行了一项NMA，以评估这四种呼吸策略对新发AHRF患者的有效性。

方法

检索Cochrane对照试验中心注册库、MEDLINE、EMBASE和日本医学中央杂志数据库。纳入年龄≥18岁的AHRF成人患者以及比较两种不同氧疗技术（SOT、NIV、HFNO或IMV）的随机对照试验（RCT）。采用基于频率学派的多变量随机效应Meta分析方法。结局指标为死亡率和插管率。

结果

在最初识别的14263条记录中，纳入了25项研究（3302例患者）。在死亡率分析中，与SOT相比，NIV（风险比[RR]，0.76；95%置信区间[CI]，0.61 - 0.95）降低了死亡率；然而，IMV（RR，1.01；95%CI，0.57 - 1.78）和HFNO（RR，0.89；95%CI，0.66 - 1.20）未降低死亡率。对于插管发生率评估，与SOT相比，使用NIV（RR，0.63；95%CI，0.51 - 0.79）与插管减少相关，但HFNO（RR，0.82；95%CI，0.61 - 1.11）无显著差异。