Department of Neurosurgery, Suzhou Kowloon Hospital, Shanghai Jiao Tong University, School of Medicine, Suzhou, China.
Medical Center, Suzhou Kowloon Hospital, Shanghai Jiao Tong University, School of Medicine, Suzhou, China.
J Clin Nurs. 2023 Aug;32(15-16):4283-4294. doi: 10.1111/jocn.16619. Epub 2023 Feb 1.
To evaluate the effects and safety of intermittent versus continuous control of cuff pressure in patients with mechanical ventilation.
Tracheal cuff pressure management is vital to the prognosis of patients with mechanical ventilation.
A meta-analysis.
This meta-analysis was conducted and reported according to the PRISMA checklist. We searched Pubmed, Embase, The Cochrane Library, BMJ Best Practice, Web of Science, ProQuest Dissertations, as well as the Chinese Biomedical Literature Database, Wanfang, and China national knowledge infrastructure databases up to 5 August 2022 for randomised controlled trials (RCTs) on the intermittent versus continuous control of cuff pressure. Review Manager 5.3 software was used for relevant data analysis.
A total of 18 RCTs involving 1998 patients with mechanical ventilation were included. The synthesised outcomes indicated that continuous control of cuff pressure is beneficial to reduce the incidence of ventilator-associated pneumonia (VAP) [RR = 0.41, 95%CI (0.35, 0.49)], aspiration [RR = 0.36, 95%CI (0.21, 0.63)], duration of mechanical ventilation [MD = -3.23, 95%CI (-4.66, -1.79)], length of ICU stay [MD = -4.12, 95%CI (-5.40, -2.83)], and increase the volume of subglottic drainage [MD = 18.54, 95%CI (16.50, 20.58)]. There was no significant difference in the mortality between two groups [RR = 1.01, 95%CI (0.84, 1.21)]. Egger regression analyses showed that there were no obvious publication biases in the synthesised results (all p > .05).
Existing evidence shows that compared with intermittent monitoring of cuff pressure, continuous monitoring of cuff pressure can reduce the occurrence of aspiration and VAP, shorten the patient's duration of mechanical ventilation and length of ICU stay.
Continuous monitoring of cuff pressure is more beneficial and should be promoted in clinical nursing care of patients undergoing mechanical ventilation.
评估机械通气患者中袖带压力间歇性与持续性控制的效果和安全性。
气管套囊压力管理对机械通气患者的预后至关重要。
荟萃分析。
根据 PRISMA 清单，进行并报告了本次荟萃分析。我们检索了 Pubmed、Embase、The Cochrane Library、BMJ Best Practice、Web of Science、ProQuest Dissertations 以及中国生物医学文献数据库、万方数据库和中国国家知识基础设施数据库，以获取截至 2022 年 8 月 5 日关于袖带压力间歇性与持续性控制的随机对照试验（RCT）。使用 Review Manager 5.3 软件进行相关数据分析。
共纳入 18 项涉及 1998 例机械通气患者的 RCT。综合结果表明，持续控制袖带压力有利于降低呼吸机相关性肺炎（VAP）的发生率[RR=0.41，95%CI（0.35，0.49）]、吸入[RR=0.36，95%CI（0.21，0.63）]、机械通气时间[MD=-3.23，95%CI（-4.66，-1.79）]、ICU 住院时间[MD=-4.12，95%CI（-5.40，-2.83）]，并增加声门下分泌物量[MD=18.54，95%CI（16.50，20.58）]。两组死亡率无显著差异[RR=1.01，95%CI（0.84，1.21）]。Egger 回归分析显示，综合结果无明显发表偏倚（均 p>.05）。
现有证据表明，与间歇性监测袖带压力相比，持续监测袖带压力可降低吸入和 VAP 的发生，缩短患者机械通气时间和 ICU 住院时间。
与间歇性监测袖带压力相比，持续监测袖带压力对机械通气患者更有益，应在临床护理中推广。
