Departments of Anesthesiology, DongGuan SongShan Lake Tungwah Hospital, DongGuan, China.
Departments of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
BMC Anesthesiol. 2023 Apr 1;23(1):105. doi: 10.1186/s12871-023-02064-6.
The benefit of remote ischemia preconditioning (RIPreC) in pediatric cardiac surgery is unclear. The objective of this systematic review and meta-analysis was to examine the effectiveness of RIPreC in reducing the duration of mechanical ventilation and intensive care unit (ICU) length of stay after pediatric cardiac surgery.
We searched PubMed, EMBASE and the Cochrane Library from inception to December 31, 2022. Randomized controlled trials comparing RIPreC versus control in children undergoing cardiac surgery were included. The risk of bias of included studies was assessed using the Risk of Bias 2 (RoB 2) tool. The outcomes of interest were postoperative duration of mechanical ventilation and ICU length of stay. We conducted random-effects meta-analysis to calculate weighted mean difference (WMD) with 95% confidence interval (CI) for the outcomes of interest. We performed sensitivity analysis to examine the influence of intraoperative propofol use.
Thirteen trials enrolling 1,352 children were included. Meta-analyses of all trials showed that RIPreC did not reduce postoperative duration of mechanical ventilation (WMD -5.35 h, 95% CI -12.12-1.42) but reduced postoperative ICU length of stay (WMD -11.48 h, 95% CI -20.96- -2.01). When only trials using propofol-free anesthesia were included, both mechanical ventilation duration (WMD -2.16 h, 95% CI -3.87- -0.45) and ICU length of stay (WMD -7.41 h, 95% CI -14.77- -0.05) were reduced by RIPreC. The overall quality of evidence was moderate to low.
The effects of RIPreC on clinical outcomes after pediatric cardiac surgery were inconsistent, but both postoperative mechanical ventilation duration and ICU length of stay were reduced in the subgroup of children not exposed to propofol. These results suggested a possible interaction effect of propofol. More studies with adequate sample size and without intraoperative propofol use are needed to define the role of RIPreC in pediatric cardiac surgery.
远程缺血预处理（RIPreC）在儿科心脏手术中的益处尚不清楚。本系统评价和荟萃分析的目的是研究 RIPreC 对减少儿科心脏手术后机械通气时间和重症监护病房（ICU）住院时间的有效性。
我们检索了 PubMed、EMBASE 和 Cochrane 图书馆，检索时间从建库至 2022 年 12 月 31 日。纳入比较 RIPreC 与对照组在接受心脏手术的儿童中的随机对照试验。使用风险偏倚 2 工具（RoB 2）评估纳入研究的风险偏倚。主要结局为术后机械通气时间和 ICU 住院时间。我们进行了随机效应荟萃分析，计算了感兴趣结局的加权均数差（WMD）及其 95%置信区间（CI）。我们进行了敏感性分析，以检查术中使用异丙酚的影响。
纳入了 13 项试验，共纳入 1352 名儿童。所有试验的荟萃分析显示，RIPreC 并未减少术后机械通气时间（WMD-5.35 小时，95%CI-12.12-1.42），但缩短了术后 ICU 住院时间（WMD-11.48 小时，95%CI-20.96- -2.01）。当仅纳入使用无异丙酚麻醉的试验时，机械通气时间（WMD-2.16 小时，95%CI-3.87- -0.45）和 ICU 住院时间（WMD-7.41 小时，95%CI-14.77- -0.05）均缩短。整体证据质量为中等到低。
RIPreC 对儿科心脏手术后临床结局的影响不一致，但在未接触异丙酚的儿童亚组中，术后机械通气时间和 ICU 住院时间均缩短。这些结果提示异丙酚可能存在交互作用。需要更多具有足够样本量且术中不使用异丙酚的研究来确定 RIPreC 在儿科心脏手术中的作用。
