各种皮质类固醇预防拔管后喘鸣和再次插管的比较疗效：一项系统评价和网状Meta分析。

Comparative efficacies of various corticosteroids for preventing postextubation stridor and reintubation: a systematic review and network meta-analysis.

作者信息

Feng I-Jung, Lin Jia-Wei, Lai Chih-Cheng, Cheng Kuo-Chen, Chen Chin-Ming, Chao Chien-Ming, Wang Ying-Ting, Chiang Shyh-Ren, Liao Kuang-Ming

机构信息

Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.

Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.

出版信息

Front Med (Lausanne). 2023 Jul 24;10:1135570. doi: 10.3389/fmed.2023.1135570. eCollection 2023.

DOI:10.3389/fmed.2023.1135570

PMID:37554508

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10406286/

Abstract

OBJECTIVES

We assessed the efficacies of various corticosteroid treatments for preventing postexubation stridor and reintubation in mechanically ventilated adults with planned extubation.

METHODS

We searched the Pubmed, Embase, the Cochrane databases and ClinicalTrial.gov registration for articles published through September 29, 2022. Only randomized controlled trials (RCTs) that compared the clinical efficacies of systemic corticosteroids and other therapeutics for preventing postextubation stridor and reintubation were included. The primary outcome was postextubation stridor and the secondary outcome was reintubation.

RESULTS

The 11 assessed RCTs reported 4 nodes: methylprednisolone, dexamethasone, hydrocortisone, and placebo, which yielded 3 possible pairs for comparing the risks of post extubation stridor and 3 possible pairs for comparing the risks of reintubation. The risk of postextubation stridor was significantly lower in dexamethasone- and methylprednisolone-treated patients than in placebo-treated patients (dexamethasone: OR = 0.39; 95% CI = 0.22-0.70; methylprednisolone: OR = 0.22; 95% CI = 0.11-0.41). The risk of postextubation stridor was significantly lower in methylprednisolone-treated patients than in hydrocortisone-treated: OR = 0.24; 95% CI = 0.08-0.67) and dexamethasone-treated patients: OR = 0.55; 95% CI = 0.24-1.26). The risk of reintubation was significantly lower in dexamethasone- and methylprednisolone-treated patients than in placebo-treated patients: (dexamethasone: OR = 0.34; 95% CI = 0.13-0.85; methylprednisolone: OR = 0.42; 95% CI = 0.25-0.70). Cluster analysis showed that dexamethasone- and methylprednisolone-treated patients had the lowest risks of stridor and reintubation. Subgroup analyses of patients with positive cuff-leak tests showed similar results.

CONCLUSIONS

Methylprednisolone and dexamethasone were the most effective agents against postextubation stridor and reintubation.

摘要

目的

我们评估了多种皮质类固醇治疗方案对计划拔管的机械通气成年患者预防拔管后喘鸣和再次插管的疗效。

方法

我们检索了截至2022年9月29日发表的PubMed、Embase、Cochrane数据库和ClinicalTrial.gov注册库中的文章。仅纳入比较全身皮质类固醇与其他治疗方法预防拔管后喘鸣和再次插管临床疗效的随机对照试验（RCT）。主要结局为拔管后喘鸣，次要结局为再次插管。

结果

11项评估的RCT报告了4个节点：甲泼尼龙、地塞米松、氢化可的松和安慰剂，产生了3对比较拔管后喘鸣风险的可能组合以及3对比较再次插管风险的可能组合。地塞米松和甲泼尼龙治疗的患者拔管后喘鸣风险显著低于安慰剂治疗的患者（地塞米松：OR = 0.39；95% CI = 0.22 - 0.70；甲泼尼龙：OR = 0.22；95% CI = 0.11 - 0.41）。甲泼尼龙治疗的患者拔管后喘鸣风险显著低于氢化可的松治疗的患者（OR = 0.24；95% CI = 0.08 - 0.67）和地塞米松治疗的患者（OR = 0.55；95% CI = 0.24 - 1.26）。地塞米松和甲泼尼龙治疗的患者再次插管风险显著低于安慰剂治疗的患者（地塞米松：OR = 0.34；95% CI = 0.13 - 0.85；甲泼尼龙：OR = 0.42；95% CI = 0.25 - 0.70）。聚类分析表明，地塞米松和甲泼尼龙治疗的患者喘鸣和再次插管风险最低。气囊漏气试验阳性患者的亚组分析显示了类似结果。