接受瑞芬太尼的重症监护病房患者机械通气时间并未缩短：基于贝叶斯理论的随机对照试验和网状荟萃分析的系统评价

ICU patients receiving remifentanil do not experience reduced duration of mechanical ventilation: a systematic review of randomized controlled trials and network meta-analyses based on Bayesian theories.

作者信息

Lu Fangjie, Qin Sirun, Liu Chang, Chen Xunxun, Dai Zhaoqiu, Li Cong

机构信息

Department of Critical Care Medicine, Changshu Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Changshu, Jiangsu, China.

Department of Cardiovascular Medicine, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China.

出版信息

Front Med (Lausanne). 2024 Aug 7;11:1370481. doi: 10.3389/fmed.2024.1370481. eCollection 2024.

BACKGROUND

The purpose of this network meta-analysis (NMA) was to evaluate the efficacy of intravenous opioid μ-receptor analgesics in shortening the duration of mechanical ventilation (MV) in ICU patients.

METHODS

Randomized controlled trials comparing the efficacy of remifentanil, sufentanil, morphine, and fentanyl on the duration of MV in ICU patients were searched in Embase, Cochrane, Pubmed, and Web of Science electronic databases. The primary outcome was MV duration. The Bayesian random-effects framework was used to evaluate relative efficacy.

RESULTS

In total 20 studies were included in this NMA involving 3,442 patients. Remifentanil was not associated with a reduction in the duration of MV compared with fentanyl (mean difference (MD) -0.16; 95% credible interval (CrI): -4.75 ~ 5.63) and morphine (MD 3.84; 95% CrI: -0.29 ~ 10.68). The secondary outcomes showed that, compared with remifentanil, sufentanil can prolong the duration of extubation. No regimen significantly shortened the ICU length of stay and improved the ICU mortality, efficacy, safety, and drug-related adverse events.

CONCLUSION

Among these analgesics, remifentanil did not appear to be associated with a reduction in MV duration. Clinicians should carefully titrate the analgesia of MV patients to prevent a potentially prolonged duration of MV due to excessive or inadequate analgesic therapy.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, CRD42021232604.

背景

本网络荟萃分析（NMA）的目的是评估静脉注射阿片类μ受体镇痛药在缩短重症监护病房（ICU）患者机械通气（MV）持续时间方面的疗效。

方法

在Embase、Cochrane、Pubmed和Web of Science电子数据库中检索比较瑞芬太尼、舒芬太尼、吗啡和芬太尼对ICU患者MV持续时间疗效的随机对照试验。主要结局是MV持续时间。采用贝叶斯随机效应框架评估相对疗效。

结果

本NMA共纳入20项研究，涉及3442例患者。与芬太尼（平均差（MD）-0.16；95%可信区间（CrI）：-4.75至5.63）和吗啡（MD 3.84；95% CrI：-0.29至10.68）相比，瑞芬太尼与MV持续时间缩短无关。次要结局显示，与瑞芬太尼相比，舒芬太尼可延长拔管时间。没有一种方案能显著缩短ICU住院时间并改善ICU死亡率、疗效、安全性和药物相关不良事件。