金属涂层气管导管预防呼吸机相关性肺炎的荟萃分析。
Prevention of ventilator-associated pneumonia by metal-coated endotracheal tubes: a meta-analysis.
机构信息
Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, China.
Department of Pharmacy, Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
出版信息
Crit Care. 2024 Sep 17;28(1):309. doi: 10.1186/s13054-024-05095-8.
PURPOSE
This study aimed to evaluate whether endotracheal tubes (ETTs) with a metal coating reduce the incidence of ventilator-associated pneumonia (VAP) compared to uncoated ETTs.
METHODS
An extensive literature review was conducted to find studies that compared metal-coated ETT with uncoated ETT across four databases: PubMed, Embase, Cochrane Library, and Web of Science. The search parameters were set from the inception of each database until June 2024. The primary outcome measures were the rates of VAP and hospital mortality. Two independent researchers carried out the literature selection, data extraction, and quality evaluation. Data analysis was performed with RevMan 5.4.1. Furthermore, a Deeks funnel plot was used to evaluate potential publication bias in the studies included.
RESULTS
Following the screening process, five randomized controlled trials (RCTs) encompassing a total of 2157 patients were identified. In terms of the primary outcome, the VAP incidence was found to be lower in the group utilizing metal-coated ETT compared to those with uncoated ETT, demonstrating a statistically significant difference [RR = 0.71, 95% CI (0.54-0.95), P = 0.02]. No notable difference in mortality rates was observed between the two groups [RR = 1.05, 95% CI (0.86-1.27), P = 0.65]. Concerning secondary outcomes, two studies were evaluated to compare the mechanical ventilation duration (RR = 0.60, 95% CI (- 0.52, 1.72), P = 0.29, I = 97%) and intensive care unit (ICU) stay for both patient groups (RR = 0.47, 95% CI (- 1.02, 1.95), P = 0.54, I = 50%). Due to the marked heterogeneity, a comparison of mechanical ventilation length between the two patient groups was not feasible. However, both studies suggested no significant difference in ventilation duration between patients using metal-coated ETT and those with uncoated ETT.
CONCLUSIONS
Metal-coated ETT show a lower occurrence of VAP compared to the uncoated ETT. Nevertheless, they do not considerably decrease the length of mechanical ventilation, the duration of ICU admission, nor do they reduce hospital mortality rates.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/ , identifier CRD42024560618.
目的
本研究旨在评估与未涂层的气管导管（ETT）相比，具有金属涂层的 ETT 是否会降低呼吸机相关性肺炎（VAP）的发生率。
方法
通过四个数据库（PubMed、Embase、Cochrane 图书馆和 Web of Science）进行广泛的文献综述，以查找比较金属涂层 ETT 与未涂层 ETT 的研究。搜索参数设置为从每个数据库的创建到 2024 年 6 月。主要结局指标是 VAP 和医院死亡率。两名独立的研究人员进行了文献选择、数据提取和质量评估。使用 RevMan 5.4.1 进行数据分析。此外，使用 Deeks 漏斗图评估纳入研究的潜在发表偏倚。
结果
经过筛选过程，确定了五项共纳入 2157 名患者的随机对照试验（RCT）。在主要结局方面，与使用未涂层 ETT 的患者相比，使用金属涂层 ETT 的患者 VAP 发生率较低，差异具有统计学意义[RR=0.71，95%CI（0.54-0.95），P=0.02]。两组之间的死亡率无显著差异[RR=1.05，95%CI（0.86-1.27），P=0.65]。关于次要结局，有两项研究评估了比较两组患者的机械通气持续时间（RR=0.60，95%CI（-0.52，1.72），P=0.29，I=97%）和重症监护病房（ICU）住院时间（RR=0.47，95%CI（-1.02，1.95），P=0.54，I=50%）。由于存在显著异质性，因此无法比较两组患者的机械通气时间。然而，这两项研究均表明，使用金属涂层 ETT 的患者与使用未涂层 ETT 的患者之间的通气持续时间无显著差异。
结论
与未涂层的 ETT 相比，金属涂层的 ETT 发生 VAP 的几率较低。然而，它们并没有显著减少机械通气时间、ICU 住院时间，也没有降低医院死亡率。
系统评价注册
https://www.crd.york.ac.uk/prospero/ ，标识符 CRD42024560618。
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