Department of Anesthesiology, Dongying People's Hospital, Dongying, China.
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
BMJ Open. 2024 Nov 20;14(11):e081592. doi: 10.1136/bmjopen-2023-081592.
Coughing during extubation can lead to several postoperative complications, including surgical site bleeding, intracranial hypertension and high intraocular pressure. Currently, various pharmacological and non-pharmacological interventions are employed in clinical practice to reduce coughing during extubation. However, it is unclear which of these interventions has the best preventive effect and the fewest adverse events. Therefore, we plan to conduct a systematic review and network meta-analysis to compare the effects of all interventions.
We will search MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, CNKI and Wanfang databases, as well as reference lists from previously published papers, from the date of their inception to April 2024. We will only include randomised controlled trials, regardless of publication in any language. The primary outcome is the incidence of cough during extubation, using the modified Minogue scales. The secondary outcomes are as follows: (1) the incidence of severe coughing (grade 4); (2) the incidence of other types of postoperative airway complications, such as laryngospasm, apnoea, hypoxaemia and sore throat, which will be evaluated within 24 hours after surgery; (3) the side effects related to the interventions, such as bradycardia (heart rate less than 60 beats per minute), hypotension or allergic reactions, which will be evaluated within 24 hours from the start of the drug to the postoperative period and (4) the time from the end of the surgery to the extubation of the endotracheal tube. The articles meeting the criteria will be independently evaluated by two researchers based on the established screening criteria. The data will then be extracted. Bias will be assessed for all included studies using the Cochrane Risk of Bias Risk Assessment Tool Version 2. We will use the Netmeta package of the R software with a random-effects model to make direct and indirect comparisons through the frequency framework. We will assess the quality of evidence using Confidence in Network Meta-Analysis.
Ethical approval is not required for this protocol, as we will only pool published data. We plan to submit our manuscript for publication in a peer-reviewed academic journal.
CRD42023401609.
拔管时咳嗽可导致多种术后并发症，包括手术部位出血、颅内压升高和眼内压升高。目前，临床实践中采用了各种药理和非药理干预措施来减少拔管时的咳嗽。然而，尚不清楚哪种干预措施具有最佳的预防效果和最少的不良事件。因此，我们计划进行系统评价和网络荟萃分析，以比较所有干预措施的效果。
我们将检索 MEDLINE、Embase、Web of Science、Cochrane 对照试验中心注册库、中国知网和万方数据库，以及之前发表的论文的参考文献列表，从其成立日期到 2024 年 4 月。我们将仅纳入随机对照试验，无论语言如何发表。主要结局是使用改良的 Minogue 量表评估拔管时咳嗽的发生率。次要结局如下：（1）剧烈咳嗽（等级 4）的发生率；（2）手术后 24 小时内发生的其他类型的术后气道并发症，如喉痉挛、呼吸暂停、低氧血症和喉咙痛的发生率；（3）与干预相关的副作用，如心动过缓（心率低于 60 次/分钟）、低血压或过敏反应的发生率，将在药物开始至术后期间的 24 小时内评估；（4）从手术结束到拔出气管内导管的时间。符合标准的文章将由两位研究人员根据既定的筛选标准独立评估。然后提取数据。我们将使用 Cochrane 风险偏倚评估工具版本 2 对所有纳入的研究进行偏倚评估。我们将使用 R 软件的 Netmeta 包，采用随机效应模型，通过频率框架进行直接和间接比较。我们将使用网络荟萃分析置信度评估证据质量。
本方案不需要伦理批准，因为我们只会汇总已发表的数据。我们计划将我们的手稿提交给同行评审的学术期刊发表。
PROSPERO 注册号：CRD42023401609。
