Keenan S P, Kernerman P D, Cook D J, Martin C M, McCormack D, Sibbald W J
Division of Critical Care Medicine, University of Western Ontario, London Health Sciences Centre, Canada.
Crit Care Med. 1997 Oct;25(10):1685-92. doi: 10.1097/00003246-199710000-00018.
To critically appraise and summarize the trials examining the addition of noninvasive positive pressure ventilation to standard therapy on hospital mortality and need for endotracheal intubation in patients admitted with acute respiratory failure.
We searched MEDLINE (1966 to September 1995) and key references were searched forward using the Scientific Citation Index (SCISEARCH). Bibliographies of all selected articles and review articles were examined. Authors of all selected and review articles were contacted by letter to identify unpublished work.
a)
patients with acute respiratory failure; b) intervention: noninvasive positive pressure ventilation; c) outcome: mortality and/or endotracheal intubation; and d) design: randomized, controlled study. Two of us independently selected the articles for inclusion; disagreements were settled by consensus. Seven (three unpublished) of 212 initially identified studies were selected.
Two authors independently extracted data and evaluated methodologic quality of the studies.
Noninvasive positive pressure ventilation was associated with decreased mortality (odds ratio = 0.29; 95% confidence interval 0.15 to 0.59) and a decreased need for endotracheal intubation (odds ratio = 0.20; 95% confidence interval 0.11 to 0.36). Sensitivity analysis suggested a greater benefit of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease (COPD). The inclusion/exclusion of unpublished trials did not influence these results.
The addition of noninvasive positive pressure ventilation to standard therapy in patients with acute respiratory failure improves survival and decreases the need for endotracheal intubation. However, this effect is restricted to patients whose cause of acute respiratory failure is an exacerbation of COPD. Further research is warranted to determine whether noninvasive positive pressure ventilation confers benefit in patients without COPD who have acute respiratory failure.
严格评估并总结关于在标准治疗基础上加用无创正压通气对急性呼吸衰竭住院患者死亡率及气管插管需求影响的试验。
检索MEDLINE（1966年至1995年9月），并使用科学引文索引（SCISEARCH）对关键参考文献进行追溯检索。查阅所有入选文章及综述文章的参考文献。通过信函联系所有入选及综述文章的作者以识别未发表的研究。
a）研究对象：急性呼吸衰竭患者；b）干预措施：无创正压通气；c）结局指标：死亡率和/或气管插管；d）研究设计：随机对照研究。我们两人独立选择纳入的文章；分歧通过协商解决。在最初识别的212项研究中，选择了7项（3项未发表）。
两位作者独立提取数据并评估研究的方法学质量。
无创正压通气与死亡率降低（比值比=0.29；95%置信区间0.15至0.59）及气管插管需求减少（比值比=0.20；95%置信区间0.11至0.36）相关。敏感性分析表明，无创正压通气对慢性阻塞性肺疾病（COPD）患者的益处更大。纳入/排除未发表的试验不影响这些结果。
在急性呼吸衰竭患者的标准治疗基础上加用无创正压通气可提高生存率并减少气管插管需求。然而，这种效果仅限于急性呼吸衰竭病因是COPD加重的患者。有必要进一步研究以确定无创正压通气对无COPD的急性呼吸衰竭患者是否有益。
