SCI18 June 2020 Association of Noninvasive Oxygenation Strategies With All-Cause Mortality in Adults With Acute Hypoxemic Respiratory Failure Ferreyro Bruno L,Angriman Federico,Munshi Laveena et al. Association of Noninvasive Oxygenation Strategies With All-Cause Mortality in Adults W...
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SCI
18 June 2020
Association of Noninvasive Oxygenation Strategies With All-Cause Mortality in Adults With Acute Hypoxemic Respiratory Failure
Ferreyro Bruno L,Angriman Federico,Munshi Laveena et al. Association of Noninvasive Oxygenation Strategies With All-Cause Mortality in Adults With Acute Hypoxemic Respiratory Failure: A Systematic Review and Meta-analysis.[J] .JAMA, 2020, undefined: undefined.
IMPORTANCE 重要性
Treatment with noninvasive oxygenation strategies such as noninvasive ventilation and high-flow nasal oxygen may be more effective than standard oxygen therapy alone in patients with acute hypoxemic respiratory failure. |
對于急性低氧血癥性呼吸衰竭的患者,采用無創通氧策略(如無創通氣和高流量鼻氧)治療可能比單獨使用標準氧療更有效。
OBJECTIVE 目的
To compare the association of noninvasive oxygenation strategies with mortality and endotracheal intubation in adults with acute hypoxemic respiratory failure. |
為了比較急性低氧血癥性呼吸衰竭成人的無創氧合作用、氣管插管與死亡率的關系。
DATA SOURCES 數據源
The following bibliographic databases were searched from inception until April 2020: MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and LILACS. No limits were applied to language, publication year, sex, or race. |
從開始到2020年4月,搜索了以下書目數據庫:MEDLINE,Embase,PubMed,Cochrane對照試驗中央注冊機構,CINAHL,Web of Science和LILACS。語言,出版年份,性別或種族沒有限制。
STUDY SELECTION 研究選擇
Randomized clinical trials enrolling adult participants with acute hypoxemic respiratory failure comparing high-flow nasal oxygen, face mask noninvasive ventilation, helmet noninvasive ventilation, or standard oxygen therapy. |
隨機臨床試驗招募患有急性低氧血癥性呼吸衰竭的成年人,比較高流量鼻氧,面罩無創通氣,頭盔無創通氣或標準氧氣療法。
DATA EXTRACTION AND SYNTHESIS 數據提取與綜合
Two reviewers independently extracted individual study data and evaluated studies for risk of bias using the Cochrane Risk of Bias tool. Network meta-analyses using a bayesian framework to derive risk ratios (RRs) and risk differences along with 95% credible intervals (CrIs) were conducted. GRADE methodology was used to rate the certainty in findings. |
兩名審閱者獨立提取個人研究數據,并使用Cochrane偏倚風險工具評估了偏倚風險的研究。使用貝葉斯框架進行網絡薈萃分析以得出風險比(RRs)和風險差異以及95%可信區間(CrIs)。使用GRADE方法對結果的確定性進行評分。
MAIN OUTCOMES AND MEASURES 主要成果和措施
The primary outcome was all-cause mortality up to 90 days. A secondary outcome was endotracheal intubation up to 30 days. |
主要結果是長達90天的全因死亡率。次要結果是長達30天的氣管插管。
RESULTS 結果
Twenty-five randomized clinical trials (3804 participants) were included. Compared with standard oxygen, treatment with helmet noninvasive ventilation and face mask noninvasive ventilation were associated with a lower risk of mortality, face mask noninvasive ventilation and high-flow nasal oxygen were associated with lower risk of endotracheal intubation. The risk of bias due to lack of blinding for intubation was deemed high. |
包括二十五項隨機臨床試驗(3804名參與者)。與標準氧氣相比,頭盔無創通氣和面罩無創通氣治療的死亡率較低,面罩無創通氣和高流量鼻氧與氣管插管的風險較低。由于插管不致盲造成的偏倚風險被認為很高。
CONCLUSIONS AND RELEVANCE 結論與關聯
In this network meta-analysis of trials of adult patients with acute hypoxemic respiratory failure, treatment with noninvasive oxygenation strategies compared with standard oxygen therapy was associated with lower risk of death. Further research is needed to better understand the relative benefits of each strategy. |
在這項針對成年急性低氧血癥性呼吸衰竭患者的試驗的網絡薈萃分析中,與標準氧療相比,采用無創氧合策略進行治療可降低死亡風險。需要進一步研究以更好地了解每種策略的相對利益。
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