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首页> 外文期刊>Critical care : >Efficacy and adverse events of high-frequency oscillatory ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis
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Efficacy and adverse events of high-frequency oscillatory ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis

机译：成年急性呼吸窘迫综合征患者高频振荡通气的疗效和不良事件的荟萃分析

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IntroductionTheoretically, high-frequency oscillatory ventilation (HFOV) achieves all goals of a lung-protective ventilatory mode and seems ideal for the treatment of adult patients with acute respiratory distress syndrome (ARDS). However, its effects on mortality and adverse clinical outcomes remain uncertain given the paucity of high-quality studies in this area. This meta-analysis was performed to evaluate the efficacy and adverse events of HFOV in adults with ARDS.MethodsWe searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials through February 2014 to retrieve randomized controlled trials of HFOV in adult ARDS patients. Two independent reviewers extracted data on study methods, clinical and physiological outcomes and adverse events. The primary outcome was 30-day or hospital mortality. Risk of bias was evaluated with the Cochrane Collaboration’s tool. Mortality, oxygenation and adverse effects of HFOV were compared to those of conventional mechanical ventilation. A random-effects model was applied for meta-analysis.ResultsA total of five trials randomly assigning 1,580 patients met inclusion criteria. Pooled data showed that HFOV significantly improved oxygenation on day one of therapy (four studies; 24% higher; 95% confidence interval (CI) 11 to 40%; P <0.01). However, HFOV did not reduce mortality risk (five studies; risk ratio (RR) 1.04; 95% CI 0.83 to 1.31; P?=?0.71) and two early terminated studies suggested a harmful effect of HFOV in ARDS (two studies; RR 1.33; 95% CI 1.09 to 1.62; P <0.01). Safety profiles showed that HFOV was associated with a trend toward increased risk of barotrauma (five studies; RR 1.19; 95% CI 0.83 to 1.72; P?=?0.34) and unfavorable hemodynamics (five studies; RR 1.16; 95% CI 0.97 to 1.39; P?=?0.12).ConclusionsHFOV improved oxygenation in adult patients with ARDS; however, it did not confer a survival benefit and might cause harm in the era of lung-protective ventilation strategy. The evidence suggests that HFOV should not be a routine practice in ARDS and further studies specifically selecting patients for this ventilator mode should be pursued.
机译：简介从理论上讲，高频振荡通气（HFOV）达到了肺保护通气模式的所有目标，并且似乎是治疗成人急性呼吸窘迫综合征（ARDS）的理想选择。但是，鉴于该领域缺乏高质量的研究，其对死亡率和不良临床结果的影响仍不确定。这项荟萃分析旨在评估HFOV在ARDS成人患者中的疗效和不良事件。方法我们检索了PubMed，EMBASE和Cochrane对照试验中央登记册（截止至2014年2月），以检索HFOV在成人ARDS患者中的随机对照试验。两名独立的评论者提取了有关研究方法，临床和生理结果以及不良事件的数据。主要结果是30天或医院死亡。使用Cochrane协作工具评估了偏见风险。将HFOV的死亡率，氧合作用和不良反应与常规机械通气进行了比较。结果采用随机效应模型进行荟萃分析。结果总共进行了5项试验，随机分配了1,580例患者符合纳入标准。汇总数据显示，在治疗的第一天，HFOV可以显着改善氧合（四项研究;高出24％; 95％置信区间（CI）为11％至40％; P <0.01）。但是，HFOV并未降低死亡率风险（五项研究;风险比（RR）为1.04; 95％CI为0.83至1.31; P？=？0.71），两项提前终止的研究表明HFOV对ARDS有有害作用（两项研究; RR 1.33; 95％CI 1.09至1.62; P <0.01）。安全性研究表明，HFOV与气压伤风险增加趋势相关（五项研究; RR 1.19; 95％CI 0.83至1.72; P？=？0.34）和不良的血流动力学（五项研究; RR 1.16; 95％CI 0.97至1.65）。结论：HFOV可改善成人ARDS患者的氧合作用; 1.39; P？=？0.12）。但是，它没有赋予生存优势，并且可能在保护肺的通气策略时代造成损害。有证据表明HFOV不应作为ARDS的常规做法，应进行进一步研究以选择适合这种呼吸机模式的患者。

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