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. |
对于急性低氧血症性呼吸衰竭的患者,采用无创通氧策略(如无创通气和高流量鼻氧)治疗可能比单独使用标准氧疗更有效。
OBJECTIVE 目的
To compare the association of noninvasive oxygenation strategies with mortality and endotracheal intubation in adults with acute hypoxemic respiratory failure. |
为了比较急性低氧血症性呼吸衰竭成人的无创氧合作用、气管插管与死亡率的关系。
DATA SOURCES 数据源
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. |
从开始到2020年4月,搜索了以下书目数据库:MEDLINE,Embase,PubMed,Cochrane对照试验中央注册机构,CINAHL,Web of Science和LILACS。语言,出版年份,性别或种族没有限制。
STUDY SELECTION 研究选择
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. |
随机临床试验招募患有急性低氧血症性呼吸衰竭的成年人,比较高流量鼻氧,面罩无创通气,头盔无创通气或标准氧气疗法。
DATA EXTRACTION AND SYNTHESIS 数据提取与综合
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. |
两名审阅者独立提取个人研究数据,并使用Cochrane偏倚风险工具评估了偏倚风险的研究。使用贝叶斯框架进行网络荟萃分析以得出风险比(RRs)和风险差异以及95%可信区间(CrIs)。使用GRADE方法对结果的确定性进行评分。
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. |
主要结果是长达90天的全因死亡率。次要结果是长达30天的气管插管。
RESULTS 结果
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. |
包括二十五项随机临床试验(3804名参与者)。与标准氧气相比,头盔无创通气和面罩无创通气治疗的死亡率较低,面罩无创通气和高流量鼻氧与气管插管的风险较低。由于插管不致盲造成的偏倚风险被认为很高。
CONCLUSIONS AND RELEVANCE 结论与关联
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. |
在这项针对成年急性低氧血症性呼吸衰竭患者的试验的网络荟萃分析中,与标准氧疗相比,采用无创氧合策略进行治疗可降低死亡风险。需要进一步研究以更好地了解每种策略的相对利益。
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