Crit Care:急性低氧血症性呼吸衰竭成年患者插管前预吸氧方法

2019-09-21 xing.T MedSci原创

由此可见,对于急性低氧血症性呼吸衰竭成年患者,NIV是一种安全且可能是最有效的预吸氧方法。

急性低氧血症性呼吸衰竭的患者在气管插管过程中会发生危及生命并发症的风险。预吸氧可能有助于降低低氧血症和插管相关并发症的风险。近日,危重病医学领域权威杂志Critical Care上发表了一篇研究文章,该网络荟萃分析总结了预吸氧方法在成年急性低氧血症性呼吸衰竭患者中的疗效和安全性。

研究人员检索了截至2019年4月PubMed、EMBASE和Cochrane图书馆对照试验中心登记处研究急性低氧血症性呼吸衰竭患者插管前给予常规氧气疗法(COT)、高流量鼻导管(HFNC)、无创通气(NIV)、HFNC和NIV作为预吸氧的随机对照试验(RCT)。文献的筛选,研究选择,数据提取和偏倚评估的风险由两名作者独立进行。该研究的主要结局是在插管过程中的最低SpO2。

研究人员纳入了7项RCT(959例患者)。与使用COT(均数差,MD为5.53,95%CI为2.71-8.34)和HFNC(MD为3.58,95%CI为0.59-6.57)治疗的患者相比,NIV预吸氧的患者的去氧饱和度明显更低。NIV(比值比,OR为0.43,95%CI为0.21-0.87)和HFNC(OR为0.49,95%CI为0.28-0.88)与COT相比,发生插管相关并发症的风险更低。在预吸氧期间使用NIV和HFNC,以及COT、HFNC和NIV之间,死亡率没有显著差异。 

由此可见,对于急性低氧血症性呼吸衰竭成年患者,NIV是一种安全且可能是最有效的预吸氧方法。 

原始出处:

Ka Man Fong.et al.Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials.Critical Care.2019.https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2596-1

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