Non-Invasive Continuous Respiratory Monitoring on General Hospital Wards: A Systematic Review.
Non-Invasive Continuous Respiratory Monitoring on General Hospital Wards: A Systematic Review.
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DOI：
10.1371/journal.pone.0144626
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Peelen LM
中科院分区：
文献类型：
--
作者：
van Loon K;van Zaane B;Bosch EJ;Kalkman CJ;Peelen LM
未能认识到住院患者的急性恶化可能会导致心肺骤停、计划外重症监护室入院和死亡率增加。在这篇系统性综述中，我们的目的是确定连续无创呼吸监测是否能改善患者病情恶化的早期诊断，并减少医院病房的危急事件。从Medline、Embase、CINAHL和科克伦图书馆检索研究，检索时间为1970年至2014年10月25日。使用关键词和相应的同义词“病房”、“连续”、“监测”和“呼吸”检索电子数据库。排除了儿科、胎儿和动物研究。由于目前没有经过验证的工具可用于连续监测的诊断或干预研究，因此使用基于改良STARD、CONSORT和TREND声明的改良工具评估了方法学质量。纳入了6项干预性研究和5项诊断性研究，评价了8种不同器械用于连续呼吸监测的使用情况。定量数据合成是不可能的，因为干预措施，研究设计和结果之间的差异很大。干预研究的结局估计值范围为RR 0.14（0.03，0.64）心肺复苏至RR 1.00（0.41，2.35）对于引入连续呼吸监测后的计划外ICU入院，大多数研究的方法学质量为中等，例如“前后”设计，主要结局报告不完整，以及监测系统的临床实施不完整。根据本系统评价的结果，由于结果不确定，还不能提倡在综合医院病房实施常规连续无创呼吸监测，研究的方法学质量需要改进。这一领域的未来研究应侧重于明确适用于低护理环境的技术以及定制的警报和治疗算法。
Failure to recognize acute deterioration in hospitalized patients may contribute to cardiopulmonary arrest, unscheduled intensive care unit admission and increased mortality. In this systematic review we aimed to determine whether continuous non-invasive respiratory monitoring improves early diagnosis of patient deterioration and reduces critical incidents on hospital wards. Studies were retrieved from Medline, Embase, CINAHL, and the Cochrane library, searched from 1970 till October 25, 2014. Electronic databases were searched using keywords and corresponding synonyms ‘ward’, ‘continuous’, ‘monitoring’ and ‘respiration’. Pediatric, fetal and animal studies were excluded. Since no validated tool is currently available for diagnostic or intervention studies with continuous monitoring, methodological quality was assessed with a modified tool based on modified STARD, CONSORT, and TREND statements. Six intervention and five diagnostic studies were included, evaluating the use of eight different devices for continuous respiratory monitoring. Quantitative data synthesis was not possible because intervention, study design and outcomes differed considerably between studies. Outcomes estimates for the intervention studies ranged from RR 0.14 (0.03, 0.64) for cardiopulmonary resuscitation to RR 1.00 (0.41, 2.35) for unplanned ICU admission after introduction of continuous respiratory monitoring, The methodological quality of most studies was moderate, e.g. ‘before-after’ designs, incomplete reporting of primary outcomes, and incomplete clinical implementation of the monitoring system. Based on the findings of this systematic review, implementation of routine continuous non-invasive respiratory monitoring on general hospital wards cannot yet be advocated as results are inconclusive, and methodological quality of the studies needs improvement. Future research in this area should focus on technology explicitly suitable for low care settings and tailored alarm and treatment algorithms.