Effect of airway clearance techniques in patients experiencing an acute exacerbation of chronic obstructive pulmonary disease: a systematic review.
Effect of airway clearance techniques in patients experiencing an acute exacerbation of chronic obstructive pulmonary disease: a systematic review.
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DOI：
10.1177/1479972309348659
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发表时间：
2010-01-01
影响因子：
4.1
通讯作者：
Brooks, Dina
中科院分区：
文献类型：
--
作者：
Hill, Kylie;Patman, Shane;Brooks, Dina
寻求以下问题的答案：主要用于清除气道分泌物的技术是否安全有效？对以下研究进行了系统性综述：（i）随机对照或随机交叉试验，（ii）AECOPD期间招募的患者，（iii）报告组间分析的结果，（iv）研究主要用于清除气道分泌物的技术的效果。排除了检查无创正压通气（NIPPV）和早期康复的研究。提取与静息肺功能、气体交换、咳痰、症状、NIPPV使用和住院时间相关的数据。纳入了5项研究，平均物理治疗证据数据库（PEDro）评分为4.4 +/- 1.1（范围：3-6）。主要发现是：（i）气道清除技术没有改善静息肺功能的测量值，也没有产生气体交换测量值的任何一致性变化，（ii）连续胸壁叩击5分钟的应用减少了1秒用力呼气量（FEV（1）），（iii）在有大量分泌物、机械振动、非振荡呼气正压（PEP）面罩治疗增加了高碳酸血症呼吸衰竭患者的痰量;（iv）肺内扩张通气（IPV）和PEP面罩治疗分别减少了NIPPV的需要和持续时间。除连续胸壁叩击外，气道清除技术在AECOPD患者中是安全的。振动和非振荡PEP有助于气道分泌物丰富的患者排痰。在呼吸衰竭患者中，对气道施加正压的技术可以减少NIPPV的需要或持续时间以及住院时间。
Answers were sought to the following question: Are techniques, applied predominantly with the aim of clearing secretions from the airways, to patients during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), safe and effective? A systematic review was undertaken of studies that (i) were either randomized controlled or randomized cross-over trials, (ii) recruited patients during an AECOPD, (iii) reported the results of between-group analyses and (iv) investigated the effect of techniques applied primarily with the aim of clearing secretions from the airways. Studies that examined non-invasive positive pressure ventilation (NIPPV) and early rehabilitation were excluded. Data were extracted pertaining to resting lung function, gas exchange, sputum expectoration, symptoms, NIPPV use and hospital stay. Five studies were included with a mean Physiotherapy Evidence Database (PEDro) score of 4.4 +/- 1.1 (range: 3-6). The main findings were that (i) airway clearance techniques did not improve measures of resting lung function or produce any consistent change in measures of gas exchange, (ii) the application of 5 min of continuous chest wall percussion reduced forced expiratory volume in 1 second (FEV( 1)), (iii) in people with copious secretions, mechanical vibration, and non-oscillating positive expiratory pressure (PEP) mask therapy increased sputum expectoration and (iv) in patients with hypercapnic respiratory failure, intrapulmonary percussive ventilation (IPV) and PEP mask therapy reduced the need for, and duration of, NIPPV, respectively. With the exception of continuous chest wall percussion, airway clearance techniques were safe in patients during an AECOPD. Vibration and non-oscillating PEP facilitated sputum expectoration in patients characterized by copious airway secretions. In patients with respiratory failure, techniques that apply a positive pressure to the airways may reduce either the need for, or duration of, NIPPV and hospital length of stay.