Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation
Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation
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DOI：
10.3310/hta19420
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发表时间：
2015-06-01
影响因子：
3.6
通讯作者：
Penn-Ashman, Jerry
中科院分区：
文献类型：
--
作者：
Pandor, Abdullah;Thokala, Praveen;Penn-Ashman, Jerry
背景：无创通气（NIV）以持续气道正压通气（CPAP）或双水平吸气式气道正压通气（BiPAP）的形式在医院被用于治疗急性呼吸衰竭患者。院前NIV可能比院内NIV更有效，但需要额外的救护车服务资源。目的：我们的目的是确定院前NIV与常规护理相比，对急诊服务的急性呼吸衰竭成人的临床效果和成本效益，并确定未来研究的重点。数据来源：从成立到2013年8月，我们检索了14个电子数据库和研究注册库（包括MEDLINE in - process & Other Non-Indexed citation， MEDLINE， EMBASE, and Cumulative Index to Nursing and Allied Health Literature），并辅以手工检索参考文献列表和联系该领域的专家。回顾方法：我们纳入了急性呼吸衰竭患者院前NIV的所有随机或准随机对照试验。根据既定标准评估方法学质量。死亡率和插管的综合数据网络荟萃分析（NMA）用于联合评估相对于常规护理的干预效果。使用个体患者水平数据（IPD）和无法获得IPD的汇总数据进行NMA，以评估协变量是否为治疗效果调节剂。我们建立了一个从头开始的经济模型，以探讨院前NIV（特别是护理人员提供的CPAP）和标准护理（院内NIV）应用于急性呼吸衰竭患者的假设队列时的成本和健康结果。
Background: Non-invasive ventilation (NIV), in the form of continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP), is used in hospital to treat patients with acute respiratory failure. Pre-hospital NIV may be more effective than in-hospital NIV but requires additional ambulance service resources.Objectives: We aimed to determine the clinical effectiveness and cost-effectiveness of pre-hospital NIV compared with usual care for adults presenting to the emergency services with acute respiratory failure and to identify priorities for future research.Data sources: Fourteen electronic databases and research registers (including MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to August 2013, supplemented by hand-searching reference lists and contacting experts in the field.Review methods: We included all randomised or quasi-randomised controlled trials of pre-hospital NIV in patients with acute respiratory failure. Methodological quality was assessed according to established criteria. An aggregate data network meta-analysis (NMA) of mortality and intubation was used to jointly estimate intervention effects relative to usual care. A NMA, using individual patient-level data (IPD) and aggregate data where IPD were not available, was carried out to assess whether or not covariates were treatment effect modifiers. A de novo economic model was developed to explore the costs and health outcomes when pre-hospital NIV (specifically CPAP provided by paramedics) and standard care (in-hospital NIV) were applied to a hypothetical cohort of patients with acute respiratory failure.