Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis.
Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis.
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选择性消化或口咽净化和局部口咽氯己定用于预防一般重症监护中的死亡：系统评价和网络荟萃分析。
DOI：
10.1136/bmj.g2197
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发表时间：
2014-03-31
期刊：
影响因子：
--
通讯作者：
SuDDICU Collaboration
中科院分区：
文献类型：
--
作者：
Price R;MacLennan G;Glen J;SuDDICU Collaboration
目的确定选择性消化道去污、选择性口咽去污和局部口咽洗必泰对普通重症监护病房成人患者死亡率的影响，并在网络荟萃分析中比较这些干预措施。设计系统性综述、传统荟萃分析和网络荟萃分析。检索了Medline、Embase和CENTRAL至2012年12月。还检索了既往荟萃分析、会议摘要和关键期刊。我们使用成对荟萃分析来估计来自干预对照试验的直接证据，并在贝叶斯框架内使用网络荟萃分析来结合联合收割机直接和间接证据。入选标准：前瞻性随机对照试验，招募普通重症监护病房的成年患者，研究选择性消化道去污、选择性口咽去污或口咽洗必泰与标准治疗或安慰剂的比较。结果选择性消化道去污对死亡率有有利影响，直接证据优势比为0.73（95%可信区间0.64 ~ 0.84）。选择性口咽部去污的直接证据优势比为0.85（0.74 - 0.97）。洗必泰与死亡率增加相关（比值比1.25，1.05 - 1.50）。当每种干预措施与其他干预措施进行比较时，选择性消化去污和选择性口咽去污均上级洗必泰。选择性消化道去污和选择性口咽去污之间的差异是不确定的。结论选择性消化道去污染对普通重症监护病房成人患者的死亡率有较好的影响。在这些患者中，选择性口咽去污的效果不太确定。选择性消化道去污和选择性口咽去污均上级洗必泰，并且洗必泰可能与死亡率增加相关。
Objectives To determine the effect on mortality of selective digestive decontamination, selective oropharyngeal decontamination, and topical oropharyngeal chlorhexidine in adult patients in general intensive care units and to compare these interventions with each other in a network meta-analysis. Design Systematic review, conventional meta-analysis, and network meta-analysis. Medline, Embase, and CENTRAL were searched to December 2012. Previous meta-analyses, conference abstracts, and key journals were also searched. We used pairwise meta-analyses to estimate direct evidence from intervention-control trials and a network meta-analysis within a Bayesian framework to combine direct and indirect evidence. Inclusion criteria Prospective randomised controlled trials that recruited adult patients in general intensive care units and studied selective digestive decontamination, selective oropharyngeal decontamination, or oropharyngeal chlorhexidine compared with standard care or placebo. Results Selective digestive decontamination had a favourable effect on mortality, with a direct evidence odds ratio of 0.73 (95% confidence interval 0.64 to 0.84). The direct evidence odds ratio for selective oropharyngeal decontamination was 0.85 (0.74 to 0.97). Chlorhexidine was associated with increased mortality (odds ratio 1.25, 1.05 to 1.50). When each intervention was compared with the other, both selective digestive decontamination and selective oropharyngeal decontamination were superior to chlorhexidine. The difference between selective digestive decontamination and selective oropharyngeal decontamination was uncertain. Conclusion Selective digestive decontamination has a favourable effect on mortality in adult patients in general intensive care units. In these patients, the effect of selective oropharyngeal decontamination is less certain. Both selective digestive decontamination and selective oropharyngeal decontamination are superior to chlorhexidine, and there is a possibility that chlorhexidine is associated with increased mortality.
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DOI：
10.1164/ajrccm.156.5.96-04076
发表时间：
1997-11-01
影响因子：
24.7
作者：
GarrousteOrgeas, M;Chevret, S;Schlemmer, B
通讯作者：
Schlemmer, B
影响因子：
4.5
作者：
Bellissimo-Rodrigues, Fernando;Bellissimo-Rodrigues, Wanessa Teixeira;Martinez, Roberto
通讯作者：
Martinez, Roberto
影响因子：
8.1
作者：
Berry, A. M.;Davidson, P. M.;Ollerton, R.
通讯作者：
Ollerton, R.
影响因子：
39.2
作者：
COCKERILL, FR;MULLER, SR;THOMPSON, RL
通讯作者：
THOMPSON, RL
DOI：
10.1164/ajrccm.158.3.9712079
发表时间：
1998-09-01
影响因子：
24.7
作者：
García, MS;Galache, JAC;del Castillo, JAS
通讯作者：
del Castillo, JAS