Tidal Volume and Mortality in Mechanically Ventilated Children: A Systematic Review and Meta-Analysis of Observational Studies
Tidal Volume and Mortality in Mechanically Ventilated Children: A Systematic Review and Meta-Analysis of Observational Studies
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DOI：
10.1097/ccm.0000000000000546
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发表时间：
2014-12-01
影响因子：
8.8
通讯作者：
Kneyber, Martin C. J.
中科院分区：
文献类型：
--
作者：
de Jager, Pauline;Burgerhof, Johannes G. M.;Kneyber, Martin C. J.
目的：探讨危重机械通气患儿潮气量与死亡率的关系。数据来源：MEDLINE， EM BASE和CINAHL数据库，从成立到2013年7月，无语言限制的纳入研究的参考文献。研究选择：随机临床试验和观察性研究报告了机械通气PICU患者的死亡率。数据提取：两位作者独立选择研究并提取研究方法学、质量和患者结果的数据。meta分析采用Mantel-Haenszel随机效应模型。异质性用p量化，研究质量用纽卡斯尔-渥太华评分对队列研究进行评估。数据综合：142篇引用中，有7篇研究符合纳入标准，并从检索到的文章的参考文献中确定了另外2篇文章。1人被排除在外。这8项研究包括1756名患者。死亡率从13%到42%不等。当潮气量分为7、8、10或12 mL/kg时，潮气量与死亡率之间没有关联。比较潮气量小于7 mL/kg大于10 mL/kg或大于12 mL/kg通气患者与潮气量小于8 mL/kg大于10 mL/kg或大于12 mL/kg通气患者的潮气量与死亡率也无相关性。限制对急性肺损伤/急性呼吸窘迫综合征患者的分析并没有改变这些结果。在所有合并分析中均观察到异质性。结论：无论疾病的严重程度如何，无法确定机械通气儿童的潮气量与死亡率之间的关系。在合并分析中观察到的显著异质性需要在明确定义的患者群体中进行进一步的研究，以了解潮汐量对患者预后的影响。
Objective: To determine whether tidal volume is associated with mortality in critically ill, mechanically ventilated children.Data Sources: MEDLINE, EM BASE, and CINAHL databases from inception until July 2013 and bibliographies of included studies without language restrictions.Study Selection: Randomized clinical trials and observational studies reporting mortality in mechanically ventilated PICU patients.Data Extraction: Two authors independently selected studies and extracted data on study methodology, quality, and patient outcomes. Meta-analyses were performed using the Mantel-Haenszel random-effects model. Heterogeneity was quantified using P. Study quality was assessed using the Newcastle-Ottawa Score for cohort studies.Data Synthesis: Out of 142 citations, seven studies met the inclusion criteria, and additional two articles were identified from references of the found articles. One was excluded. These eight studies included 1,756 patients. Mortality rates ranged from 13% to 42%. There was no association between tidal volume and mortality when tidal volume was dichotomized at 7, 8, 10, or 12 mL/kg. Comparing patients ventilated with tidal volume less than 7 mL/kg and greater than 10 mL/kg or greater than 12 mL/kg and tidal volume less than 8 mL/kg and greater than 10 mL/kg or greater than 12 mL/kg also showed no association between tidal volume and mortality. Limiting the analysis to patients with acute lung injury/acute respiratory distress syndrome did not change these results. Heterogeneity was observed in all pooled analyses.Conclusions: A relationship between tidal volume and mortality in mechanically ventilated children could not be identified, irrespective of the severity of disease. The significant heterogeneity observed in the pooled analyses necessitates future studies in well-defined patient populations to understand the effects of tidal volume on patient outcome.