The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials.
The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials.
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DOI：
10.1186/cc13896
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发表时间：
2014-05-28
期刊：
影响因子：
--
通讯作者：
Qiu HB
中科院分区：
文献类型：
--
作者：
Hu SL;He HL;Pan C;Liu AR;Liu SQ;Liu L;Huang YZ;Guo FM;Yang Y;Qiu HB
俯卧位(PP)可改善严重急性呼吸窘迫综合征(ARDS)患者的生存。然而，PP的有益效果是否与呼气末正压(PEEP)水平和PP的持续时间有关尚不确定。在这项荟萃分析中，我们的目的是评估PP对死亡率的影响是否受PEEP水平和PP持续时间的影响，并确定哪些患者可能从PP中获益最多。通过搜索以下电子数据库，检索描述研究人员比较俯卧和仰卧通风的随机对照试验(RCT)的文献：PubMed/MEDLINE、Cochrane图书馆、Web of Science和Elsevier Science(始于2013年5月)。两名研究人员独立选择了随机对照试验，并评估了它们的质量。从随机对照试验中提取的数据被合并在累积荟萃分析中，并使用Cochrane Collaboration推荐的方法进行分析。共纳入9项随机对照试验，总计2,242名患者。使用Jadad等人推荐的方法，所有研究都得到了高达3分的分数。其中一次审判没有隐瞒分配情况。这项荟萃分析显示，与仰卧位相比，PP降低了急性呼吸窘迫综合征患者28至30天的死亡率，其比率为动脉氧分压/吸入氧分压≤100毫米汞柱(n = 508，Risk Ratio(RR) = 0.71，95可信区间(CI) = 0.57至0.89；P = 0.003)。PP可降低呼吸窘迫综合征患者的60d死亡率(n = 5 18，RR = 0.82，95%CI = 0.6 8~0.99；P = 0.0 4)和90 d死亡率(n = 5 16，RR = 0.5 7，95%CI = 0.43~0.75；P <； 0.0001)。此外，当PP持续时间为12小时/天时，PP可降低28至30天的死亡率(n = 1,067，RR = 0.73，95%CI = 0.54至0.99；P = 0.04)。PP降低了严重ARDS患者和接受相对较高PEEP水平的患者的死亡率。此外，长期PP可提高ARDS患者的存活率。
Prone positioning (PP) has been reported to improve the survival of patients with severe acute respiratory distress syndrome (ARDS). However, it is uncertain whether the beneficial effects of PP are associated with positive end-expiratory pressure (PEEP) levels and long durations of PP. In this meta-analysis, we aimed to evaluate whether the effects of PP on mortality could be affected by PEEP level and PP duration and to identify which patients might benefit the most from PP. Publications describing randomized controlled trials (RCTs) in which investigators have compared prone and supine ventilation were retrieved by searching the following electronic databases: PubMed/MEDLINE, the Cochrane Library, the Web of Science and Elsevier Science (inception to May 2013). Two investigators independently selected RCTs and assessed their quality. The data extracted from the RCTs were combined in a cumulative meta-analysis and analyzed using methods recommended by the Cochrane Collaboration. A total of nine RCTs with an aggregate of 2,242 patients were included. All of the studies received scores of up to three points using the methods recommended by Jadad et al. One trial did not conceal allocation. This meta-analysis revealed that, compared with supine positioning, PP decreased the 28- to 30-day mortality of ARDS patients with a ratio of partial pressure of arterial oxygen/fraction of inspired oxygen ≤100 mmHg (n = 508, risk ratio (RR) = 0.71, 95 confidence interval (CI) = 0.57 to 0.89; P = 0.003). PP was shown to reduce both 60-day mortality (n = 518, RR = 0.82, 95% CI = 0.68 to 0.99; P = 0.04) and 90-day mortality (n = 516, RR = 0.57, 95% CI = 0.43 to 0.75; P < 0.0001) in ARDS patients ventilated with PEEP ≥10 cmH2O. Moreover, PP reduced 28- to 30-day mortality when the PP duration was >12 h/day (n = 1,067, RR = 0.73, 95% CI = 0.54 to 0.99; P = 0.04). PP reduced mortality among patients with severe ARDS and patients receiving relatively high PEEP levels. Moreover, long-term PP improved the survival of ARDS patients.
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影响因子：
4
作者：
Hozo SP;Djulbegovic B;Hozo I
通讯作者：
Hozo I
DOI：
10.1164/ajrccm/146.2.300
发表时间：
1992-08-01
期刊：
AMERICAN REVIEW OF RESPIRATORY DISEASE
影响因子：
--
作者：
MUTOH, T;GUEST, RJ;ALBERT, RK
通讯作者：
ALBERT, RK
影响因子：
38.9
作者：
Gattinoni, L;Pesenti, A
通讯作者：
Pesenti, A
DOI：
10.1164/rccm.200503-353oc
发表时间：
2006-06-01
影响因子：
24.7
作者：
Mancebo, Jordi;Fernandez, Rafael;Albert, Richard K.
通讯作者：
Albert, Richard K.
影响因子：
120.7
作者：
Curley, MAQ;Hibberd, PL;Arnold, JH
通讯作者：
Arnold, JH