Efficacy of interventions for bronchiolitis in critically ill infants: a systematic review and meta-analysis.
Efficacy of interventions for bronchiolitis in critically ill infants: a systematic review and meta-analysis.
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DOI：
10.1097/01.pcc.0000128891.54799.67
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发表时间：
2004-09-01
期刊：
影响因子：
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通讯作者：
Randolph, Adrienne G
中科院分区：
文献类型：
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作者：
Davison, Caroline;Ventre, Kathleen M;Randolph, Adrienne G
背景：病毒性细支气管炎是美国婴儿呼吸衰竭的主要原因。目前，治疗的支柱是支持性护理。治疗机械通气的毛细支气管炎婴儿的有效性尚不清楚。目的：评估支持使用目前可用的治疗毛细支气管炎危重婴儿的证据的强度。资料来源：我们检索了PubMed，相关文章的引用，个人档案和会议记录，并联系了该领域的专家。随机对照试验评价任何治疗毛细支气管炎，包括儿童在重症监护室。数据提取：两名评论家独立提取数据和评估方法学quality.DATA SYNTHESIS：共2,319引文进行筛选，16个随机对照试验被纳入。有三项表面活性剂试验，三项利巴韦林试验，三项免疫球蛋白试验，三项全身性皮质类固醇试验，以及维生素A、干扰素、促红细胞生成素和氦氧混合气各一项试验。对三项表面活性剂研究的荟萃分析显示，机械通气持续时间有明显减少的趋势，减少了2.58天（95%置信区间，-5.34至0.18天; p = 0.07），重症监护室天数显著减少了3.3天（95%置信区间，-6.38至0.23天; p = 0.04）。对三项全身性皮质类固醇研究的荟萃分析显示，当所有三项试验合并时，对机械通气持续时间没有总体影响（-0.62天; 95%置信区间，-2.78至1.53天; p = 0.57）。我们确定了一个发表的荟萃分析的三个利巴韦林的研究显示，呼吸机天与利巴韦林显着减少（-1.2天; 95%置信区间，-0.2至-3.4天; p = 0.2）。结论：目前，有没有明确有效的干预措施，以改善重症毛细支气管炎的婴儿的结果。表面活性剂似乎是一种有希望的干预措施，皮质类固醇或利巴韦林也可能是有益的。
BACKGROUND: Viral bronchiolitis is the leading cause of respiratory failure among infants in the United States. Currently, the mainstay of treatment is supportive care. The effectiveness of treatments used for mechanically ventilated infants with bronchiolitis is unclear.OBJECTIVE: To evaluate the strength of the evidence supporting the use of currently available treatments for critically ill infants with bronchiolitis.DATA SOURCE: We searched PubMed, citations of relevant articles, personal files, and conference proceedings, and we contacted experts in the field.STUDY SELECTION: Randomized, controlled trials evaluating any therapy for bronchiolitis that included children in an intensive care unit.DATA EXTRACTION: Two reviewers independently extracted data and assessed methodologic quality.DATA SYNTHESIS: A total of 2,319 citations were screened, and 16 randomized, controlled trials were included. There were three trials of surfactant, three of ribavirin, three of immune globulin, three of systemic corticosteroids, and one each of vitamin A, interferon, erythropoietin, and heliox. A meta-analysis of the three surfactant studies showed a strong trend toward a decrease in duration of mechanical ventilation of 2.58 days (95% confidence interval, -5.34 to 0.18 days; p =.07) and a significant decrease of 3.3 intensive care unit days (95% confidence interval, -6.38 to -0.23 days; p =.04). A meta-analysis of the three systemic corticosteroid studies showed no overall effect on duration of mechanical ventilation when all three trials were combined (-0.62 day; 95% confidence interval, -2.78 to 1.53 days; p =.57). We identified one published meta-analysis of three ribavirin studies showing a significant decrease in ventilator days with ribavirin (-1.2 days; 95% confidence interval, -0.2 to -3.4 days; p =.2).CONCLUSIONS: Currently, there are no clearly effective interventions available to improve the outcome of critically ill infants with bronchiolitis. Surfactant seems to be a promising intervention, and corticosteroids or ribavirin may also be beneficial.