Tracheal intubation in critically ill patients: a comprehensive systematic review of randomized trials.
Tracheal intubation in critically ill patients: a comprehensive systematic review of randomized trials.
复制标题
重症患者的气管插管：对随机试验的全面系统综述。
DOI：
10.1186/s13054-017-1927-3
复制
发表时间：
2018-01-20
期刊：
影响因子：
--
通讯作者：
Zangrillo A
中科院分区：
文献类型：
--
作者：
Cabrini L;Landoni G;Baiardo Redaelli M;Saleh O;Votta CD;Fominskiy E;Putzu A;Snak de Souza CD;Antonelli M;Bellomo R;Pelosi P;Zangrillo A
我们对随机对照研究进行了系统评价，评价旨在提高危重患者气管插管成功率或安全性的任何药物、技术或器械。我们检索了PubMed、BioMed Central、Embase和科克伦临床试验中心注册库以及检索到的文献的参考文献。最后，还扫描了相关评论，以检测2017年5月之前的进一步研究。考虑以下入选标准：成人重症患者气管插管;随机对照试验;在重症监护室、急诊科或普通病房进行的研究;以及过去20年发表的工作。排除标准为院前或手术室环境和基于模拟的研究。两名研究人员选择研究进行最终分析。提取的数据包括第一作者、出版年份、患者特征和临床环境、干预详情、对照药物和相关结局。使用科克伦协作组的偏倚风险工具评估偏倚风险。我们确定了22项试验，涉及使用术前检查表（1项研究）、预氧合或呼吸暂停氧合（6项研究）、镇静剂（3项研究）、神经肌肉阻滞剂（1项研究）、患者体位（1项研究）、视频喉镜检查（9项研究）和插管后肺复张（1项研究）。无创通气（NIV）和/或高流量鼻插管（HFNC）的预氧合显示出可能的有益作用。插管后复张改善了氧合，而斜坡位置增加了插管尝试的次数，硫喷妥钠对血流动力学有负面影响。未发现使用检查表、呼吸暂停氧合（对氧合和血流动力学）、视频喉镜检查（对插管尝试次数和长度）、镇静剂和神经肌肉阻滞剂（对血流动力学）的影响。最后，在多项试验中，视频喉镜检查与严重不良反应相关。有限的可用证据支持危重患者插管前使用NIV和HFNC预充氧的有益作用。复张操作可能会增加插管后氧合。倾斜位置增加了插管尝试的次数;硫喷妥钠对血流动力学有负面影响，视频喉镜检查可能会导致不良事件。本文的在线版本（doi：10.1186/s13054-017-1927-3）包含补充材料，可供授权用户使用。
We performed a systematic review of randomized controlled studies evaluating any drug, technique or device aimed at improving the success rate or safety of tracheal intubation in the critically ill. We searched PubMed, BioMed Central, Embase and the Cochrane Central Register of Clinical Trials and references of retrieved articles. Finally, pertinent reviews were also scanned to detect further studies until May 2017. The following inclusion criteria were considered: tracheal intubation in adult critically ill patients; randomized controlled trial; study performed in Intensive Care Unit, Emergency Department or ordinary ward; and work published in the last 20 years. Exclusion criteria were pre-hospital or operating theatre settings and simulation-based studies. Two investigators selected studies for the final analysis. Extracted data included first author, publication year, characteristics of patients and clinical settings, intervention details, comparators and relevant outcomes. The risk of bias was assessed with the Cochrane Collaboration’s Risk of Bias tool. We identified 22 trials on use of a pre-procedure check-list (1 study), pre-oxygenation or apneic oxygenation (6 studies), sedatives (3 studies), neuromuscular blocking agents (1 study), patient positioning (1 study), video laryngoscopy (9 studies), and post-intubation lung recruitment (1 study). Pre-oxygenation with non-invasive ventilation (NIV) and/or high-flow nasal cannula (HFNC) showed a possible beneficial role. Post-intubation recruitment improved oxygenation, while ramped position increased the number of intubation attempts and thiopental had negative hemodynamic effects. No effect was found for use of a checklist, apneic oxygenation (on oxygenation and hemodynamics), videolaryngoscopy (on number and length of intubation attempts), sedatives and neuromuscular blockers (on hemodynamics). Finally, videolaryngoscopy was associated with severe adverse effects in multiple trials. The limited available evidence supports a beneficial role of pre-oxygenation with NIV and HFNC before intubation of critically ill patients. Recruitment maneuvers may increase post-intubation oxygenation. Ramped position increased the number of intubation attempts; thiopental had negative hemodynamic effects and videolaryngoscopy might favor adverse events. The online version of this article (doi:10.1186/s13054-017-1927-3) contains supplementary material, which is available to authorized users.
登录
查看更多内容
DOI：
10.1186/cc13776
发表时间：
2014-03-18
期刊：
Critical care (London, England)
影响因子：
--
作者：
De Jong A;Jung B;Jaber S
通讯作者：
Jaber S
DOI：
10.1164/rccm.200509-1507oc
发表时间：
2006-07-15
影响因子：
24.7
作者：
Baillard, Christophe;Fosse, Jean-Philippe;Jaber, Samir
通讯作者：
Jaber, Samir
影响因子：
120.7
作者：
Lascarrou, Jean Baptiste;Boisrame-Helms, Julie;Reignier, Jean
通讯作者：
Reignier, Jean
影响因子：
9.8
作者：
Lee, B. J.;Kang, J. M.;Kim, D. O.
通讯作者：
Kim, D. O.
影响因子：
6.7
作者：
Lebowitz, Philip W.;Shay, Hamilton;Bodner, Scott
通讯作者：
Bodner, Scott