择期手术后患者常规无创呼吸支持与肺炎的关系：随机试验的系统回顾和Meta分析

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择期手术后患者常规无创呼吸支持与肺炎的关系

：随机试验的系统回顾和Meta分析

贵州医科大学  麻醉与心脏电生理课题组

翻译：胡廷菊   编辑：张中伟   审校：曹莹

  01   背景

包括肺炎在内的术后并发症是术后一系列并发症的原因。我们假设常规无创呼吸支持与术后较低的肺炎发生率有关。

  02   方法

我们比较常规使用持续气道正压通气(CPAP)，无创通气（NIV），高流量鼻导管通气（HFNO）与标准成人术后护理的随机对照试验的系统回顾和meta分析。搜索截止到2021年7月MEDLINE (PubMed)， EMBASE和CENTRAL数据库的文献。审阅文章，数据备份，并由一名资深的研究员解决差异问题。主要结果为肺炎，次要结果为术后肺部并发症。我们使用DerSimonian和Laird随机效应模型计算95%置信区间的风险差。使用Cochrane偏倚风险工具评估偏倚风险。

  03   结果

在18513项记录中，我们纳入了包含9782个患者的38项试验。接受无创呼吸支持的病人与接受标准护理的病人相比较肺炎发生率分别为4.9%和5.5%（RD-0.01，95%CI为-0.02到0.00；I2=8%; P=0.23）。接受无创呼吸支持的病人与接受标准护理的病人相比较术后并发症发生率分别为28%和31%（RD-0.11，95%CI为-0.23到0.01；I2=79%; P=0.07）。亚组分析显示持续气道正压通气(CPAP)，无创通气（NIV），高流量鼻导管通气（HFNO）对于预防肺炎的发生没有优势。发表偏倚显示有6项未报道的试验。

  0 4 结论

这项综合证据不支持术后常规使用持续气道正压通气(CPAP)，无创通气（NIV），高流量鼻导管通气（HFNO）来预防成人术后肺炎。

  0 5 原始文献来源

Sara Hui , Alexander J. Fowler,Richard M. J. Cashmore ,et al. Routine postoperative noninvasive respiratory support and pneumonia after elective surgery: a systematic review and meta analysis of randomised trials. [J] Br J Anaesth. 2022 Feb;128(2):363-374. doi: 10.1016/j.bja.2021.10.047. Epub 2021 Dec 13.

英文原文    

Routine postoperative noninvasive respiratory support and pneumonia after elective surgery: a systematic review and Meta analysis of randomised trials

Abstract

Background: Postoperative pulmonary complications, including pneumonia, are a substantial cause of morbidity. We hypothesised that routine noninvasive respiratory support was associated with a lower incidence of pneumonia after surgery.

Method:Systematic review and meta-analysis of RCTs comparing the routine use of continuous positive airway pressure (CPAP), noninvasive ventilation (NIV), or high-flow nasal oxygen (HFNO) against standard postoperative care in the adult population. We searched MEDLINE (PubMed), EMBASE, and CENTRAL from the start of indexing to July 27, 2021. Articles were reviewed and data extracted in duplicate, with discrepancies resolved by a senior investigator. The primary outcome was pneumonia, and the secondary outcome was postoperative pulmonary complications. We calculated risk

difference (RD) with 95% confidence intervals using DerSimonian and Laird random effects models. We assessed risk of bias using the Cochrane risk of bias tool.

Results:From 18 513 records, we included 38 trials consisting of 9782 patients. Pneumonia occurred in 214/4403 (4.9%) patients receiving noninvasive respiratory support compared with 216/3937 (5.5%) receiving standard care (RD-0.01 [95% confidence interval:-0.02 to 0.00]; I2=8%; P=0.23). Postoperative pulmonary complications occurred in 393/1379 (28%)

patients receiving noninvasive respiratory support compared with 280/902 (31%) receiving standard care (RD-0.11 [-0.23 to 0.01]; I2=79%; P=0.07). Subgroup analyses did not identify a benefit of CPAP, NIV, or HFNO in preventing pneumonia. Tests for publication bias suggest six unreported trials.

Conclusion:The results of this evidence synthesis do not support the routine use of postoperative CPAP, NIV, or HFNO to prevent pneumonia after surgery in adults.

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