INTENSIV-News
Effect of noninvasive positive pressure ventilation on mortality
in patients admitted with acute respiratory failure: A meta-analysis
Sean P. Keenan, Philip D. Kernerman, Deborah J. Cook et al. Crit Care Med 1997; 25:1685-1692
OBJECTIVE:
To critically appraise and summarize the trials examining the addition
of noninvasive positive pressure ventilation to standard therapy on
hospital mortality and need for endotracheal intubation in patients
admitted with acute respiratory failure.
DATA SOURCES: We searched
MEDLINE (1966 to September 1995) and key references were searched
forward using the Scientific Citation Index (SCISEARCH). Bibliographies
of all selected articles and review were examined. Authors of all
selected articles and review articles were examined. Authors of all
selected and review articles were contacted by letter to identify
unpublished work.
STUDY SELECTION: a) Population: patients with acute
respiratory failure; b) intervention: noninvasive positive pressure
ventilation; c) outcome; mortality and/or endotracheal intubation; and
d) design: randomized, controlled study. Two of us independently
selected the articles for inclusion; disagreements were settled by
consensus. Seven (three unpublished) of 212 initially identified studies
were selected.
DATA EXTRACTION: Two authors independently extracted data and evaluated methodologic quality of the studies.
DATA
SYNTHESIS: Noninvasive positive pressure ventilation was associated
with decreased mortality (odds ratio = 0.29; 95% confidence interval
0.15 to 0.59) and a decreased need for endotracheal intubation (odds
ratio = 0.20; 95% confidence interval 0.11 to 0.36).Sensitivity analysis
suggested a greater benefit of noninvasive positive pressure
ventilation in patients with chronic obstructive pulmonary disease
(COPD). The inclusion/ exclusion of unpublished trials did not influence
these results.
CONCLUSIONS: The addition of noninvasive positive
pressure ventilation to standard therapy in patients with acute
respiratory failure improves survival and decreases the need for
endotracheal intubation. However, this effect is restricted to patients
whose cause of acute respiratory failure is an exacerbation of COPD.
Further research is warranted to determine whether noninvasive positive
pressure ventilation confers benefit in patients without COPD who have
acute respiratory failure.
Der niedrigere Invasivitätsgrad einer positiven Druckbeatmung über eine Nasen- oder Gesichtsmaske resultiert aus der Vermeidung von Folgeschäden der endotrachealen Intubation an Glottis und Trachea und dem verringerten Risiko nosokomialer Infektionen wie ventilatorassoziierte Pneumonie und Sinusitis. Bei Beachtung von Kontraindikationen wie Koma, unkooperative Patienten, hämodynamische Instabilität, schwere gastrointestinale Blutungen, Zustand nach Oberbaucheingriffen bietet diese Form der Beatmung mehrere Vorteile. Sie kann intermittierend durchgeführt werden, die Nahrungsaufnahme, Sprechen und Schlucken des Patienten sind gewährleistet, der Hustenmechanismus bleibt aufrecht, der Weaningprozeß wird vereinfacht und letztlich bleibt, wenn notwendig, die Möglichkeit der endotrachealen Intubation bestehen.
Melden Sie sich an um weiter zu lesen ...
Tags: intensiv-news pneumologie pneumonie niv non-invasiv beatmung ards lungenversagen
Wir wollen Fachärzte und Pfleger topaktuell und wissenschaftlich fundiert über Studien, fachspezifische Entwicklungen und deren praktische Umsetzung informieren, um sie in ihrer Arbeit und Fortbildung zu unterstützen.
Wählen Sie dazu bitte Ihr Land aus.