首页> 外文期刊>Anesthesia and Analgesia: Journal of the International Anesthesia Research Society >Inhaled nitric oxide for acute respiratory distress syndrome and acute lung injury in adults and children: a systematic review with meta-analysis and trial sequential analysis.
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Inhaled nitric oxide for acute respiratory distress syndrome and acute lung injury in adults and children: a systematic review with meta-analysis and trial sequential analysis.

机译:一氧化氮用于成人和儿童急性呼吸窘迫综合征和急性肺损伤:荟萃分析和试验序贯分析的系统评价。

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BACKGROUND: Acute hypoxemic respiratory failure, defined as acute lung injury and acute respiratory distress syndrome, are critical conditions associated with frequent mortality and morbidity in all ages. Inhaled nitric oxide (iNO) has been used to improve oxygenation, but its role remains controversial. We performed a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials (RCTs). We searched CENTRAL, Medline, Embase, International Web of Science, LILACS, the Chinese Biomedical Literature Database, and CINHAL (up to January 31, 2010). Additionally, we hand-searched reference lists, contacted authors and experts, and searched registers of ongoing trials. Two reviewers independently selected all parallel group RCTs comparing iNO with placebo or no intervention and extracted data related to study methods, interventions, outcomes, bias risk, and adverse events. All trials, irrespective of blinding or language status were included. Retrieved trials were evaluated with Cochrane methodology. Disagreements were resolved by discussion. Our primary outcome measure was all-cause mortality. We performed subgroup and sensitivity analyses to assess the effect of iNO in adults and children and on various clinical and physiological outcomes. We assessed the risk of bias through assessment of trial methodological components. We assessed the risk of random error by applying trial sequential analysis. RESULTS: We included 14 RCTs with a total of 1303 participants; 10 of these trials had a high risk of bias. iNO showed no statistically significant effect on overall mortality (40.2%versus 38.6%) (relative risks [RR] 1.06, 95% confidence interval [CI] 0.93 to 1.22; I(2) = 0) and in several subgroup and sensitivity analyses, indicating robust results. Limited data demonstrated a statistically insignificant effect of iNO on duration of ventilation, ventilator-free days, and length of stay in the intensive care unit and hospital. We found a statistically significant but transient improvement in oxygenation in the first 24 hours, expressed as the ratio of Po(2) to fraction of inspired oxygen (mean difference [MD] 15.91, 95% CI 8.25 to 23.56; I(2) = 25%). However, iNO appears to increase the risk of renal impairment among adults (RR 1.59, 95% CI 1.17 to 2.16; I(2) = 0) but not the risk of bleeding or methemoglobin or nitrogen dioxide formation. CONCLUSION: iNO cannot be recommended for patients with acute hypoxemic respiratory failure. iNO results in a transient improvement in oxygenation but does not reduce mortality and may be harmful.
机译:背景:急性低氧血症性呼吸衰竭被定义为急性肺损伤和急性呼吸窘迫综合征,是与所有年龄段的频繁死亡和发病相关的关键疾病。吸入一氧化氮(iNO)已用于改善氧合作用,但其作用仍存在争议。我们对荟萃分析和随机临床试验(RCT)的试验顺序分析进行了系统的审查。我们搜索了CENTRAL,Medline,Embase,International Web of Science,LILACS,中国生物医学文献数据库和CINHAL(截至2010年1月31日)。此外,我们手动搜索了参考文献列表,联系的作者和专家,并搜索了正在进行的试验的注册资料。两名评价者独立选择所有平行组RCT,将iNO与安慰剂或不进行干预进行比较,并提取与研究方法,干预措施,结果,偏倚风险和不良事件相关的数据。包括所有试验,无论盲目的或语言状态如何。检索的试验采用Cochrane方法进行评估。分歧通过讨论得到解决。我们的主要结局指标是全因死亡率。我们进行了亚组和敏感性分析,以评估iNO对成人和儿童以及各种临床和生理结果的影响。我们通过评估试验方法的组成部分来评估偏倚的风险。我们通过应用试验顺序分析评估了随机错误的风险。结果:我们纳入了14项RCT,共有1303名参与者。这些试验中有10个有偏见的高风险。 iNO对总体死亡率无统计学意义(40.2%对38.6%)(相对风险[RR] 1.06,95%置信区间[CI] 0.93至1.22; I(2)= 0),并且在几个亚组和敏感性分析中,表示稳健的结果。有限的数据表明,iNO对通气时间,无呼吸机天数以及在重症监护室和医院的住院时间的影响在统计学上不显着。我们发现在头24小时内,氧合在统计学上有显着但短暂的改善,表示为Po(2)与吸入氧气的比例(平均差[MD] 15.91,95%CI 8.25至23.56; I(2)= 25%)。但是,iNO似乎会增加成年人肾功能损害的风险(RR 1.59,95%CI 1.17至2.16; I(2)= 0),但不会增加出血,高铁血红蛋白或二氧化氮形成的风险。结论:急性低氧血症性呼吸衰竭患者不推荐使用iNO。 iNO可以暂时改善氧合作用,但不会降低死亡率,并且可能有害。

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