Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis

Guo, Lei; Wang, Weiwei; Zhao, Ning; Guo, Liang; Chi, Chao; Hou, Wei; Wu, Anqi; Tong, Hongshuang; Wang, Yue; Wang, Changsong; Li, Enyou

doi:10.1186/s13054-016-1396-0

Cited by 40 publications

(24 citation statements)

References 55 publications

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“…Most notably, IPFR is a used clinical predictor of H7N9 VI's outcome in the present study, though its diagnostic utility is disputed in clinical work. 26 In accordance with the present result, previous studies 27,28 have demonstrated that PFR is a very essential indicator to assess the acute lung injury or acute respiratory distress syndrome of a patient. As known, the oxygen transport is diffusion-limited from the alveolus to the pulmonary capillary in patients with pulmonary diseases (i.e., pulmonary fibrosis).…”

Section: Discussionsupporting

confidence: 91%

“…As known, the oxygen transport is diffusion-limited from the alveolus to the pulmonary capillary in patients with pulmonary diseases (i.e., pulmonary fibrosis). 29 Several reports [26][27][28][29] have shown that the PFR responds to an increase of diversion at a constant oxygen saturation by indicating poorer pulmonary function. Thus, it is reasonable to assume that the PFR may be used in clinical settings as an indicator of predicting pulmonary function status of patients with H7N9 VI.…”

Section: Discussionmentioning

confidence: 99%

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<p>Nomogram for the Individualized Prediction of Survival Among Patients with H7N9 Infection</p>

Cheng

Zhou

Zhao

et al. 2020

RMHP

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These authors contributed equally to this work Background: Until recently, almost all of these studies have identified multiple risk factors but did not offer practical instruments for routine use in predicting individualized survival in human H7N9 infection cases. The objective of this study is to create a practical instrument for use in predicting an individualized survival probability of H7N9 patients. Methods: A matched case-control study (1:2 ratios) was performed in Zhejiang Province between 2013 and 2019. We reviewed specific factors and outcomes regarding patients with H7N9 virus infection (VI) to determine relationships and developed a nomogram to calculate individualized survival probability. This tool was used to predict each individual patient's probability of survival based on results obtained from the multivariable Cox proportional hazard regression analysis. Results: We examined 227 patients with H7N9 VI enrolled in our study. Stepwise selection was applied to the data, which resulted in a final model with 8 independent predictors [including initial PaO 2 /FiO 2 ratio ≤300 mmHg, age ≥60 years, chronic diseases, poor hand hygiene, time from illness onset to the first medical visit, incubation period ≤5 days, peak C-reactive protein ≥120 mg/L], and initial bilateral lung infection. The concordance index of this nomogram was 0.802 [95% confidence interval (CI): 0.694-0.901] and 0.793 (95% CI: 0.611-0.952) for the training and validation sets, respectively, which indicates adequate discriminatory power. The calibration curves for the survival showed optimal agreement between nomogram prediction and actual observation in the training and validation sets, respectively. Conclusion: We established and validated a novel nomogram that can accurately predict the survival probability of patients with H7N9 VI. This nomogram can serve an important role in counseling patients with H7N9 VI and guide treatment decisions.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

<p>Nomogram for the Individualized Prediction of Survival Among Patients with H7N9 Infection</p>

Cheng

Zhou

Zhao

et al. 2020

RMHP

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“…A recent systematic review has drawn similar conclusions on the aspects around optimal ventilation [6].…”

mentioning

confidence: 55%

Introductory Overview: IATSIC Symposium, WJS

Hardcastle

2017

World j. surg.

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“…A number of interventions have been proposed in the past decade; however, few of them obtained strong recommendation [5,6]. Only lung-protective mechanical ventilation strategy has been proven beneficial for prognosis of these patients [5,7]. Neuromuscular blocking agents (NMBAs) may be a useful therapeutic strategy in patients with ARDS [8].…”

Section: Backgroundsmentioning

confidence: 99%

Neuromuscular blocking agents for acute respiratory distress syndrome: an updated meta-analysis of randomized controlled trials

et al. 2020

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Backgrounds:The aim of this study is investigating the benefits and harms of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS). Methods:We comprehensively searched PubMed, EMBASE, and Cochrane library for randomized controlled trials comparing NMBAs to any other comparator. We pooled data using relative risk (RR) for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes, with 95% confidence intervals. We assessed the quality of included studies using the Cochrane tool and levels of evidence using the GRADE method.Results: Finally, six RCTs (n = 1557 patients) were eligible for analysis. The results showed NMBAs use was not associated with reduced 28 days mortality (RR 0.78; 95% CI, 0.58 to 1.06; P = 0.11), 90 days mortality (RR, 0.92; 95% CI, 0.81 to 1.04; P = 0.16), and intensive care unit (ICU) mortality (RR, 0.90; 95% CI, 0.79 to 1.03; P = 0.13) in patients with ARDS. However, 21-28 days mortality was slightly lower in patients received NMBAs (RR 0.73; 95% CI, 0.54 to 0.99; P = 0.04; I 2 = 53%). Besides, NMBAs use could improve the PaO 2 /FiO 2 ratio at 48 and 72 h, decrease plateau pressure and PEEP at 72 h. Additionally, NMBAs had no significant effects on days free of ventilation at day 28 (WMD, 0.55; 95% CI, − 0.46 to 1.57; P = 0.29), days not in ICU at day 28 (WMD, 0.12; 95% CI, − 0.85 to 1.08; P = 0.82), ICU-acquired weakness (RR, 1.23; 95% CI, 0.99 to 1.93; P = 0.06). Finally, NMBAs use was associated with a lower risk of barotrauma (RR, 0.55; 95% CI, 0.35 to 0.85; P = 0.007). Conclusion:In patients with respiratory distress syndrome, NMBAs may be beneficial in reverse refractory hypoxemia and may be associated with reduced short-term mortality and incidence of barotrauma. However, there is no significant effects of NMBAs on mid-term and long-term mortality, and further studies are required.

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Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis

Cited by 40 publications

References 55 publications

<p>Nomogram for the Individualized Prediction of Survival Among Patients with H7N9 Infection</p>

<p>Nomogram for the Individualized Prediction of Survival Among Patients with H7N9 Infection</p>

Introductory Overview: IATSIC Symposium, WJS

Neuromuscular blocking agents for acute respiratory distress syndrome: an updated meta-analysis of randomized controlled trials

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