Pressure and Volume Limited Ventilation for the Ventilatory Management of Patients with Acute Lung Injury A Systematic Review and Meta-Analysis 英文参考文献.docVIP

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Pressure and Volume Limited Ventilation for the Ventilatory Management of Patients with Acute Lung Injury A Systematic Review and Meta-Analysis 英文参考文献.doc

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Pressure and Volume Limited Ventilation for the Ventilatory Management of Patients with Acute Lung Injury A Systematic Review and Meta-Analysis 英文参考文献

PressureandVolumeLimitedVentilationforthe VentilatoryManagementofPatientswithAcuteLung Injury:ASystematicReviewandMeta-Analysis KarenE.A.Burns1,2*,NeillK.J.Adhikari1,3,ArthurS.Slutsky1,2,GordonH.Guyatt4,JesusVillar2,5,6, HaiboZhang1,2,QiZhou4,DeborahJ.Cook4,ThomasE.Stewart1,MaureenO.Meade4 1InterdepartmentalDivisionofCriticalCare,UniversityofToronto,Toronto,Canada,2KeenanResearchCentreandLiKaShingKnowledgeInstitute,St.Michael’sHospital, Toronto, Canada, 3Department of Critical Care Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada, 4Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada, 5CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain, 6ResearchUnit,HospitalUniversitarioDr.Negrin,LasPalmasdeGranCanaria,Spain Abstract Background:Acutelunginjury(ALI)andacuterespiratorydistresssyndrome(ARDS)arelifethreateningclinicalconditions seenincriticallyillpatientswithdiverseunderlyingillnesses.Lunginjurymaybeperpetuatedbyventilationstrategiesthat do not limit lung volumes and airway pressures. We conducted a systematic review and meta-analysis of randomized controlledtrials(RCTs)comparingpressureandvolume-limited(PVL)ventilationstrategieswithmoretraditionalmechanical ventilationinadultswithALIandARDS. Methods and Findings: We searched Medline, EMBASE, HEALTHSTAR and CENTRAL, related articles on PubMedTM , conference proceedings and bibliographies of identified articles for randomized trials comparing PVL ventilation with traditionalapproachestoventilationincriticallyilladultswithALIandARDS.Tworeviewersindependentlyselectedtrials, assessedtrialquality,andabstracteddata.Weidentifiedtentrials(n=1,749)meetingstudyinclusioncriteria.Tidalvolumes achievedincontrolgroupswereatthelowerendofthetraditionalrangeof10–15mL/kg.Wefoundaclinicallyimportant but borderline statistically significant reduction in hospital mortality with PVL [relative risk (RR) 0.84; 95% CI 0.70, 1.