Utility and safety of draining pleural effusions in mechanically ventilated patients a systematic review and meta-analysis 英文参考文献.docVIP

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Utility and safety of draining pleural effusions in mechanically ventilated patients a systematic review and meta-analysis 英文参考文献.doc

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Utility and safety of draining pleural effusions in mechanically ventilated patients a systematic review and meta-analysis 英文参考文献

Goligheretal.CriticalCare2011,15:R46 /content/15/1/R46 RESEARCH OpenAccess Utilityandsafetyofdrainingpleuraleffusions inmechanicallyventilatedpatients:asystematic reviewandmeta-analysis EwanCGoligher1,2,JeromeALeis2,RobertAFowler3,RuxandraPinto3,NeillKJAdhikari3,NiallDFerguson1,4* Abstract Introduction:Pleuraleffusionsarefrequentlydrainedinmechanicallyventilatedpatientsbutthebenefitsandrisks ofthisprocedurearenotwellestablished. Methods:Weperformedaliteraturesearchofmultipledatabases(MEDLINE,EMBASE,HEALTHSTAR,CINAHL)upto April2010toidentifystudiesreportingclinicalorphysiologicaloutcomesofmechanicallyventilatedcriticallyill patientswhounderwentdrainageofpleuraleffusions.Studieswereadjudicatedforinclusionindependentlyandin duplicate.Dataondurationofventilationandotherclinicaloutcomes,oxygenationandlungmechanics,and adverseeventswereabstractedinduplicateindependently. Results:Nineteenobservationalstudies(N=1,124)metselectioncriteria.ThemeanPaO2:FiO2ratioimprovedby 18%(95%confidenceinterval(CI)5%to33%,I2=53.7%,fivestudiesincluding118patients)aftereffusion drainage.Reportedcomplicationrateswerelowforpneumothorax(20eventsin14studiesincluding965patients; pooledmean3.4%,95%CI1.7to6.5%,I2=52.5%)andhemothorax(4eventsin10studiesincluding721patients; pooledmean1.6%,95%CI0.8to3.3%,I2=0%).Theuseofultrasoundguidance(eitherreal-timeorforsite marking)wasnotassociatedwithastatisticallysignificantreductionintheriskofpneumothorax(OR=0.32;95% CI0.08to1.19).Studiesdidnotreportdurationofventilation,lengthofstayintheintensivecareunitorhospital, ormortality. Conclusions:Drainageofpleuraleffusionsinmechanicallyventilatedpatientsappearstoimproveoxygenation andissafe.Wefoundnodatatoeithersupportorrefuteclaimsofbeneficialeffectsonclinicallyimportant outcomessuchasdurationofventilationorlengthofstay. Introduction unclear [2]. Data from animal studies suggest that Pleuraleffusionsarecommoninthecriticallyill,occur- pleural effusions reduce respiratory system compliance ringinover60%ofpatie