Abstract
背景使用床边技术评估的临界病患者肌肉功能与临床结果的关系尚未得到系统描述。我们旨在评估床边评价和死亡率或从机械通气的死亡率评估的肌肉虚弱之间的关联,以及每种评估工具预测结果的能力。
方法从2000年1月到2018年12月,搜查了五个数据库(PubMed,Embase,Cinahl,Cochrane图书馆,科学直接)。提取数据并进行随机效应Meta分析。
Results分析了60项研究,包括4382名患者。重症监护单元(ICU) - 相关的肌肉弱点与总体死亡率的增加有关,几率比率范围为1.2(95%CI 0.60-2.40)至4.48(95%CI 1.49-13.42)。Transdiaphragmatic抽搐压力具有最高的预测能力,用于总体死亡率最高,灵敏度为0.87(95%CI 0.76-0.93),特异性为0.36(95%CI 0.27-0.43)。曲线(AUC)下的区域为0.74(95%CI 0.70-0.78)。肌肉弱点与机械通风断奶失效率的增加有关,其几率比率范围为2.64(95%CI 0.72-9.64)至19.07(95%CI 9.35-38.9)。隔膜增稠馏分具有最高的预测能力,可断奶敏感性为0.76(95%CI 0.67-0.83),特异性为0.86(95%CI 0.78-0.92)。AUC为0.86(95%CI 0.83-0.89)。
结论床边技术检测到的ICU相关的肌肉弱点是一种与死亡或长期机械通气的高风险相关的严重问题。评估隔膜功能应该是ICU中的临床优先级。
Abstract
评估隔膜功能的工具更好地预测ICU中的死亡率或断奶失败https://bit.ly/2vhc0wh.
脚注
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其他合作者:Naeem阿里,大学spital, Division of Pulmonary, Critical Care, and Sleep Medicine, Columbus, OH, USA, provided data and information for the conduct and analysis of the work; Cédric Carrié, Critical Care Department, Centre Hospitalier Robert Boulin, Libourne, France, provided data and information for the conduct and analysis of the work; Guillaume Cottereau, Physiotherapy and Rehabilitation Dept, Hôpital Antoine-Béclère, Clamart, France, provided data and information for the conduct and analysis of the work; Alexandre Demoule, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne Université, Paris, France, provided data and information for the conduct and analysis of the work and critical revision of the manuscript for important intellectual content; Martin Dres, Sorbonne University, Experimental and Clinical Neurophysiology, National Institute for Health and Medical Research (INSERM, UMRS-1158) the Pneumology and Intensive Care Dept, Pitie Salpetriere Hospital, Paris, France, provided data and information for the conduct and analysis of the work and critical revision of the manuscript for important intellectual content; Bruno Pierre Dubé, Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada, provided data and information for the conduct and analysis of the work and critical revision of the manuscript for important intellectual content; Ewan Goligher, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada, Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada and Toronto and General Hospital Research Institute, Toronto, ON, Canada, provided data and information for the conduct and analysis of the work; Greet Hermans, Dept of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium and Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium, provided data and information for the conduct and analysis of the work; Aliae Mohamed Hussein, Chest Dept, Faculty of Medicine, Assiut University, Assiut, Egypt, provided data and information for the conduct and analysis of the work; Savino Spadaro, Dept of Morphology, Experimental Medicine and Surgery, Section of Anaesthesia and Intensive Care, Arcispedale Sant’ Anna, University of Ferrara, Ferrara, Italy, provided data and information for the conduct and analysis of the work; Eva María Tenza-Lozano, Intensive Care Unit of the General University Hospital of Elche, Spain, provided data and information for the conduct and analysis of the work; Luuk Wieske, Dept of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands, provided data and information for the conduct and analysis of the work; Esther Witteveen, Dept of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers, Amsterdam, The Netherlands, provided data and information for the conduct and analysis of the work.
作者捐款:担保人:C. Medrinal;研究概念与设计:C. Medrinal,Y.Combret,G.Prieur,O. Contal和B. Lamia;收购数据:所有作者;汇总数据的分析与解释:C. Medrinal,Y.Combret,R.Hilfiker,G.Prieur,F-E。Gravier,T.Bonnevie,O.争论和B. Lamia;手稿的起草:C. Medrinal,Y.Combret,R.Hilfiker和G. Prieur;对重要知识分子内容的稿件的关键修订:所有作者;汇总数据的统计分析:R. Hilfiker。C. Medriginal完全访问了研究中的所有数据,并负责数据的完整性以及数据分析的准确性。
本研究登记为系统审查:Prospero 2019,CRD42019122081。可以从相应的作者获得元分析中包含的研究特定摘要数据。
利益冲突:C. Mediginal报告空中液化的个人费用,非财政支持来自阿迪尔援助,在提交的工作之外。
Conflict of interest: Y. Combret has nothing to disclose.
利益冲突:R. Hilfiker没有任何披露。
兴趣冲突:G. Prieur无需披露。
利益冲突:N. Arochane没有什么可披露的。
利益冲突:F-E。崇拜报告非财政支持在提交的工作之外与阿迪尔协会的会议出席。
Conflict of interest: T. Bonnevie reports non-financial support for meeting attendance from ADIR Association, outside the submitted work.
利益冲突:O.符合士没有披露。
兴趣冲突:B. Lamia报告从Novartis,Astrazeneca,Chiesi,Lowenstein和Elivie的赠款,来自Resporonics的非财政支持,在提交的工作之外。
- 收到2019年12月24日。
- 公认2020年4月22日。
- 版权所有©ers 2020