Low Tidal Volume Ventilation for Emergency Department Patients: A Systematic Review and Meta-Analysis on Practice Patterns and Clinical Impact.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 06 2022
01 06 2022
Historique:
pubmed:
5
2
2022
medline:
28
5
2022
entrez:
4
2
2022
Statut:
ppublish
Résumé
Data suggest that low tidal volume ventilation (LTVV) initiated in the emergency department (ED) has a positive impact on outcome. This systematic review and meta-analysis quantify the impact of ED-based LTVV on outcomes and ventilator settings in the ED and ICU. We systematically reviewed MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, references, conferences, and ClinicalTrials.gov. Randomized and nonrandomized studies of mechanically ventilated ED adults were eligible. Two reviewers independently screened abstracts. The primary outcome was mortality. Secondary outcomes included ventilation duration, lengths of stay, and occurrence rate of acute respiratory distress syndrome (ARDS). We assessed impact of ED LTVV interventions on ED and ICU tidal volumes. The search identified 1,023 studies. Eleven studies (n = 12,912) provided outcome data and were meta-analyzed; 10 additional studies (n = 1,863) provided descriptive ED tidal volume data. Overall quality of evidence was low. Random effect meta-analytic models revealed that ED LTVV was associated with lower mortality (26.5%) versus non-LTVV (31.1%) (odds ratio, 0.80 [0.72-0.88]). ED LTVV was associated with shorter ICU (mean difference, -1.0; 95% CI, -1.7 to -0.3) and hospital (mean difference, -1.2; 95% CI, -2.3 to -0.1) lengths of stay, more ventilator-free days (mean difference, 1.4; 95% CI, 0.4-2.4), and lower occurrence rate (4.5% vs 8.3%) of ARDS (odds ratio, 0.57 [0.44-0.75]). ED LTVV interventions were associated with reductions in ED (-1.5-mL/kg predicted body weight [PBW] [-1.9 to -1.0]; p < 0.001) and ICU (-1.0-mL/kg PBW [-1.8 to -0.2]; p = 0.01) tidal volume. The use of LTVV in the ED is associated with improved clinical outcomes and increased use of lung protection, recognizing low quality of evidence in this domain. Interventions aimed at implementing and sustaining LTVV in the ED should be explored.
Identifiants
pubmed: 35120042
doi: 10.1097/CCM.0000000000005459
pii: 00003246-202206000-00009
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
986-998Subventions
Organisme : NHLBI NIH HHS
ID : R34 HL150404
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Dr. Fuller is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) under award number R34HL150404. Dr. Palmer’s institution received funding from the Barnes Jewish Foundation grant and Washington University Department of Anesthesia; he disclosed he is an Omnicure seed investor. Dr. Ablordeppey’s institution received funding from the National Heart, Lung, and Blood Institute. Dr. Fuller’s institution received funding from the National Institutes of Health NIH (R34HL150404); he received support for article research from the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Funders played no role in the following features of the study: study design, data collection, data management, data analysis, data interpretation, writing of the manuscript, or decision to submit the article for publication. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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