Partial liquid ventilation for preventing death and morbidity in adults with acute lung injury and acute respiratory distress syndrome

摘要: Background: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are syndromes of severe failure that associated with substantial mortality morbidity. Artifical ventilatory support is commonly required may exacerbate injury. Partial liquid ventilation (PLV) has been proposed as a less injurious form for these patients. Although PLV shown to improve gas exchange reduce inflammation in experimental models ALI, previous systematic review did not find any evidence or refute its use humans ALI ARDS. Objectives: The primary objective this was assess whether reduced (at 28 d, at discharge from the intensive care unit (ICU), hospital one, two five years) adults ARDS when compared conventional support. Secondary objectives were determine how regard duration invasive mechanical ventilation, support, oxygen therapy, length ICU stay, incidence infection, long-term cognitive impairment, health related quality life, long- term function, morbidity costs adverse events. following events considered: hypoxia (arterial PO <80 mm Hg), pneumothorax (any air leak into pleural space requiring therapeutic intervention), hypotension (systolic blood pressure < 90 Hg sustained longer than minutes treatment fluids vasoactive drugs), bradycardia (heart rate 50 beats per minute one intervention) cardiac arrest (absence effective output). Search methods: In updated review, we searched Cochrane Central Register Controlled Trials (CENTRAL Issue 10, 2012, Library; MEDLINE (Ovid SP, 1966 November 2012); EMBASE 1980 2012) CINAHL (EBSCOhost,1982 published studies. our original until May 2004. Grey literature identified by searching conference proceedings trial registries contacting experts field. Selection criteria: As authors selected randomized controlled trials other forms (16 y age older) ARDS, reporting more following: mortality; stay hospital; infection; impairment health-related life; function cost. Data collection analysis: Two independently evaluated relevant studies extracted data included Main results: new eligible study included, yielding total (including combined 401 participants). Of those participants, 170 received 'high'-dose partial (i.e. mean dose least 20 mL/kg), 99 'low-dose' 10 mL/kg) 132 (CMV). Pooled estimates effect calculated all who versus ventilation. No indicated either d (risk ratio (RR) 1.21, 95% confidence interval (CI) 0.79 1.85, P = 0.37) increased number days free CMV (mean difference (MD) -2.24, CI -4.71 0.23, 0.08). pooled estimate significantly greater (RR 2.51, 1.31 4.81, 0.005). events-hypoxia, pneumothorax, arrest- showed nonsignificant trend towards higher occurrence treated PLV. Because neither addressed beyond it possible on outcomes. Authors' conclusions: supports ARDS; some suggests an risk use.