Health technology assessment of non- drugs intervention for acute lung injury and ARDS_Chinese Journal of Evidence-Based Medicine

Authors：

ZOU Yan ¹² , LI Youping ¹³ , YANG Xiaodong ⁴ , LU Jun ² , DU Liang ² , CHEN Lin ²

1. Chinese Cochrane Center; West China Hospital; Sichuan University; Chengdu; 610041; China2. West China Medicine school; Sichuan University3. Key Lab of Transplant Engineering and Immunology （Ministry of Health; China）; West China Hospital; Sichuan University4. West China Hospital of Sichuan University;

Corresponding author：

Keywords：

ARDS; SARS; non-drugs interventions; mechanical ventilation; evidence based medicine; Health technology assessment

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Objectives 　About 12.9-50% patients of SARS (Severe Acute Respiratory Syndrome), require brief mechanical ventilation (MV) to save life. All the reported principles and guidelines for therapy SARS were based on experiences from clinical treatments and facts of inadequacy. Neither prospective randomized controlled trials (RCT) nor other high quality evidences were in dealing with SARS. Our objective is to seek safe and rational non-drugs interventions for patients with severe SARS by retrospectively reviewing clinical studies about MV all over the world, which include clinical guidelines, systematic reviews (SR), Meta-analysis, economic researches and adverse events.
Methods 　To search MEDLINE and Cochrane Library with computer. According to the standards of inclucion or exclusion, the quality of the article which as assessed, and relevant data which were extracted double checked. The Meta-analysis was conducted if the studies had no heterogeneity.
Results 　14 papers were eligible. Due to the significant heterogeneity between these studies, further Meta-analysis could not be conducted, and the authors’ conclusions were described only.
Conclusions 　The outcome of PPV is better than that of VPV. Patients who underwent PPV had a significantly lower mortality than that of VPV. Of course, the volutrauma should be watched. With low tidal volume and proper PEEP, or decreased FiO2, even permissive hypercapnia, the mortality and length of stay were cut down. Non-invasive mechanical ventilation (NIMV) was effective in treating haemodynamical stable patients, minimizing complications and reducing medical staff infection. Patients with serious dyspnea with PaO2/FiO2 lt;200, no profit of NIMV, or couldn’t tolerance hypoxaemia were unlikely to benefit from this technique and needed ventilation with endotracheal intubation. Prone position could improve PaO2/FiO2, NO maybe increased pulmonary perfusion, improved V/Q, and raised oxygenation. Furthermore, Inhaled NO sequentially (SQA) was better than Inhaled NO continuouly (CTA). Some studies implied that practice of protocol-directed weaning from mechanical ventilation implemented by nurses excelled that of traditional physician-directed weaning.

Citation： ZOU Yan,LI Youping,YANG Xiaodong,LU Jun,DU Liang,CHEN Lin. Health technology assessment of non- drugs intervention for acute lung injury and ARDS. Chinese Journal of Evidence-Based Medicine, 2003, 03(2): 128-134. doi: Copy

1.	［1］Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratorydistressinadults[J]. Lancet 1967 ;2(7511):319 23.1.
2.	［2］Freund A, Jorch G. Pediatric characteristics of adult respiratory dist ress syndrome: a meta - analysis [ J ]. Klin Padiat r 1993 Nov-Dec;205(6):411-5.
3.	［3］Bryan At. Cormments of a devil’s advocate [J ]. Am Rev Respir Dis. 1974;110: 143- 144.
4.	［4］Extracorporeal lung assist with heparin- coated systems. RossaintR, Slama K, Lewandowski K, Streich R, Henin P, Hopfe’I ,Barth H, Nienhaus M, Weidemann H, Lemmens P, et al [J ]. IntJ Artif Organs. 1992 Jan; 15( 1 ) :29 - 34.
5.	［5］Krafft P, Fridrich P, Pernerstorfer T, et al. The acute respiriratory distress syndrome: definitions, severity and clinical outcome.An analysis of 101 clinical investigations [J]. Intensive Care Med1996 Jun;22(6) :519 - 29.
6.	［6］Barrington KJ, Finer NN. Inhaled nitric oxide for respiratory fail ure in preterm infants(Cochrane Review). In: Cochrane Library. Issue 1. Oxford, Update Software; 2003.
7.	［7］Sokol J, Jacobs SE, Bohn D. Inhaled nitric oxide for acute hypoxemic respiratory failure in children and adults(Cochrane Review).In: Cochrane Library. Issue 1. Oxford, Update Software; 2003.
8.	［8］Cuthbertson BH, Dellinger P, Dyar OJ, et al. UK guidelines forthe use of inhaled nitric oxide therapy in adult ICUs. American European Consensus Conference on ALI/ARDS [J]. Intensive Care Med 1997 Dec;23(12):1212-8.
9.	［9］Mourgeon E, Gallart L, Rao GS, et al. Distribution of inhaled nitric oxide during sequential and continuous administration into the inspiratory limb of the ventilator [J]. Intensive Care Med 1997;23(8) :849 - 58.
10.	［10］Ball C, Adams J, Boyce S, et al. Clinical guidelines for the use ofthe prone position in acute respiratory distress syndrome [J]. Intensive Crit Care Nurs 2001 Apr; 17(2):94- 104.
11.	［11］Curley MA. Prone positioning of patients with acute respiratory distress syndrome: a systematic review [J ]. Am J Crit Care 1999 Nov;8(6) :397 - 405.
12.	［12］Steltzer H, Hiesmayr M, Mayer N, et al. The relationship be tween oxygen delivery and uptake in the critically ill: is there a critical or optimal therapeutic value? A meta- analysis [J].Anaesthesia 1994 Mar;49(3) :229-36.
13.	［13］Bidani A, Tzouanakis AE, Cardenas VJ Jr, et al. JB. Permissivehypercapnia in acute respiratory failure [J ]. JAMA 1994 Sep 28;272( 12):957 - 62.
14.	［14］Kollef MH, Shapiro SD, Silver P, et al. A randomized, con trolled trial of protocol - directed versus physician - directed weaning from mechanical ventilation [J]. Crit Care Med 1997Apr;25(4) :567 - 74.
15.	［15］Hamel MB, Phillips RS, Davis RB, et al. Outcomes and cost effectiveness of ventilator support and aggressive care for patients with acute respiratory failure due to pneumonia or acute respirato ry distress syndrome [ J ]. Am J Med 2000 Dec 1; 109 ( 8): 614 - 20.
16.	［16］Brook AD, Sherman G, Malen J, et al. Early versus late tra cheostomy in patients who require prolonged mechanical ventila tion [J]. Am J Crit Care 2000 Sep;9(5):352 -9.
17.	［17］Armstrong PA, McCarthy MC, Peoples JB. Reduced use of resources by early tracheostomy in ventilator-dependent patients with blunt trauma [J]. Surgery 1998 Oct; 124(4):763 - 6.
18.	［18］中国医学论坛报, 3003. 4. 24.
19.	［19］Rappaport SH, Shpiner R, Yoshihara G, Wright J, Chang P, Abraham E Randomized, prospective trial of pressure- limited versus volume-controlled ventilation in severe respiratory failure [J]. Crit Care Med. 1994; 22(11): 1888-9.
20.	［20］俞森洋.主编.现代机械通气的理论和实践[J].第一版.北京: 中国协和医科大学出版社,2000:854-65.
21.	［21］Pelosi P, Brazzi L, Gattinoni L. Prone position in acute respiratory distress syndrome [J]. Eur Respir J 2002;20(4):1017-28.
22.	［22］俞森洋.主编.现代机械通气的监护和临床应用[M]第一版北京:中国协和医科大学出版社,2000:420-31.
23.	［23］urchardi H, Sydow M. Artificial ventilation: some unresolvedproblems [J]. EurJ Anaesthesiol 1994 Jan;11(1):53-63.
24.	［24］So LK, Lau AC, Yam LY, Cheung TM, Poon E, Yung RW, Yuen KY. Development of a standard treatment protocol for severe acute respiratory syndrome [J]. Lancet 2003 10; 361 (9369):1615-7.
25.	［25］Booth CM, Matukas LM, Tomlinson GA, Clinical Features and Short-term Outcomes of 144 Patients With SARS in the Greater Toronto Area [J]. JAMA 2003 May 6.
26.	［26］Poutanen SM, Low DE, Henry B, Finkelstein S, et al. ldenlification of severe acute respiratory syndrome in Canada [J ]. N En gl J Med 2003 May 15;348(20):1995 - 2005.
27.	［27］Cheung MT, Yam LY, Lau CW, Ching CK, Lee CH. Use ofnon- invasive positive-pressure ventilation for acute respiratoryfailure: prospective study [J]. Hong Kong Med J 2000; 6(4):361-7.
28.	［28］28 S Krall SP, Zubrow MT, Silverman ME. uccess in using non - invasive mechanical ventilation is predicted by patient patho physiology. A retrospective review of 199 patients [J]. Del Med J. 1999; 71(5):213 -20.
29.	［29］Teba L, Marks P, Benzo R. Non - invasive mechanieal ventila tion: the benefits of the BiPAP system [J]. W V Med J. 1996;92(1):18- 21.
30.	［30］Mollica C, Brunetti G, Buseajoni M, et al. Non-invasive pressure support ventilation in acute hypoxemic (non hypercapnie) respiratory failure. Observations in Respiratory Intemediate In tensive Care Unit [J]. Minerva Anestesiol 2001 ; 67(3): 107-15.
31.	［31］Gregoretti C, Confalonieri M, Navalesi P, et al. Evaluation of patient skin breakdown and comfort with a new face mask fornon- invasive ventilation: a multi- center study [J]. Intensive Care Med. 2002;28(3) :278 - 84.
32.	［32］Khilnani GC, Bhatta N. Non- invasive ventilation: current status [J]. Natl Med J India 2002 Sep- Oct; 15(5):269-74.
33.	［33］Hoffman LA, Miro AM, Tasota FJ, Delgado E, Zullo TG, Lutz J, Pinsky MR. Tracheal gas insufflation, Limits of efficacy inadults with acute respiratory distress syndrome [J ]. Am J Respir Crit Care Med 2000 Aug; 162(2 Pt 1 ): 387 - 92.
34.	［34］Lewandowski K, Weimann J. Can lung protective ventilationmethods modify outcome [J ]? - A critical review Anaesthesiol Reanim 2002;27(5):124-30.
35.	［35］Houston P. An approach to ventilation in acute respiratory dis tress syndrome [J]. Can J Surg 2000 Aug;43(4):263-8.
36.	［36］Lee KH, Lim TK. Ventilatory strategies for acute respiratory distress syndrome [J]. Ann Acad Med Singapore 1998 May; 27(3) :409 - 13.

1. ［1］Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratorydistressinadults[J]. Lancet 1967 ;2(7511):319 23.1.
2. ［2］Freund A, Jorch G. Pediatric characteristics of adult respiratory dist ress syndrome: a meta - analysis [ J ]. Klin Padiat r 1993 Nov-Dec;205(6):411-5.
3. ［3］Bryan At. Cormments of a devil’s advocate [J ]. Am Rev Respir Dis. 1974;110: 143- 144.
4. ［4］Extracorporeal lung assist with heparin- coated systems. RossaintR, Slama K, Lewandowski K, Streich R, Henin P, Hopfe’I ,Barth H, Nienhaus M, Weidemann H, Lemmens P, et al [J ]. IntJ Artif Organs. 1992 Jan; 15( 1 ) :29 - 34.
5. ［5］Krafft P, Fridrich P, Pernerstorfer T, et al. The acute respiriratory distress syndrome: definitions, severity and clinical outcome.An analysis of 101 clinical investigations [J]. Intensive Care Med1996 Jun;22(6) :519 - 29.
6. ［6］Barrington KJ, Finer NN. Inhaled nitric oxide for respiratory fail ure in preterm infants(Cochrane Review). In: Cochrane Library. Issue 1. Oxford, Update Software; 2003.
7. ［7］Sokol J, Jacobs SE, Bohn D. Inhaled nitric oxide for acute hypoxemic respiratory failure in children and adults(Cochrane Review).In: Cochrane Library. Issue 1. Oxford, Update Software; 2003.
8. ［8］Cuthbertson BH, Dellinger P, Dyar OJ, et al. UK guidelines forthe use of inhaled nitric oxide therapy in adult ICUs. American European Consensus Conference on ALI/ARDS [J]. Intensive Care Med 1997 Dec;23(12):1212-8.
9. ［9］Mourgeon E, Gallart L, Rao GS, et al. Distribution of inhaled nitric oxide during sequential and continuous administration into the inspiratory limb of the ventilator [J]. Intensive Care Med 1997;23(8) :849 - 58.
10. ［10］Ball C, Adams J, Boyce S, et al. Clinical guidelines for the use ofthe prone position in acute respiratory distress syndrome [J]. Intensive Crit Care Nurs 2001 Apr; 17(2):94- 104.
11. ［11］Curley MA. Prone positioning of patients with acute respiratory distress syndrome: a systematic review [J ]. Am J Crit Care 1999 Nov;8(6) :397 - 405.
12. ［12］Steltzer H, Hiesmayr M, Mayer N, et al. The relationship be tween oxygen delivery and uptake in the critically ill: is there a critical or optimal therapeutic value? A meta- analysis [J].Anaesthesia 1994 Mar;49(3) :229-36.
13. ［13］Bidani A, Tzouanakis AE, Cardenas VJ Jr, et al. JB. Permissivehypercapnia in acute respiratory failure [J ]. JAMA 1994 Sep 28;272( 12):957 - 62.
14. ［14］Kollef MH, Shapiro SD, Silver P, et al. A randomized, con trolled trial of protocol - directed versus physician - directed weaning from mechanical ventilation [J]. Crit Care Med 1997Apr;25(4) :567 - 74.
15. ［15］Hamel MB, Phillips RS, Davis RB, et al. Outcomes and cost effectiveness of ventilator support and aggressive care for patients with acute respiratory failure due to pneumonia or acute respirato ry distress syndrome [ J ]. Am J Med 2000 Dec 1; 109 ( 8): 614 - 20.
16. ［16］Brook AD, Sherman G, Malen J, et al. Early versus late tra cheostomy in patients who require prolonged mechanical ventila tion [J]. Am J Crit Care 2000 Sep;9(5):352 -9.
17. ［17］Armstrong PA, McCarthy MC, Peoples JB. Reduced use of resources by early tracheostomy in ventilator-dependent patients with blunt trauma [J]. Surgery 1998 Oct; 124(4):763 - 6.
18. ［18］中国医学论坛报, 3003. 4. 24.
19. ［19］Rappaport SH, Shpiner R, Yoshihara G, Wright J, Chang P, Abraham E Randomized, prospective trial of pressure- limited versus volume-controlled ventilation in severe respiratory failure [J]. Crit Care Med. 1994; 22(11): 1888-9.
20. ［20］俞森洋.主编.现代机械通气的理论和实践[J].第一版.北京: 中国协和医科大学出版社,2000:854-65.
21. ［21］Pelosi P, Brazzi L, Gattinoni L. Prone position in acute respiratory distress syndrome [J]. Eur Respir J 2002;20(4):1017-28.
22. ［22］俞森洋.主编.现代机械通气的监护和临床应用[M]第一版北京:中国协和医科大学出版社,2000:420-31.
23. ［23］urchardi H, Sydow M. Artificial ventilation: some unresolvedproblems [J]. EurJ Anaesthesiol 1994 Jan;11(1):53-63.
24. ［24］So LK, Lau AC, Yam LY, Cheung TM, Poon E, Yung RW, Yuen KY. Development of a standard treatment protocol for severe acute respiratory syndrome [J]. Lancet 2003 10; 361 (9369):1615-7.
25. ［25］Booth CM, Matukas LM, Tomlinson GA, Clinical Features and Short-term Outcomes of 144 Patients With SARS in the Greater Toronto Area [J]. JAMA 2003 May 6.
26. ［26］Poutanen SM, Low DE, Henry B, Finkelstein S, et al. ldenlification of severe acute respiratory syndrome in Canada [J ]. N En gl J Med 2003 May 15;348(20):1995 - 2005.
27. ［27］Cheung MT, Yam LY, Lau CW, Ching CK, Lee CH. Use ofnon- invasive positive-pressure ventilation for acute respiratoryfailure: prospective study [J]. Hong Kong Med J 2000; 6(4):361-7.
28. ［28］28 S Krall SP, Zubrow MT, Silverman ME. uccess in using non - invasive mechanical ventilation is predicted by patient patho physiology. A retrospective review of 199 patients [J]. Del Med J. 1999; 71(5):213 -20.
29. ［29］Teba L, Marks P, Benzo R. Non - invasive mechanieal ventila tion: the benefits of the BiPAP system [J]. W V Med J. 1996;92(1):18- 21.
30. ［30］Mollica C, Brunetti G, Buseajoni M, et al. Non-invasive pressure support ventilation in acute hypoxemic (non hypercapnie) respiratory failure. Observations in Respiratory Intemediate In tensive Care Unit [J]. Minerva Anestesiol 2001 ; 67(3): 107-15.
31. ［31］Gregoretti C, Confalonieri M, Navalesi P, et al. Evaluation of patient skin breakdown and comfort with a new face mask fornon- invasive ventilation: a multi- center study [J]. Intensive Care Med. 2002;28(3) :278 - 84.
32. ［32］Khilnani GC, Bhatta N. Non- invasive ventilation: current status [J]. Natl Med J India 2002 Sep- Oct; 15(5):269-74.
33. ［33］Hoffman LA, Miro AM, Tasota FJ, Delgado E, Zullo TG, Lutz J, Pinsky MR. Tracheal gas insufflation, Limits of efficacy inadults with acute respiratory distress syndrome [J ]. Am J Respir Crit Care Med 2000 Aug; 162(2 Pt 1 ): 387 - 92.
34. ［34］Lewandowski K, Weimann J. Can lung protective ventilationmethods modify outcome [J ]? - A critical review Anaesthesiol Reanim 2002;27(5):124-30.
35. ［35］Houston P. An approach to ventilation in acute respiratory dis tress syndrome [J]. Can J Surg 2000 Aug;43(4):263-8.
36. ［36］Lee KH, Lim TK. Ventilatory strategies for acute respiratory distress syndrome [J]. Ann Acad Med Singapore 1998 May; 27(3) :409 - 13.

Chinese Journal of Evidence-Based Medicine

Health technology assessment of non- drugs intervention for acute lung injury and ARDS

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