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Cochrane Database of Systematic Reviews

Presión extratorácica negativa continua o presión positiva continua en las vías respiratorias en comparación con la asistencia respiratoria convencional para la insuficiencia respiratoria hipoxémica aguda en niños

Información

DOI:
https://doi.org/10.1002/14651858.CD003699.pub4Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 04 noviembre 2013see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Infecciones respiratorias agudas

Copyright:
  1. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Prakeshkumar S Shah

    Correspondencia a: Department of Paediatrics and Health Policy, Management and Evaluation, University of Toronto Mount Sinai Hospital, Toronto, Canada

    [email protected]

  • Arne Ohlsson

    Departments of Paediatrics, Obstetrics and Gynaecology and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

  • Jyotsna P Shah

    Department of Paediatrics, Mount Sinai Hospital, Markham, Canada

Contributions of authors

Dr. P Shah (PS) was responsible for the literature search and identification of trials, evaluation of methodological quality of trials, verification of data and entry into RevMan 2012, and writing the text of the review.
Dr. A Ohlsson (AO) was responsible for the literature search and identification of trials, evaluation of methodological quality of trials, verification of data and revision of the review.
Dr. J Shah (JS) reviewed the identified studies, acted as arbitrator in the case of disagreement, edited the review and verified data entry.

Sources of support

Internal sources

  • Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada.

External sources

  • No sources of support supplied

Declarations of interest

None known.

Acknowledgements

The authors are sincerely grateful to Dr Edmund Hey for providing feedback on the initial draft of this review. The authors wish to thank Chris Del Mar, Nelcy Rodriguez, Edmund Hey and Marilyn Oates for commenting on the 2005 updated review and Hayley Edmonds, Anne Greenough, Max Bulsara and Nick Matheson for commenting on the 2007 updated review. Finally, we wish to thank the following for commenting on this 2011 update: Lisa Banirian, Anne Greenough, Mark Jones and Carl Heneghan.

Version history

Published

Title

Stage

Authors

Version

2013 Nov 04

Continuous negative extrathoracic pressure or continuous positive airway pressure compared to conventional ventilation for acute hypoxaemic respiratory failure in children

Review

Prakeshkumar S Shah, Arne Ohlsson, Jyotsna P Shah

https://doi.org/10.1002/14651858.CD003699.pub4

2008 Jan 23

Continuous negative extrathoracic pressure or continuous positive airway pressure compared to conventional ventilation for acute hypoxaemic respiratory failure in children

Review

Prakeshkumar S Shah, Arne Ohlsson, Jyotsna P Shah

https://doi.org/10.1002/14651858.CD003699.pub3

2005 Jul 20

Continuous negative extrathoracic pressure or continuous positive airway pressure for acute hypoxemic respiratory failure in children

Review

Prakeshkumar S Shah, Arne Ohlsson, Jyotsna P Shah

https://doi.org/10.1002/14651858.CD003699.pub2

2003 Jul 21

Continuous negative extrathoracic pressure or continuous positive airway pressure for acute hypoxemic respiratory failure in children

Review

Prakeshkumar S Shah, Arne Ohlsson, Jyotsna P Shah

https://doi.org/10.1002/14651858.CD003699

Differences between protocol and review

None.

Notes

The review title was changed slightly in 2011 from 'Continuous negative extrathoracic pressure or continuous positive airway pressure for acute hypoxaemic respiratory failure in children' to 'Continuous negative extrathoracic pressure or continuous positive airway pressure compared to conventional ventilation for acute hypoxaemic respiratory failure in children' to clarify the treatment comparisons.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans; Infant; Infant, Newborn;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Oxygen requirement, Outcome 1 Less than 30% FiO2 after one hour of therapy.
Figuras y tablas -
Analysis 1.1

Comparison 1 Oxygen requirement, Outcome 1 Less than 30% FiO2 after one hour of therapy.

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Comparison 2 Need for assisted ventilation (intermittent positive pressure ventilation or CPAP), Outcome 1 Intermittent positive pressure ventilation during hospital stay.
Figuras y tablas -
Analysis 2.1

Comparison 2 Need for assisted ventilation (intermittent positive pressure ventilation or CPAP), Outcome 1 Intermittent positive pressure ventilation during hospital stay.

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Comparison 2 Need for assisted ventilation (intermittent positive pressure ventilation or CPAP), Outcome 2 CPAP during hospital stay.
Figuras y tablas -
Analysis 2.2

Comparison 2 Need for assisted ventilation (intermittent positive pressure ventilation or CPAP), Outcome 2 CPAP during hospital stay.

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Summary of findings for the main comparison. Continuous negative extrathoracic pressure ventilation compared with control for acute hypoxaemic respiratory failure in children

Continuous negative extrathoracic pressure ventilation compared with control for acute hypoxaemic respiratory failure in children

Patient or population: children with acute hypoxaemic respiratory failure

Settings: hospital

Intervention: continuous negative extrathoracic pressure

Comparison: control

Outcomes

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Less than 30% FiO2 after 1 hour of therapy

RR 10.69 (0.62 to 183.85)

33 (1)

⊕⊝⊝⊝
very low 1,2

Intermittent positive pressure ventilation during hospital stay

RR 0.40 (0.02 to 9.06)

33 (1)

⊕⊝⊝⊝
very low 1,3

CPAP during hospital stay

RR 0.40 (0.02 to 9.06)

33 (1)

⊕⊝⊝⊝
very low 1,3

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

CPAP = continuous positive extrathoracic pressure
FiO2 = fraction of inspired oxygen
RR = randomised controlled trial

1 = Very wide confidence intervals

2= The outcome is only reported after one hour of treatment which is a very short period for any clinically meaningful assessment

3= Limitation in study design as the results are reported in an abstract and it was not possible to assess the study adequately (see assessment of risk of biases)

Figuras y tablas -
Summary of findings for the main comparison. Continuous negative extrathoracic pressure ventilation compared with control for acute hypoxaemic respiratory failure in children
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Comparison 1. Oxygen requirement

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Less than 30% FiO2 after one hour of therapy Show forest plot

1

33

Risk Ratio (M‐H, Fixed, 95% CI)

10.69 [0.62, 183.85]
Figuras y tablas -
Comparison 1. Oxygen requirement
Ir a la tabla de la revisión
Comparison 2. Need for assisted ventilation (intermittent positive pressure ventilation or CPAP)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Intermittent positive pressure ventilation during hospital stay Show forest plot

1

33

Risk Ratio (M‐H, Fixed, 95% CI)

0.40 [0.02, 9.06]

2 CPAP during hospital stay Show forest plot

1

33

Risk Ratio (M‐H, Fixed, 95% CI)

0.40 [0.02, 9.06]
Figuras y tablas -
Comparison 2. Need for assisted ventilation (intermittent positive pressure ventilation or CPAP)
Ir a la tabla de la revisión