OBJECTIVES: 

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.

DATA SOURCES: 

We systematically reviewed MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, references, conferences, and ClinicalTrials.gov.

STUDY SELECTION: 

Randomized and nonrandomized studies of mechanically ventilated ED adults were eligible.

DATA EXTRACTION: 

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.

DATA SYNTHESIS: 

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.

CONCLUSIONS: 

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.

中文翻译：

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急诊科患者的小潮气量通气：对实践模式和临床影响的系统回顾和荟萃分析*

目标： 

数据表明，急诊科 (ED) 启动的低潮气量通气 (LTVV) 对结果具有积极影响。这项系统回顾和荟萃分析量化了基于 ED 的 LTVV 对 ED 和 ICU 的结果和呼吸机设置的影响。

数据源： 

我们系统地回顾了 MEDLINE、EMBASE、Scopus、Cochrane 对照试验中央注册库、Cochrane 系统评价数据库、参考文献、会议和ClinicalTrials.gov。

研究选择： 

对接受机械通气的 ED 成人进行的随机和非随机研究均符合条件。

数据提取： 

两位审稿人独立筛选摘要。主要结局是死亡率。次要结局包括通气持续时间、住院时间和急性呼吸窘迫综合征（ARDS）的发生率。我们评估了 ED LTVV 干预对 ED 和 ICU 潮气量的影响。

数据综合： 

检索发现了 1,023 项研究。十一项研究 ( n = 12,912) 提供了结果数据并进行了荟萃分析；另外 10 项研究 ( n = 1,863) 提供了描述性 ED 潮气量数据。证据的总体质量较低。随机效应荟萃分析模型显示，与非 LTVV (31.1%) 相比，ED LTVV 与较低的死亡率 (26.5%) 相关（比值比，0.80 [0.72–0.88]）。ED LTVV 与较短的 ICU（平均差，-1.0；95% CI，-1.7 至 -0.3）和医院（平均差，-1.2；95% CI，-2.3 至 -0.1）住院时间、更多的呼吸机相关。空闲天数（平均差，1.4；95% CI，0.4–2.4），ARDS 发生率较低（4.5% vs 8.3%）（比值比，0.57 [0.44–0.75]）。ED LTVV 干预与 ED（-1.5 mL/kg 预测体重 [PBW] [-1.9 至 -1.0]； p < 0.001）和 ICU（-1.0 mL/kg PBW [-1.8 至 -0.2]）的减少相关]；p = 0.01）潮气量。

结论： 

在急诊室中使用 LTVV 与改善临床结果和增加肺保护的使用有关，认识到该领域的证据质量较低。应探索旨在在急诊科实施和维持 LTVV 的干预措施。