RESUMO
AIM: To investigate the efficacy and safety of ulinastatin for patients with acute lung injury (ALI) and those with acute respiratory distress syndrome (ARDS). METHODS: A systematic review of randomized controlled trials (RCTs) of ulinastatin for ALI/ARDS was conducted. Oxygenation index, mortality rate [intensive care unit (ICU) mortality rate, 28-d mortality rate] and length of ICU stay were compared between ulinastatin group and conventional therapy group. Meta-analysis was performed by using Rev Man 5.1. RESULTS: Twenty-nine RCTs with 1726 participants were totally included, the basic conditions of which were similar. No studies discussed adverse effect. Oxygenation index was reported in twenty-six studies (1552 patients). Ulinastatin had a significant effect in improving oxygenation [standard mean difference (SMD) = 1.85, 95%CI: 1.42-2.29, P < 0.00001, I(2) = 92%]. ICU mortality and 28-d mortality were respectively reported in eighteen studies (987 patients) and three studies (196 patients). We found that ulinastatin significantly decreased the ICU mortality [I(2) = 0%, RR = 0.48, 95%CI: 0.38-0.59, number needed to treat (NNT) = 5.06, P < 0.00001], while the 28-d mortality was not significantly affected (I(2) = 0%, RR = 0.78, 95%CI: 0.51-1.19, NNT = 12.66, P = 0.24). The length of ICU stay (six studies, 364 patients) in the ulinastatin group was significantly lower than that in the control group (SMD = -0.97, 95%CI: -1.20--0.75, P < 0.00001, I(2) = 86%). CONCLUSION: Ulinastatin seems to be effective for ALI and ARDS though most trials included were of poor quality and no information on safety was provided.
RESUMO
OBJECTIVE: To systemically analyze the effect of 45 degree angle semirecumbent position on the incidence of ventilator-associated pneumonia (VAP) and other outcomes in mechanical ventilated patients, and to evaluate whether 45 degree angle semirecumbent position is superior to 25 degree angle-30 degree angle head of bed (HOB). METHODS: The randomized controlled trials (RCTs) comparing the effect of different HOB on the outcomes of mechanical ventilated patients were searched (from 1st January 1990 to 20th July 2012) from five databases including the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, China Knowledge Resource Integrated Database (CNKI), and Wanfang Database. Meta analysis was conducted using RevMan 5.0 software. RESULTS: Data extracted from five RCTs with a total of 427 patients were analyzed. The risks of developing clinically diagnosed VAP were significantly lower among the patients in semirecumbent 45 degree angle position compared to the patients in lower position [15.96% (34/213) vs. 26.64% (57/214), relative risk (RR)=0.57, 95% confidence interval (95%CI) 0.39 to 0.83, P=0.003], while no significant differences were detected between the two groups regarding the mortality rate [27.04% (53/196) vs. 28.22% (57/202), RR=0.93, 95%CI 0.68 to 1.27, P=0.66], the length of intensive care unit (ICU) stay [weighted mean difference (WMD)=-0.45, 95%CI -1.08 to 0.18, P=0.16] and the percentage of antibiotics treatment [71.11% (32/45) vs. 60.87% (28/46), RR=1.14, 95%CI 0.85 to 1.53, P=0.37]. Two of the five trials (91 patients) were included in the sub-analysis between 45 degree angle group (45 patients) and 25 degree angle-30 degree angle group (46 patients). The results showed that comparing with 25 degree angle-30 degree angle, 45 degree angle semirecumbent position had no significance in improving patients' clinical outcomes. CONCLUSION: This study proved that the clinically preferred semirecumbent 45 degree angle position did have effect in reducing the incidence of VAP, nevertheless, whether it's superior to 25 degree angle-30 degree angle needs to be confirmed by larger-scale, higher-quality RCTs.
