Bibliographie de Médecine d'Urgence

Mois d'avril 2017


Can High-flow Nasal Cannula Reduce the Rate of Endotracheal Intubation in Adult Patients With Acute Respiratory Failure Compared With Conventional Oxygen Therapy and Noninvasive Positive Pressure Ventilation?: A Systematic Review and Meta-analysis.
Ni YN , Luo J, Yu H, Liu D, Ni Z, Cheng J, Liang BM, Liang ZA. | Chest. 2017 Apr;151(4):764-775
Keywords: acute respiratory failure; endotracheal intubation; high-flow nasal cannula; meta-analysis; prognosis

Original article

Introduction : The effects of high-flow nasal cannula (HFNC) on adult patients with acute respiratory failure (ARF) are controversial. We aimed to further determine the effectiveness of HFNC in reducing the rate of endotracheal intubation in adult patients with ARF by comparison to noninvasive positive pressure ventilation (NIPPV) and conventional oxygen therapy (COT).

Méthode : The PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials databases, as well as the Information Sciences Institute Web of Science, were searched for all controlled studies that compared HFNC with NIPPV and COT in adult patients with ARF. The primary outcome was the rate of endotracheal intubation; the secondary outcomes were ICU mortality and length of ICU stay.

Résultats : Eighteen trials with a total of 3,881 patients were pooled in our final studies. Except for ICU mortality (I2 = 67%, χ2 = 12.21, P = .02) and rate of endotracheal intubation (I2 = 63%, χ2 = 13.51, P = .02) between HFNC and NIPPV, no significant heterogeneity was found in outcome measures. Compared with COT, HFNC was associated with a lower rate of endotracheal intubation (z = 2.55, P = .01) while no significant difference was found in the comparison with NIPPV (z = 1.40, P = .16). As for ICU mortality and length of ICU stay, HFNC did not exhibit any advantage over either COT or NIPPV.

Conclusion : In patients with ARF, HFNC is a more reliable alternative than NIPPV to reduce the rate of endotracheal intubation than COT.

Conclusion (proposition de traduction) : Chez les patients en détresse respiratoire aiguë, l'HFNC est une alternative plus fiable que la VNI pour réduire le taux d'intubation endotrachéale par rapport à l'oxygénothérapie conventionnelle.

Public Library of Science One

Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta- Analysis.
Freedman SB , Pasichnyk D, Black KJL, Fitzpatrick E, Gouin S, Milne A, Hartling L; Pediatric Emergency Research Canada Gastroenteritis Study Group. | PLoS One. 2017 Apr 26;12(4):e0176741
DOI:  | Télécharger l'article au format  
Keywords: Aucun

Research article

Introduction : Gastroenteritis remains a leading cause of childhood morbidity.
Objective: Because prior reviews have focused on isolated symptoms and studies conducted in devel- oping countries, this study focused on interventions commonly considered for use in devel- oped countries. Intervention specific, patient-centered outcomes were selected.

Méthode : Data Sources: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, trial registries, grey literature, and scientific meetings.
Study Selection: Randomized controlled trials, conducted in developed countries, of children aged <18 years, with gastroenteritis, performed in emergency department or outpatient settings which evaluated oral rehydration therapy (ORT), antiemetics, probiotics or intravenous fluid administration rate.
Data Extraction: The study was conducted in accordance with the Cochrane Handbook for Systematic Re- views of Interventions and the PRISMA guidelines. Data were independently extracted by multiple investigators. Analyses employed random effects models.

Résultats : 31 trials (4,444 patients) were included. ORT: Compared with intravenous rehydration, hos- pitalization (RR 0.80, 95%CI 0.24, 2.71) and emergency department return visits (RR 0.86, 95%CI 0.39, 1.89) were similar. Antiemetics: Fewer children administered an antiemetic re- quired intravenous rehydration (RR 0.40, 95%CI 0.26, 0.60) While the data could not be meta-analyzed, three studies reported that ondansetron administration does increase the frequency of diarrhea. Probiotics: No studies reported on the primary outcome, three stud- ies evaluated hospitalization within 7 days (RR 0.87, 95%CI 0.25, 2.98). Rehydration: No difference in length of stay was identified for rapid vs. standard intravenous or nasogastric rehydration. A single study found that 5% dextrose in normal saline reduced hospitalizations compared with normal saline alone (RR 0.70, 95% CI 0.53, 0.92).

Conclusion : There is a paucity of patient-centered outcome evidence to support many interventions. Since ORT is a low-cost, non-invasive intervention, it should continue to be used. Routine probiotic use cannot be endorsed at this time in outpatient children with gastroenteritis. Despite some evidence that ondansetron administration increases diarrhea frequency, emergency department use leads to reductions in intravenous rehydration and hospitaliza- tion. No benefits were associated with ondansetron use following emergency department discharge.

Conclusion (proposition de traduction) : Il y a peu de données probantes sur les résultats centrés sur le patient pour appuyer de nombreuses interventions. Puisque le traitement par réhydratation orale est une intervention non invasive et peu coûteuse, il faut continuer à l'utiliser. L'utilisation systématique de probiotiques ne peut être approuvée pour le moment chez les enfants ambulatoires souffrant de gastro-entérite. Malgré certaines preuves qui montrent que l'administration d'ondansétron augmente la fréquence des diarrhées, son utilisation dans les services d'urgence entraîne une réduction de la réhydratation intraveineuse et de l'hospitalisation. Aucun avantage n'a été associé à l'utilisation de l'ondansétron après la sortie du service d'urgence.

Commentaire : Consulter le correctif  .