Invasieve beademing Module 3 Evidence-tabel

Kelly 2010

SR and meta-analysis of RCTs

Literature search up to January 2010

See RCT

Study design: All RCT

Source of funding and conflicts of interest:

Not reported by Kelly, 2010

Inclusion criteria SR: randomized controlled trials (RCTs) comparing heat and moisture exchangers (HMEs) to heated humidifiers (HH)

in mechanically ventilated adults and children

Exclusion criteria SR:

Not fulfilling inclusion criteria

33 studies included

Groups comparable at baseline?

Yes

Describe intervention:

heat and moisture exchangers (HMEs) in mechanically ventilated adults

Describe control:

heated humidifiers (HH)in mechanically ventilated adults

End-point of follow-up:

For duration of mechanical ventilation

For how many participants were no complete outcome data available?

(intervention/control)

NA

Ventilator-associated pneumonia

Pooled effect (random effects model):

RR=0.92 (95% CI 0.71 to 1.20))

Duration of ventilation

Pooled effect (random effects model):

RR=0.92 (95% CI 0.71 to 1.20))

Risk of bias (high, some concerns or low):

Risk of bias assessment of included studies showed that most studies were unclear on sequence generation, allocation of concealment and blinding leading to some concerns.

The authors conclude that there is little evidence of an overall difference between HMEs and HHs.

Oguz, 2013

Type of study: RCT

Setting and country: Hospital, Turkey

Funding and conflicts of interest: not stated

Inclusion criteria:

Patients who were on the first day of intubation, did not have pre-intubation pneumonia, presented to the healthcare centre with no infections at the time of presentation, were not on antibiotic treatment for pulmonary infections and did not have evidence of infiltration with chest radiography

Exclusion criteria:

Not fulfilling inclusion criteria

N total at baseline:

Intervention: 18

Control: 17

Important prognostic factors:

Sex:

I: 59.5% M

C: 40.5% M

Groups comparable at baseline?

Yes

Describe intervention (treatment/procedure/test):

Mechanical ventilation with heat and moisture exchanger (HME)

Describe control (treatment/procedure/test):

Mechanical ventilation with heated humidifiers (HHs)

Length of follow-up:

NA

Loss-to-follow-up:

NA

Incomplete outcome data:

NA

*patients had follow-up for duration of mechanical ventilation

Outcome measures and effect size (include 95%CI and p-value if available):

Developing VAP:

HME: 6/18 patients

HH 5/17 Patents

RR: 1.13 (95% CI 0.43 to 3.03)

Duration of ventilation

HME: 5.56 + 1.50

HH 5.82 + 2.81

Contamination of the airways

HME: 5/18 patients

HH 9/17 Patents

RR: 0.34 (95% CI 0.08 to 1.39)

The authors conclude that there were no significant differences

between the groups on HME filters and heated humidifiers in terms of infection development.