接种疫苗的好处:有中等质量的证据证明,有呼吸衰竭风险的患者接种流感和肺炎链球菌疫苗有益。[9]Furumoto A, Ohkusa Y, Chen M, et al. Additive effect of pneumococcal vaccine and influenza vaccine on acute exacerbation in patients with chronic lung disease. Vaccine. 2008;26:4284-4289.http://www.ncbi.nlm.nih.gov/pubmed/18585831?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
接种疫苗的好处:有中等质量的证据证明,有呼吸衰竭风险的患者接种流感和肺炎链球菌疫苗有益。[9]Furumoto A, Ohkusa Y, Chen M, et al. Additive effect of pneumococcal vaccine and influenza vaccine on acute exacerbation in patients with chronic lung disease. Vaccine. 2008;26:4284-4289.http://www.ncbi.nlm.nih.gov/pubmed/18585831?tool=bestpractice.com
治疗有效性:中等质量的证据证明,持续气道正压通气和双水平气道正压通气能够改善生理因素,但不能改善短期死亡率。[40]Park M, Sangean MC, Volpe M de S, et al. Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema. Crit Care Med. 2004;32:2407-2415.http://www.ncbi.nlm.nih.gov/pubmed/15599144?tool=bestpractice.com[41]Delclaux C, L'Her E, Alberti C, et al. Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial. JAMA. 2000;284:2352-2360.http://www.ncbi.nlm.nih.gov/pubmed/11066186?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
治疗有效性:中等质量的证据证明,持续气道正压通气和双水平气道正压通气能够改善生理因素,但不能改善短期死亡率。[40]Park M, Sangean MC, Volpe M de S, et al. Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema. Crit Care Med. 2004;32:2407-2415.http://www.ncbi.nlm.nih.gov/pubmed/15599144?tool=bestpractice.com[41]Delclaux C, L'Her E, Alberti C, et al. Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial. JAMA. 2000;284:2352-2360.http://www.ncbi.nlm.nih.gov/pubmed/11066186?tool=bestpractice.com
接种疫苗的好处:有低级别证据证明,普通人群接种流感疫苗预防肺炎有效。[10]Jackson ML, Nelson JC, Weiss NS, et al. Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: a population-based, nested case control study. Lancet. 2008;372:398-405.http://www.ncbi.nlm.nih.gov/pubmed/18675690?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
接种疫苗的好处:有低级别证据证明,普通人群接种流感疫苗预防肺炎有效。[10]Jackson ML, Nelson JC, Weiss NS, et al. Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: a population-based, nested case control study. Lancet. 2008;372:398-405.http://www.ncbi.nlm.nih.gov/pubmed/18675690?tool=bestpractice.com
诊断技术的有效性:有低质量证据证明,用来排除肺栓塞的 CT 扫描大约一半结果为阴性。[19]Tresoldi S, Kim YH, Baker SP, et al. MDCT of 220 consecutive patients with suspected acute pulmonary embolism: incidence of pulmonary embolism and of other acute or non-acute thoracic findings. Radiol Med. 2008;113:373-384.http://www.ncbi.nlm.nih.gov/pubmed/18493774?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
诊断技术的有效性:有低质量证据证明,用来排除肺栓塞的 CT 扫描大约一半结果为阴性。[19]Tresoldi S, Kim YH, Baker SP, et al. MDCT of 220 consecutive patients with suspected acute pulmonary embolism: incidence of pulmonary embolism and of other acute or non-acute thoracic findings. Radiol Med. 2008;113:373-384.http://www.ncbi.nlm.nih.gov/pubmed/18493774?tool=bestpractice.com
诊断技术的有效性:有质量较差的证据表明,用力呼气量 (FEV) <根据年龄和体重确定的预计值的 35%-50% 可以预测急性哮喘患者发生呼吸衰竭的风险。[27]Rodrigo G, Rodrigo C. Early prediction of poor response in acute asthma patients in the emergency department. Chest. 1998;114:1016-1021.http://www.ncbi.nlm.nih.gov/pubmed/9792570?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
诊断技术的有效性:有质量较差的证据表明,用力呼气量 (FEV) <根据年龄和体重确定的预计值的 35%-50% 可以预测急性哮喘患者发生呼吸衰竭的风险。[27]Rodrigo G, Rodrigo C. Early prediction of poor response in acute asthma patients in the emergency department. Chest. 1998;114:1016-1021.http://www.ncbi.nlm.nih.gov/pubmed/9792570?tool=bestpractice.com
治疗有效性:有质量较差的证据证明持续气道正压通气对心输出量没有不良影响。[35]Naughton MT, Rahman MA, Hara K, et al. Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation. 1995;91:1725-1731.http://www.ncbi.nlm.nih.gov/pubmed/7882480?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
治疗有效性:有质量较差的证据证明持续气道正压通气对心输出量没有不良影响。[35]Naughton MT, Rahman MA, Hara K, et al. Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation. 1995;91:1725-1731.http://www.ncbi.nlm.nih.gov/pubmed/7882480?tool=bestpractice.com
治疗有效性:有质量较差的证据证明,持续气道正压通气和双水平气道正压通气对改善短期生理参数都有效。[36]Mehta S, Jay GD, Woolard RH, et al. Randomized, prospective trial of bilevel versus continuous positive airway pressure in acute pulmonary edema. Crit Care Med. 1997;25:620-628.http://www.ncbi.nlm.nih.gov/pubmed/9142026?tool=bestpractice.com[37]Moritz F, Brousse B, Gellee B, et al. Continuous positive airway pressure versus bilevel noninvasive ventilation in acute cardiogenic pulmonary edema: a randomized multicenter trial. Ann Emerg Med. 2007;50:666-675.http://www.ncbi.nlm.nih.gov/pubmed/17764785?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
治疗有效性:有质量较差的证据证明,持续气道正压通气和双水平气道正压通气对改善短期生理参数都有效。[36]Mehta S, Jay GD, Woolard RH, et al. Randomized, prospective trial of bilevel versus continuous positive airway pressure in acute pulmonary edema. Crit Care Med. 1997;25:620-628.http://www.ncbi.nlm.nih.gov/pubmed/9142026?tool=bestpractice.com[37]Moritz F, Brousse B, Gellee B, et al. Continuous positive airway pressure versus bilevel noninvasive ventilation in acute cardiogenic pulmonary edema: a randomized multicenter trial. Ann Emerg Med. 2007;50:666-675.http://www.ncbi.nlm.nih.gov/pubmed/17764785?tool=bestpractice.com
并发症风险:有质量较差的证据证明,气管插管和机械通气与肺部感染有关。[53]Cook DJ, Kollef MH. Risk factors for ICU-acquired pneumonia. JAMA. 1998;279:1605-1606.http://www.ncbi.nlm.nih.gov/pubmed/9613899?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
并发症风险:有质量较差的证据证明,气管插管和机械通气与肺部感染有关。[53]Cook DJ, Kollef MH. Risk factors for ICU-acquired pneumonia. JAMA. 1998;279:1605-1606.http://www.ncbi.nlm.nih.gov/pubmed/9613899?tool=bestpractice.com
预防并发症:有质量较差的证据证明,声门下吸引分泌物减少气管插管患者的肺部感染。[82]Valles J, Artigas A, Rello J, et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med. 1995;122;179-186.http://www.ncbi.nlm.nih.gov/pubmed/7810935?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
预防并发症:有质量较差的证据证明,声门下吸引分泌物减少气管插管患者的肺部感染。[82]Valles J, Artigas A, Rello J, et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med. 1995;122;179-186.http://www.ncbi.nlm.nih.gov/pubmed/7810935?tool=bestpractice.com