Objective To evaluate the efficacy and safety of alveolar lavage by fiberoptic bronchoscopy in adjuvant treatment of ventilator-associated pneumonia(VAP) based on meta-analysis.
Methods A number of Chinese and English databases (CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, Web of Science) were systematically retrieved for literature on randomized controlled trials of fiberoptic bronchoscopy in the treatment of severe VAP from the database establishment, and the data were analyzed using Revman 5.4 software.
Results A total of 531 literature were searched, and a total of 26 literatures were finally selected. There were 2 121 patients were included in the study, with 1 060 in trial group(routine treatment of western medicine and conventional sputum suction treatment) and 1 061 in control group(conventional treatment of western medicine and alveolar lavage by fiberoptic bronchoscopy). The results of meta-analysis showed that alveolar lavage by fiberoptic bronchoscopy in adjuvant treatment of VAP could improve clinical efficiency (RR=1.26, 95%CI, 1.19 to 1.32, P < 0.001), reduce mortality(RR=0.40, 95%CI, 0.20 to 0.79, P=0.009), shorten ICU stay (MD=-3.87, 95%CI, -4.50 to -3.25, P < 0.001), shorten hospital stay (MD=-4.05, 95%CI, -5.30 to -2.79, P < 0.001), shorten mechanical ventilation time (MD=-3.81, 95%CI, -4.25 to -3.36, P < 0.001), reduce Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score(MD=-3.18, 95%CI, -4.79 to -1.57, P < 0.001), reduce clinical pulmonary infection score (MD=-1.72, 95%CI, -2.26 to -1.19, P < 0.001), shorten time of infection control (MD=-4.69, 95%CI, -5.14 to -4.25, P < 0.001).
Conclusion Alveolar lavage by fiberoptic bronchoscopy in adjuvant treatment of VAP is better in improving the clinical effective rate, reducing the mortality, shortening the length of hospital stay and duration of mechanical ventilation, and it is safe and effective.
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