Ventilação não invasiva com pressão positiva para prevenção de complicações após ressecção pulmonar em pacientes com câncer de pulmão: revisão sistemática da literatura

• Autor(a) principal: Torres, Maria Fernanda Santos [UNIFESP]
• Data de Publicação: 2016
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4488752; https://repositorio.unifesp.br/handle/11600/47388
• topic: lung cancer; treatment; meta-analysis; câncer de pulmão; tratamento; meta-análise

Objective: To assess the efficacy and safety of NIPPV for prevention of complications in patients who underwent pulmonary resection for lung cancer. Methods: It was developed a systematic review according to Cochrane Collaboration methodology. We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS and PEDro (last search on 17 March 2015) to identify potentially eligible trials. We did not use any date or language restrictions in the electronic searches for trials. We searched the reference lists of relevant papers and contacted experts in the field for information about additional published and unpublished studies. Additionally we accessed the Register of Controlled Trials (www.controlled-trials.com) and ClinicalTrials.gov (clinicaltrials.gov) to identify ongoing studies. We considered randomised or quasi-randomised clinical trials that compared NIPPV in the immediate postoperative pulmonary resection with no intervention or conventional respiratory therapy. Two authors collected data and assessed trial risk of bias. Where possible, we pooled data from the individual studies using a fixed-effect model (quantitative synthesis) otherwise we tabulated or presented the data in the main text (qualitative synthesis). Where a substantial heterogeneity existed, we applied a random-effects model. Results: From the 155 references retrieved from search strategies, six randomised clinical trials (RCTs) and one quasi-randomised trial fulfilled the eligibility criteria for this review, including a total of 436 patients. There was no statistical difference between the use or not of NIPPV when: (a) pulmonary complications rate (RR 1,03; IC 95% 0,72 to 1,47; five studies), (b) intubation rate (RR 0,55; IC 95% 0,25 to 1,20; three studies), (c) mortality (RR 0,60; 95% CI 0,24 to 1,53; five studies), (d) length of intensive care unit stay (DM-0,75; IC 95% -3,93 to 2,43; two studies), (e) length of hospital stay (DM-0,12; 95% CI -6,15 to 5,90; four studies). None study describe any complications related to NIPPV. Regarding the quality of evidence, four studies were considered "low risk of bias" in all domains evaluated; two were considered 'high risk of bias" to allocation concealment domain where one of those also considered at "high risk of bias" to random sequence generation domain. One study was considered "high risk of bias" because inclusion of participants with more severe clinical conditions compared to participants from other studies. Conclusions: This review demonstrated that there was no additional benefit of using NIPPV in postoperative pulmonary resection for all outcomes analysed (pulmonary complications, rate of intubation, mortality, rate of non-pulmonary complications, postoperative consumption of antibiotics, length of intensive care unit stay, length of hospital stay and adverse effects related to NIPPV). However, the quality of evidence is "very low", "low" and "moderate" since there were few studies, with small sample size and low frequency of outcomes. New welldesigned and well-conducted randomised trials are needed to answer the questions of this review with greater certainty.