To evaluate the efficacy and safety of continuous veno-venous hemofiltration (CVVH) in patients with acute respiratory distress syndrome (ARDS) using a meta-analytic approach.
Approach:
Search Strategy: Randomized controlled trials on CVVH for ARDS were retrieved from Chinese databases and international databases. Meta-analysis was performed using Review Manager 5.3 software.
Inclusion Criteria: Included 28 randomized controlled trials (RCTs) involving 1,739 patients with ARDS, comparing CVVH therapy to conventional treatment.
Key Findings:
CVVH group showed superior oxygenation index (MD = 52.80, 95% CI [39.75, 65.84], p < 0.00001).
Mortality rate was lower in the CVVH group (OR = 0.43, 95% CI [0.34, 0.56], p < 0.00001).
ICU hospitalization duration was shorter in the CVVH group (MD = −4.88, 95% CI [−6.45, −3.31], p < 0.00001).
Mechanical ventilation duration was reduced in the CVVH group (MD = −4.10, 95% CI [−5.04, −3.15], p < 0.00001).
CVVH group had lower APACHE II scores (MD = −3.62, 95% CI [−4.30, −2.95], p < 0.00001).
Incidence of ventilator-associated pneumonia (VAP) was lower in the CVVH group (OR = 0.21, 95% CI [0.12, 0.36], p < 0.00001).
CVVH group showed significant reductions in inflammatory markers (TNF-α, IL-6, CRP, PCT, WBC).
No significant differences in PaCO₂ (MD = −3.05, 95% CI [−7.12, 1.02], p = 0.14) or cardiac index (MD = 0.36, 95% CI [−0.89, 1.60], p = 0.57) between groups.
Interpretation:
Limitations:
Substantial heterogeneity and potential publication bias exist, particularly regarding the oxygenation index and mechanical ventilation duration.
All included studies are from China.
Conclusion:
CVVH demonstrates potential benefits in ARDS treatment, but large-scale, multicenter RCTs are needed to confirm findings and optimize treatment protocols.
