Changyang Lin1, Huapeng Yu2, Huizhen Fan2, Zhongli Li2. 1. Department of Respiratory Disease, Zhujiang Hospital, Southern Medical University, 253 Gongye Avenue, Guangzhou, Guangdong, China. Electronic address: Huapengyu123@126.com. 2. Department of Respiratory Disease, Zhujiang Hospital, Southern Medical University, 253 Gongye Avenue, Guangzhou, Guangdong, China.
Abstract
INTRODUCTION: To determine the effectiveness of noninvasive ventilation (NIV) in the management of postextubation respiratory failure. METHODS: Databases including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to find relevant trials. Randomized and quasi-randomized trials studying NIV in adult patients with postextubation respiratory failure were included. Effects on primary outcomes (i.e., reintubation rate, and ICU or/and hospital mortality) were accessed in this meta-analysis. RESULTS: Ten trials involving 1382 patients were included: two used NIV in patients with established postextubation respiratory failure, and eight used NIV immediately after extubation. The use of NIV following extubation for patients (n = 302) with established respiratory failure did not decrease the reintubation rate (relative risk [RR] 1.02, 95% confidence interval [CI] 0.83-1.25) and ICU mortality (RR 1.14, 95% CI 0.43-3.00), compared to standard medical therapy (SMT). Early application of NIV after extubation (n = 1080) also did not decrease the reintubation rate (RR 0.75, 95% CI 0.45-1.15) significantly. However, in the planned extubation subgroup (n = 849), there were significant reductions in the reintubation rate (RR 0.65, 95% CI 0.46-0.93), ICU mortality rate (RR 0.41, 95% CI 0.21-0.82), and hospital mortality rate (RR 0.59, 95% CI 0.38-0.93) compared to SMT. CONCLUSION: Current evidence suggests that the use of NIV in patients with established postextubation respiratory failure should be monitored cautiously. Early use of NIV can benefit patients with planned extubation by decreasing the reintubation rate and the ICU and hospital mortality rates.
INTRODUCTION: To determine the effectiveness of noninvasive ventilation (NIV) in the management of postextubation respiratory failure. METHODS: Databases including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to find relevant trials. Randomized and quasi-randomized trials studying NIV in adult patients with postextubation respiratory failure were included. Effects on primary outcomes (i.e., reintubation rate, and ICU or/and hospital mortality) were accessed in this meta-analysis. RESULTS: Ten trials involving 1382 patients were included: two used NIV in patients with established postextubation respiratory failure, and eight used NIV immediately after extubation. The use of NIV following extubation for patients (n = 302) with established respiratory failure did not decrease the reintubation rate (relative risk [RR] 1.02, 95% confidence interval [CI] 0.83-1.25) and ICU mortality (RR 1.14, 95% CI 0.43-3.00), compared to standard medical therapy (SMT). Early application of NIV after extubation (n = 1080) also did not decrease the reintubation rate (RR 0.75, 95% CI 0.45-1.15) significantly. However, in the planned extubation subgroup (n = 849), there were significant reductions in the reintubation rate (RR 0.65, 95% CI 0.46-0.93), ICU mortality rate (RR 0.41, 95% CI 0.21-0.82), and hospital mortality rate (RR 0.59, 95% CI 0.38-0.93) compared to SMT. CONCLUSION: Current evidence suggests that the use of NIV in patients with established postextubation respiratory failure should be monitored cautiously. Early use of NIV can benefit patients with planned extubation by decreasing the reintubation rate and the ICU and hospital mortality rates.
Authors: Samir Jaber; Giacomo Bellani; Lluis Blanch; Alexandre Demoule; Andrés Esteban; Luciano Gattinoni; Claude Guérin; Nicholas Hill; John G Laffey; Salvatore Maurizio Maggiore; Jordi Mancebo; Paul H Mayo; Jarrod M Mosier; Paolo Navalesi; Michael Quintel; Jean Louis Vincent; John J Marini Journal: Intensive Care Med Date: 2017-08-07 Impact factor: 17.440
Authors: Sang Yong Om; Junho Hyun; Kyung Hun Nam; Sun Hack Lee; Seung Min Song; Jung Ae Hong; Sang Eun Lee; Min-Seok Kim Journal: J Thorac Dis Date: 2019-09 Impact factor: 2.895