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Non-invasive ventilation as a strategy for weaning from invasive mechanical ventilation : a systematic review and Bayesian meta-analysis
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Yeung, Joyce, Couper, Keith, Ryan, Elizabeth G., Gates, Simon, Hart, Nick and Perkins, Gavin D. (2018) Non-invasive ventilation as a strategy for weaning from invasive mechanical ventilation : a systematic review and Bayesian meta-analysis. Intensive Care Medicine, 44 . pp. 2192-2204. doi:10.1007/s00134-018-5434-z ISSN 0342-4642.
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WRAP-Non-invasive-ventilation-strategy-weaning-invasive-mechanical-ventilation-Yeung-2018.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons: Attribution-Noncommercial 4.0. Download (2713Kb) | Preview |
Official URL: http://dx.doi.org/10.1007/s00134-018-5434-z
Abstract
Purpose
A systematic review and meta-analysis was conducted to answer the question ‘In adults with respiratory failure requiring invasive ventilation for more than 24 h, does a weaning strategy with early extubation to non-invasive ventilation (NIV) compared to invasive ventilation weaning reduce all-cause hospital mortality?’
Methods
We included randomised and quasi-randomised controlled trials that evaluated the use of non-invasive ventilation, compared to invasive ventilation, as a weaning strategy in adults mechanically ventilated for at least 24 h. The EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) bibliographic databases were searched from inception to February 2018. Bayesian hierarchical models were used to perform the meta-analysis. The primary outcome was mortality at hospital discharge. Secondary outcomes included mortality (30, 60, 90 and 180 days), quality of life, duration of invasive ventilation, weaning failure, length of stay [intensive care unit (ICU) and hospital] and adverse events.
Results
Twenty-five relevant studies involving 1609 patients were included in the quantitative analysis. Studies had moderate to high risk of bias due to risk of performance and detection bias. Mortality at hospital discharge was lower in the NIV weaning group compared to the invasive weaning group [pooled odds ratio (OR) 0.58, 95% highest density interval (HDI) 0.29–0.89]. Subgroup analyses showed lower pooled mortality at hospital discharge rates in NIV weaning than those in the control group in chronic obstructive pulmonary disease (COPD) patients (pooled OR 0.43, 95% HDI 0.13–0.81) and the effect is less certain in the mixed ICU population (pooled OR 0.88, 95% HDI 0.25–1.48). NIV weaning reduced the duration of invasive ventilation in patients [standardised mean difference (SMD) − 1.34, 95% HDI − 1.92 to − 0.77] and ICU length of stay (SMD − 0.70, 95% HDI − 0.94 to − 0.46). Reported rates of ventilator associated pneumonia (VAP) were lower in the NIV group. NIV weaning did not reduce overall hospital length of stay or long-term mortality. There were insufficient data to compare other adverse events and health-related quality of life.
Conclusions
The use of NIV in weaning from mechanical ventilation decreases hospital mortality, the incidence of VAP and ICU length of stay. NIV as a weaning strategy appears to be most beneficial in patients with COPD.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RC Internal medicine | ||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||
| Library of Congress Subject Headings (LCSH): | Respiratory insufficiency -- Treatment, Airway extubation | ||||||||
| Journal or Publication Title: | Intensive Care Medicine | ||||||||
| Publisher: | Springer | ||||||||
| ISSN: | 0342-4642 | ||||||||
| Official Date: | December 2018 | ||||||||
| Dates: |
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| Volume: | 44 | ||||||||
| Page Range: | pp. 2192-2204 | ||||||||
| DOI: | 10.1007/s00134-018-5434-z | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 22 November 2018 | ||||||||
| Date of first compliant Open Access: | 22 November 2018 | ||||||||
| RIOXX Funder/Project Grant: |
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