title: Can non-invasive positive pressure ventilation prevent endotracheal intubation in acute lung injury/acute respiratory distress syndrome? A meta-analysis.
abstract: The role of non-invasive positive pressure ventilation (NIPPV) in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is controversial. The aim of this study was to investigate whether NIPPV could prevent endotracheal intubation and decrease mortality rate in patients with ALI/ARDS. Randomized controlled trials (RCT) which reported endotracheal intubation and mortality rate in patients with ALI/ARDS treated by NIPPV were identified in Pubmed, Medline, Embase, Central Cochrane Controlled Trials Register, Chinese National Knowledge Infrastructure, reference lists and by manual searches. Fixed- and random-effects models were used to calculate pooled relative risks. This meta-analysis included six RCT involving 227 patients. The results showed that endotracheal intubation rate was lower in NIPPV (95% confidence interval (CI): 0.44-0.80, z = 3.44, P = 0.0006), but no significant difference was found either in intensive care unit (ICU) mortality (95% CI: 0.45-1.07, z = 1.65, P = 0.10) or in hospital mortality (95% CI: 0.17-1.58, z = 1.16, P = 0.25). Only two studies discussed the aetiology of ALI/ARDS as pulmonary or extra-pulmonary, and neither showed statistical heterogeneity (I(2)  = 0%, χ(2)  = 0.31, P = 0.58), nor a significant difference in endotracheal intubation rate (95% CI: 0.35-9.08, z = 0.69, P = 0.49). In conclusion, the early use of NIPPV can decrease the endotracheal intubation rate in patients with ALI/ARDS, but does not change the mortality of these patients.
authors.affiliation: Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Luo
authors.forename: Mao-yun
authors.initials: MY
authors.lastname: Wang
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
authors.forename: Bin-miao
authors.initials: BM
authors.lastname: Liang
authors.forename: Dan
authors.initials: D
authors.lastname: Liu
authors.forename: Xia-ying
authors.initials: XY
authors.lastname: Peng
authors.forename: Rong-chun
authors.initials: RC
authors.lastname: Wang
authors.forename: Chun-tao
authors.initials: CT
authors.lastname: Li
authors.forename: Chen-yun
authors.initials: CY
authors.lastname: He
authors.forename: Zong-an
authors.initials: ZA
authors.lastname: Liang
mesh_terms: D055371:Acute Lung Injury / Q000401:mortality / Q000628:therapy; D000328:Adult; D044466:Asian People; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000379:methods*; D018579:Patient Selection; D011175:Positive-Pressure Respiration / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy; D018570:Risk Assessment
keywords: acute lung injury; acute respiratory distress syndrome; meta-analysis; non-invasive ventilation; randomized controlled trial