title: Prehospital noninvasive ventilation for acute respiratory failure: systematic review, network meta-analysis, and individual patient data meta-analysis.
abstract: OBJECTIVE
  This meta-analysis aimed to determine the effectiveness of prehospital continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP) in acute respiratory failure.
  
  
  METHODS
  Fourteen electronic databases and research registers were searched from inception to August 2013. Randomized or quasi-randomized controlled trials that reported mortality or intubation rate for prehospital CPAP or BiPAP were selected and compared to a relevant comparator in patients with acute respiratory failure. An aggregate data network meta-analysis was used to jointly estimate intervention effects relative to standard care. A network meta-analysis using a mixture of individual patient-level data and aggregate data was carried out to assess potential treatment effect modifiers.
  
  
  RESULTS
  Eight randomized and two quasi-randomized controlled trials (six CPAP, four BiPAP, sample sizes 23 to 207) were identified. The aggregate data network meta-analysis suggested that CPAP was the most effective treatment in terms of mortality (probability = 0.989) and intubation rate (probability = 0.639) and reduced both mortality (odds ratio [OR] = 0.41; 95% credible interval [CrI] = 0.20 to 0.77) and intubation rate (OR = 0.32; 95% CrI = 0.17 to 0.62), compared to standard care. The effect of BiPAP on mortality (OR = 1.94; 95% CrI = 0.65 to 6.14) and intubation rate (OR = 0.40; 95% CrI = 0.14 to 1.16) was uncertain. The network meta-analysis using individual patient-level data and aggregate data suggested that sex was a modifier of the effect of treatment on mortality.
  
  
  CONCLUSIONS
  Prehospital CPAP can reduce mortality and intubation rates compared to standard care, while the effectiveness of prehospital BiPAP is uncertain.
authors.affiliation: The School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Goodacre
authors.forename: John W
authors.initials: JW
authors.lastname: Stevens
authors.forename: Abdullah
authors.initials: A
authors.lastname: Pandor
authors.forename: Edith
authors.initials: E
authors.lastname: Poku
authors.forename: Shijie
authors.initials: S
authors.lastname: Ren
authors.forename: Anna
authors.initials: A
authors.lastname: Cantrell
authors.forename: Vincent
authors.initials: V
authors.lastname: Bounes
authors.forename: Arantxa
authors.initials: A
authors.lastname: Mas
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
authors.forename: David
authors.initials: D
authors.lastname: Petrie
authors.forename: Markus Soeren
authors.initials: MS
authors.lastname: Roessler
authors.forename: Gunther
authors.initials: G
authors.lastname: Weitz
authors.forename: Laurent
authors.initials: L
authors.lastname: Ducros
authors.forename: Patrick
authors.initials: P
authors.lastname: Plaisance
mesh_terms: D045422:Continuous Positive Airway Pressure; D004632:Emergency Medical Services; D004638:Emergency Treatment; D006801:Humans; D063087:Noninvasive Ventilation / Q000379:methods*; D012131:Respiratory Insufficiency / Q000628:therapy*