title: Efficacy of two noninvasive weaning strategies in intubated patients with chronic obstructive pulmonary disease: A meta-analysis and indirect treatment comparison.
abstract: The purpose of our indirect comparison was to explore the optimal switching time to noninvasive ventilation for further weaning in patients with chronic obstructive pulmonary disease (COPD) undergoing invasive mechanical ventilation. A comprehensive literature search was performed to identify randomized controlled trials comparing noninvasive weaning at spontaneous breathing trial (SBT) failure after meeting simple weaning criteria or at the pulmonary infection control window (PIC window) with conventional invasive weaning in COPD patients. Using conventional invasive weaning as a bridge, we indirectly compared the two noninvasive weaning strategies using the Bucher approach. Noninvasive weaning at SBT failure after meeting simple weaning criteria was associated with an extended duration of endotracheal mechanical ventilation (standardized mean difference 1.90, 95% CI 1.27-2.53, P < 0.001) compared with noninvasive weaning at the PIC window. No significant differences in mortality or the rate of ventilator-associated pneumonia were observed. Our study suggests that the PIC window may be a promising switching time for noninvasive weaning in COPD patients.
authors.affiliation: Department of Respiratory and Critical Care Medicine, West China School of Medicine/West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, PR China.
authors.forename: Pei-Jun
authors.initials: PJ
authors.lastname: Li
authors.affiliation: Department of Respiratory and Critical Care Medicine, West China School of Medicine/West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, PR China.
authors.forename: Ting
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Intensive Care Unit, West China School of Medicine/West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu 610041, PR China.
authors.forename: Jun
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Department of Respiratory and Critical Care Medicine, West China School of Medicine/West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, PR China.
authors.forename: Fa-Ming
authors.initials: FM
authors.lastname: Jiang
authors.affiliation: Department of Respiratory and Critical Care Medicine, West China School of Medicine/West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, PR China.
authors.forename: Jian
authors.initials: J
authors.lastname: Luo
authors.affiliation: Department of Respiratory and Critical Care Medicine, West China School of Medicine/West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, PR China.
authors.forename: Chao-Li
authors.initials: CL
authors.lastname: Shi
authors.affiliation: Chinese Evidence-Based Medicine Center, West China School of Medicine/West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu 610041, PR China.
authors.forename: Guan-Jian
authors.initials: GJ
authors.lastname: Liu
authors.affiliation: Department of Respiratory and Critical Care Medicine, West China School of Medicine/West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, PR China. Electronic address: za_liang319@163.com.
authors.forename: Zong-An
authors.initials: ZA
authors.lastname: Liang
mesh_terms: D006801:Humans; D063087:Noninvasive Ventilation; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D015300:Ventilator Weaning / Q000379:methods*
keywords: Chronic obstructive pulmonary disease; Indirect treatment comparison; Meta-analysis; Noninvasive ventilation; Weaning