Use of noninvasive ventilation at the pulmonary infection control window for acute respiratory failure in AECOPD patients: A systematic review and meta-analysis based on GRADE approach.
The aim of the study was to comprehensively examine the efficacy and safety of noninvasive ventilation used at the pulmonary infection control (PIC) window for acute respiratory failure (ARF) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).Seven electronic databases and relevant resources were searched to identify randomized controlled trials (RCTs) comparing patients using noninvasive ventilation at PIC window with those continuing receiving invasive ventilation. Retrieved citations were screened, risk of bias was assessed, and data were extracted by 2 independent review authors. Overall effect sizes were synthesized by using meta-analyses. Quality of evidence was rated by using Grading of Recommendations, Assessment, Development and Evaluation approach.A total of 17 trials involving 959 participants were included for this review. Compared with continuous invasive ventilation, noninvasive ventilation used at PIC window significantly reduced mortality, ventilator-associated pneumonia, weaning failures, reintubations, duration of invasive ventilation, total duration of mechanical ventilation, length of stay (LOS) in intensive care unit, and LOS in hospital as well as hospital costs. Of these, mortality significantly decreased (risk ratio = 0.27, 95% confidence interval: 0.17-0.42, P < 0.001) without significant heterogeneity (I = 0%, P = 0.99). Quality of evidence regarding the 9 outcomes across the included studies was rated from moderate to low.Use of noninvasive ventilation at PIC window showed beneficial effects across identified trials for ARF in AECOPD patients. Considering the absence of high quality of available evidence and the uncertainty of long-term effect of this intervention, a weak recommendation for clinical practice was generated, and further well-designed and adequately powered RCTs are required to validate this conclusion.
Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Le
L
Peng
Peng-Wei
PW
Ren
Xue-Ting
XT
Liu
Chao
C
Zhang
Hong-Xia
HX
Zuo
De-Ying
DY
Kang
Yu-Ming
YM
Niu
D014943:Global Health; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D063087:Noninvasive Ventilation; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012128:Respiratory Distress Syndrome / Q000628:therapy*