title: Noninvasive versus invasive mechanical ventilation for immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis.
abstract: To determine the effects of noninvasive mechanical ventilation (NIV) compared with invasive mechanical ventilation (IMV) as the initial mechanical ventilation on clinical outcomes when used for treatment of acute respiratory failure (ARF) in immunocompromised patients.
  
  
  
  We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Biomedical Literature Database (CBM) and other databases. Subgroup analyses by disease severity and causes of immunodeficiency were also conducted.
  
  
  
  Thirteen observational studies with a total of 2552 patients were included. Compared to IMV, NIV was shown to significantly reduce in-hospital mortality (OR 0.43, 95 % CI 0.23 to 0.80, P value = 0.007) and 30-day mortality (OR 0.34, 95 % CI 0.20 to 0.61, P value < 0.0001) in overall analysis. Subgroup analysis showed NIV had great advantage over IMV for less severe, AIDS, BMT and hematological malignancies patients in reducing mortality and duration of ICU stay.
  
  
  
  The overall evidence we obtained shows NIV does more benefits or at least no harm to ARF patients with certain causes of immunodeficiency or who are less severe.
authors: Emergency Department, Peking Union Medical College Hospital, Beijing, 100730, China.
authors: Tao
authors: T
authors: Wang
authors: Department of Cardiology, Peking Union Medical College Hospital, Beijing, 100730, China.
authors: Lixi
authors: L
authors: Zhang
authors: Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China.
authors: Kai
authors: K
authors: Luo
authors: Emergency Department, Peking Union Medical College Hospital, Beijing, 100730, China.
authors: Jianqiang
authors: J
authors: He
authors: Emergency Department, Peking Union Medical College Hospital, Beijing, 100730, China.
authors: Yong
authors: Y
authors: Ma
authors: Department of Pneumology, Peking Union Medical College Hospital, Beijing, 100730, China.
authors: Zongru
authors: Z
authors: Li
authors: Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China.
authors: Na
authors: N
authors: Zhao
authors: Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China.
authors: Qun
authors: Q
authors: Xu
authors: Emergency Department, Peking Union Medical College Hospital, Beijing, 100730, China. billliyi@126.com.
authors: Yi
authors: Y
authors: Li
authors: Emergency Department, Peking Union Medical College Hospital, Beijing, 100730, China. erxuezhongyu@sina.cn.
authors: Xuezhong
authors: X
authors: Yu
mesh_terms: D000208:Acute Disease; D017052:Hospital Mortality; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D063087:Noninvasive Ventilation; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Acute respiratory failure; Immunocompromised patients; Invasive mechanical ventilation; Meta-analysis; Noninvasive mechanical ventilation; Systematic review