title: Efficacy and safety of noninvasive ventilation in patients after cardiothoracic surgery: A PRISMA-compliant systematic review and meta-analysis.
abstract: BACKGROUND
  Noninvasive ventilation (NIV) is a promising therapeutic strategy after cardiothoracic surgery. This study aimed to meta-analyze the efficacy and safety of NIV as compared to conventional management after cardiothoracic surgery.
  
  
  METHODS
  PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing NIV with conventional management after cardiothoracic surgery. Relative risk (RR), standard mean difference (SMD), and 95% confidence intervals (CIs) were used to measure the efficacy and safety of NIV using random-effects model. Heterogeneity was evaluated using the Q statistic.
  
  
  RESULTS
  This study included 14 RCTs (1740 patients) for the evaluation of efficacy and safety of NIV as compared to conventional management after cardiothoracic surgery. Overall, NIV had minimal effect on the risk of mortality (RR: 0.64; 95% CI: 0.36-1.14; P = 0.127), endotracheal intubation (RR: 0.52; 95% CI: 0.24-1.11; P = 0.090), respiratory (RR: 0.70; 95% CI: 0.47-1.30; P = 0.340), cardiovascular (RR: 0.81; 95% CI: 0.54-1.22; P = 0.306), renal (RR: 0.70; 95% CI: 0.26-1.92; P = 0.491), and other complications (RR: 0.72; 95% CI: 0.38-1.36; P = 0.305), respiratory rate (SMD: -0.10; 95% CI: -1.21-1.01; P = 0.862), heart rate (SMD: -0.27; 95% CI: -0.76-0.22; P = 0.288), PaO2/FiO2 ratio (SMD: 0.34; 95% CI: -0.17-0.85; P = 0.194), PaCO2 (SMD: 0.83; 95% CI: -0.12-1.77; P = 0.087), systolic pressure (SMD: -0.04; 95% CI: -0.25-0.17; P = 0.700), pH (SMD: -0.01; 95% CI: -0.44-0.43; P = 0.974), length of ICU stay (SMD: -0.19; 95% CI: -0.47-0.08; P = 0.171), and hospital stay (SMD: -0.31; 95% CI: -1.00-0.38; P = 0.373). Sensitivity analysis showed that NIV was associated with higher levels of PaO2/FiO2 ratio (SMD: 0.52; 95% CI: 0.00-1.05; P = 0.048) and lower risk of endotracheal intubation (RR: 0.38; 95% CI: 0.22-0.66; P = 0.001).
  
  
  CONCLUSIONS
  As compared to conventional management, the use of NIV after cardiothoracic surgery improved patient's oxygenation and decreased the need for endotracheal intubation, without significant complications.
authors.affiliation: Department of Respiratory and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, P.R. China.
authors.forename: Guangfa
authors.initials: G
authors.lastname: Zhu
authors.forename: Yan
authors.initials: Y
authors.lastname: Huang
authors.forename: Dong
authors.initials: D
authors.lastname: Wei
authors.forename: Yingxin
authors.initials: Y
authors.lastname: Shi
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome