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Meta-Analysis
. 2016 Jun;95(24):e3880.
doi: 10.1097/MD.0000000000003880.

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

Le Peng  1 , Peng-Wei Ren, Xue-Ting Liu, Chao Zhang, Hong-Xia Zuo, De-Ying Kang, Yu-Ming Niu
Affiliations
Meta-Analysis

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

Le Peng et al. Medicine (Baltimore). 2016 Jun.

Erratum in

  • Erratum: Medicine, Volume 95, Issue 24: Erratum.
    [No authors listed] [No authors listed] Medicine (Baltimore). 2016 Aug 7;95(31):e5074. doi: 10.1097/01.md.0000490009.39850.74. eCollection 2016 Aug. Medicine (Baltimore). 2016. PMID: 31265618 Free PMC article.

Abstract

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.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of the selection process. CBM = Chinese Biomedicine Database, CENTRAL = Cochrane Central Register of Controlled Trials, CNKI = China National Knowledge Infrastructure, COPD = chronic obstructive pulmonary disease.
Figure 2
Figure 2
Efficacy of noninvasive ventilation versus invasive ventilation on mortality.
Figure 3
Figure 3
Efficacy of noninvasive ventilation versus invasive ventilation on VAP. VAP = ventilator-associated pneumonia.
Figure 4
Figure 4
Efficacy of noninvasive ventilation versus invasive ventilation on weaning failures.
Figure 5
Figure 5
Efficacy of sequential ventilation versus invasive ventilation on reintubations.
Figure 6
Figure 6
Efficacy of noninvasive ventilation versus invasive ventilation on the duration of invasive ventilation.
Figure 7
Figure 7
Efficacy of noninvasive ventilation versus invasive ventilation on the total duration of mechanical ventilation.
Figure 8
Figure 8
Efficacy of noninvasive ventilation versus invasive ventilation on the length of stay in ICU. ICU = intensive care unit.
Figure 9
Figure 9
Efficacy of noninvasive ventilation versus invasive ventilation on the length of stay in hospital.
Figure 10
Figure 10
Noninvasive ventilation versus invasive ventilation on hospital costs.
Figure 11
Figure 11
Funnel plot on VAP. VAP = ventilator-associated pneumonia.
See this image and copyright information in PMC

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MeSH terms