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. 2023 Apr 5;32(168):220196.
doi: 10.1183/16000617.0196-2022. Print 2023 Jun 30.

Noninvasive respiratory support after extubation: a systematic review and network meta-analysis

Annalisa Boscolo  1   2   3 , Tommaso Pettenuzzo  2   3 , Nicolò Sella  2 , Matteo Zatta  1 , Michele Salvagno  1 , Martina Tassone  1 , Chiara Pretto  1 , Arianna Peralta  2 , Luisa Muraro  2 , Francesco Zarantonello  2 , Andrea Bruni  4 , Federico Geraldini  2 , Alessandro De Cassai  2 , Paolo Navalesi  5   2
Affiliations

Noninvasive respiratory support after extubation: a systematic review and network meta-analysis

Annalisa Boscolo et al. Eur Respir Rev. .

Erratum in

Abstract

Background: The effect of noninvasive respiratory support (NRS), including high-flow nasal oxygen, bi-level positive airway pressure and continuous positive airway pressure (noninvasive ventilation (NIV)), for preventing and treating post-extubation respiratory failure is still unclear. Our objective was to assess the effects of NRS on post-extubation respiratory failure, defined as re-intubation secondary to post-extubation respiratory failure (primary outcome). Secondary outcomes included the incidence of ventilator-associated pneumonia (VAP), discomfort, intensive care unit (ICU) and hospital mortality, ICU and hospital length of stay (LOS), and time to re-intubation. Subgroup analyses considered "prophylactic" versus "therapeutic" NRS application and subpopulations (high-risk, low-risk, post-surgical and hypoxaemic patients).

Methods: We undertook a systematic review and network meta-analysis (Research Registry: reviewregistry1435). PubMed, Embase, CENTRAL, Scopus and Web of Science were searched (from inception until 22 June 2022). Randomised controlled trials (RCTs) investigating the use of NRS after extubation in ICU adult patients were included.

Results: 32 RCTs entered the quantitative analysis (5063 patients). Compared with conventional oxygen therapy, NRS overall reduced re-intubations and VAP (moderate certainty). NIV decreased hospital mortality (moderate certainty), and hospital and ICU LOS (low and very low certainty, respectively), and increased discomfort (moderate certainty). Prophylactic NRS did not prevent extubation failure in low-risk or hypoxaemic patients.

Conclusion: Prophylactic NRS may reduce the rate of post-extubation respiratory failure in ICU patients.

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Conflict of interest statement

Conflict of interest: None related to the present work. P. Navalesi's research lab has received grants/research equipment from Draeger, Intersurgical SPA and Gilead. P. Navalesi receives royalties from Intersurgical SPA for the Helmet Next invention. He has also received speaking fees from Getinge, Intersurgical SPA, Mindray, Gilead, MSD, Draeger and Medicair. The other authors have no other competing interests to declare.

Figures

FIGURE 1
FIGURE 1
PRISMA flowchart. RCT: randomised controlled trial.
FIGURE 2
FIGURE 2
Risk of bias assessments.
FIGURE 3
FIGURE 3
Impact of overall, “therapeutic” and “prophylactic” noninvasive respiratory support on primary outcome (re-intubation). COT: conventional oxygen therapy; HFNO: high-flow nasal oxygen; NIV: noninvasive ventilation.
FIGURE 4
FIGURE 4
Impact of “prophylactic” noninvasive respiratory support on predefined subgroups (re-intubation). COT: conventional oxygen therapy; HFNO: high-flow nasal oxygen; NIV: noninvasive ventilation.
See this image and copyright information in PMC

Comment in

References

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