Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 3:59:232-244.
doi: 10.29390/001c.89284. eCollection 2023.

Effect of noninvasive respiratory support on interstitial lung disease with acute respiratory failure: A systematic review and meta-analysis

Natthawan Sanguanwong  1   2 , Nattawat Jantarangsi  3 , Jinjuta Ngeyvijit  4 , Natthida Owattanapanich  5 , Vorakamol Phoophiboon  6   7   8
Affiliations

Effect of noninvasive respiratory support on interstitial lung disease with acute respiratory failure: A systematic review and meta-analysis

Natthawan Sanguanwong et al. Can J Respir Ther. .

Abstract

Background: Primary studies have demonstrated the effectiveness of noninvasive respiratory supports, including noninvasive positive pressure ventilation (NIPPV) and high flow nasal cannula (HFNC), for improving oxygenation and ventilation in patients with interstitial lung diseases (ILDs) and acute respiratory failure (ARF). These studies have not been synthesized and are not included in current practice guidelines. This systematic review with meta-analysis synthesizes studies that compared the effectiveness of NIPPV, HFNC and conventional oxygen therapy (COT) for improving oxygenation and ventilation in ILD patients with ARF.

Methods: MEDLINE, EMBASE and the Cochrane Library searches were conducted from inception to August 2023. An additional search of relevant primary literature and review articles was also performed. A random effects model was used to estimate the PF ratio (ratio of arterial oxygen partial pressure to fractional inspired oxygen), PaCO2 (partial pressure of carbon dioxide), mortality, intubation rate and hospital length of stay.

Results: Ten studies were included in the systematic review and meta-analysis. Noninvasive respiratory supports demonstrated a significant improvement in PF ratio compared to conventional oxygen therapy (COT); the mean difference was 55.92 (95% CI [18.85-92.99]; p=0.003). Compared to HFNC, there was a significant increase in PF ratio in NIPPV (mean difference 0.45; 95% CI [0.12-0.79]; p=0.008). There were no mortality and intubation rate benefits when comparing NIPPV and HFNC; the mean difference was 1.1; 95% CI [0.83-1.44]; p=0.51 and 1.86; 95% CI [0.42-8.33]; p=0.42, respectively. In addition, there was a significant decrease in hospital length of stay in HFNC compared to NIPPV (mean difference 9.27; 95% Cl [1.45 - 17.1]; p=0.02).

Conclusions: Noninvasive respiratory supports might be an alternative modality in ILDs with ARF. NIPPV demonstrated a potential to improve the PF ratio compared to HFNC. There was no evidence to support the benefit of NIPPV or HFNC in terms of mortality and intubation rate.

Keywords: acute exacerbation; acute respiratory failure; high-flow nasal cannula; interstitial lung disease; noninvasive positive pressure ventilation; noninvasive respiratory support; noninvasive ventilation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.. Flow diagram of the article selection procedure based on the PRISMA guideline.
Figure 2.
Figure 2.. Effect of noninvasive respiratory supports on PF ratio.
Figure 3.
Figure 3.. Effect of noninvasive respiratory supports on PaCO2.
Figure 4.
Figure 4.. Effect of NIPPV or HFNC on PF ratio.
Figure 5.
Figure 5.. Effect of NIPPV or HFNC on mortality.
Figure 6.
Figure 6.. Effect of NIPPV or HFNC on intubation rate.
Figure 7.
Figure 7.. Effect of NIPPV or HFNC on hospital length of stay.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. GBD 2013 Mortality and Causes of Death Collaborators Jan;2015 The Lancet. 385(9963):117–171. doi: 10.1016/s0140-6736(14)61682-2. doi: 10.1016/s0140-6736(14)61682-2. - DOI - DOI - PMC - PubMed
    1. Variability in Global Prevalence of Interstitial Lung Disease. Kaul Bhavika, Cottin Vincent, Collard Harold R., Valenzuela Claudia. Nov 4;2021 Frontiers in Medicine. 8:751181. doi: 10.3389/fmed.2021.751181. doi: 10.3389/fmed.2021.751181. - DOI - DOI - PMC - PubMed
    1. Interstitial Lung Disease in 2020: A History of Progress. Guler Sabina A., Corte Tamera J. Jun;2021 Clinics in Chest Medicine. 42(2):229–239. doi: 10.1016/j.ccm.2021.03.001. doi: 10.1016/j.ccm.2021.03.001. - DOI - DOI - PubMed
    1. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Travis William D., Costabel Ulrich, Hansell David M., King Talmadge E. Jr., Lynch David A., Nicholson Andrew G., Ryerson Christopher J., Ryu Jay H., Selman Moisés, Wells Athol U., Behr Jurgen, Bouros Demosthenes, Brown Kevin K., Colby Thomas V., Collard Harold R., Cordeiro Carlos Robalo, Cottin Vincent, Crestani Bruno, Drent Marjolein, Dudden Rosalind F., Egan Jim, Flaherty Kevin, Hogaboam Cory, Inoue Yoshikazu, Johkoh Takeshi, Kim Dong Soon, Kitaichi Masanori, Loyd James, Martinez Fernando J., Myers Jeffrey, Protzko Shandra, Raghu Ganesh, Richeldi Luca, Sverzellati Nicola, Swigris Jeffrey, Valeyre Dominique. Sep 15;2013 American Journal of Respiratory and Critical Care Medicine. 188(6):733–748. doi: 10.1164/rccm.201308-1483st. doi: 10.1164/rccm.201308-1483st. - DOI - DOI - PMC - PubMed
    1. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Raghu Ganesh, Remy-Jardin Martine, Myers Jeffrey L., Richeldi Luca, Ryerson Christopher J., Lederer David J., Behr Juergen, Cottin Vincent, Danoff Sonye K., Morell Ferran, Flaherty Kevin R., Wells Athol, Martinez Fernando J., Azuma Arata, Bice Thomas J., Bouros Demosthenes, Brown Kevin K., Collard Harold R., Duggal Abhijit, Galvin Liam, Inoue Yoshikazu, Jenkins R. Gisli, Johkoh Takeshi, Kazerooni Ella A., Kitaichi Masanori, Knight Shandra L., Mansour George, Nicholson Andrew G., Pipavath Sudhakar N. J., Buendía-Roldán Ivette, Selman Moisés, Travis William D., Walsh Simon L. F., Wilson Kevin C. Sep 1;2018 American Journal of Respiratory and Critical Care Medicine. 198(5):e44–e68. doi: 10.1164/rccm.201807-1255st. doi: 10.1164/rccm.201807-1255st. - DOI - DOI - PubMed

Publication types

LinkOut - more resources