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. 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.

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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

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