TY - JOUR T1 - Non-invasive ventilation versus invasive weaning in critically ill adults: a systematic review and meta-analysis JF - Thorax JO - Thorax DO - 10.1136/thoraxjnl-2021-216993 SP - thoraxjnl-2021-216993 AU - Karen E A Burns AU - James Stevenson AU - Matthew Laird AU - Neill K J Adhikari AU - Yuchong Li AU - Cong Lu AU - Xiaolin He AU - Wentao Wang AU - Zhenting Liang AU - Lu Chen AU - Haibo Zhang AU - Jan O Friedrich Y1 - 2021/10/29 UR - http://thorax.bmj.com/content/early/2021/10/28/thoraxjnl-2021-216993.abstract N2 - Background Extubation to non-invasive ventilation (NIV) has been investigated as a strategy to wean critically ill adults from invasive ventilation and reduce ventilator-related complications.Methods We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, proceedings of four conferences and bibliographies (to June 2020) for randomised and quasi-randomised trials that compared extubation with immediate application of NIV to continued invasive weaning in intubated adults and reported mortality (primary outcome) or other outcomes. Two reviewers independently screened citations, assessed trial quality and abstracted data.Results We identified 28 trials, of moderate-to-good quality, involving 2066 patients, 44.6% with chronic obstructive pulmonary disease (COPD). Non-invasive weaning significantly reduced mortality (risk ratio (RR) 0.57, 95% CI 0.44 to 0.74; high quality), weaning failures (RR 0.59, 95% CI 0.43 to 0.81; high quality), pneumonia (RR 0.30, 95% CI 0.22 to 0.41; high quality), intensive care unit (ICU) (mean difference (MD) −4.62 days, 95% CI −5.91 to −3.34) and hospital stay (MD −6.29 days, 95% CI −8.90 to −3.68). Non-invasive weaning also significantly reduced the total duration of ventilation, duration of invasive ventilation and duration of ventilation related to weaning (MD −0.57, 95% CI −1.08 to −0.07) and tracheostomy rate. Mortality, pneumonia, reintubation and ICU stay were significantly lower in trials enrolling COPD (vs mixed) populations.Conclusion Non-invasive weaning significantly reduced mortality, pneumonia and the duration of ventilation related to weaning, particularly in patients with COPD. Beneficial effects are less clear (or more careful patient selection is required) in non-COPD patients.PROSPERO registration number CRD42020201402.Data are available from KEAB. ER -