RT Journal Article
SR Electronic
T1 Non-invasive ventilation versus invasive weaning in critically ill adults: a systematic review and meta-analysis
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 752
OP 761
DO 10.1136/thoraxjnl-2021-216993
VO 77
IS 8
A1 Karen E A Burns
A1 James Stevenson
A1 Matthew Laird
A1 Neill K J Adhikari
A1 Yuchong Li
A1 Cong Lu
A1 Xiaolin He
A1 Wentao Wang
A1 Zhenting Liang
A1 Lu Chen
A1 Haibo Zhang
A1 Jan O Friedrich
YR 2022
UL http://thorax.bmj.com/content/77/8/752.abstract
AB 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. Data are available from Dr. Burns (0000-0002-9967-5424) .