Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy.
Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy.
Crit Care. 2021 Jun 1;25(1):189. doi: 10.1186/s13054-021-03595-5.
Usefulness of noninvasive ventilation (NIV) in weaning patients with non-hypercapnic hypoxemic acute respiratory failure (hARF) is unclear. The study aims to assess in patients with non-hypercapnic hARF, the efficacy of NIV after early extubation, compared to standard weaning.
In this individual patient data meta-analysis, we searched EMBASE, Medline and Cochrane Central Register of Controlled Trials to identify potentially eligible randomized controlled trials published from database inception to October 2020. To be eligible, studies had to include patients treated with NIV after early extubation and compared to conventional weaning in adult non-hypercapnic hARF patients. Anonymized individual patient data from eligible studies were provided by study investigators. Using one-step and two-step meta-analysis models we tested the difference in total days spent on invasive ventilation.
We screened 1605 records. Six studies were included in quantitative synthesis. Overall, 459 participants (mean [SD] age, 62 [15] years; 269 [59%] males) recovering from hARF were included in the analysis (233 in the intervention group and 226 controls). Participants receiving NIV had a shorter duration of invasive mechanical ventilation compared to control group (mean difference, - 3.43; 95% CI - 5.17 to - 1.69 days, p < 0.001), a shorter duration of total days spent on mechanical ventilation (mean difference, - 2.04; 95% CI - 3.82 to - 0.27 days, p = 0.024), a reduced risk of ventilatory associated pneumonia (odds ratio, 0.24; 95% CI 0.08 to 0.71, p = 0.014), a reduction of time spent in ICU (time ratio, 0.81; 95% CI 0.68 to 0.96, p = 0.015) and in-hospital (time ratio, 0.81; 95% CI 0.69 to 0.95, p = 0.010), with no difference in ICU mortality.
Although primary studies are limited, using an individual patient data metanalysis approach, NIV after early extubation appears useful in reducing total days spent on invasive mechanical ventilation.
The protocol was registered to PROSPERO database on 12/06/2019 and available at PROSPERO website inserting the study code i.e., CRD42019133837.
无创通气（NIV）在非高碳酸血症性低氧性急性呼吸衰竭（hARF）患者撤机中的作用尚不清楚。本研究旨在评估在非高碳酸血症性 hARF 患者中，与标准撤机相比，早期拔管后使用 NIV 的效果。
在这项个体患者数据荟萃分析中，我们检索了 EMBASE、Medline 和 Cochrane 对照试验中心注册库，以确定从数据库建立到 2020 年 10 月发表的潜在合格的随机对照试验。合格研究必须包括在非高碳酸血症性 hARF 患者中，早期拔管后接受 NIV 治疗，并与常规撤机进行比较。研究调查人员提供了合格研究中匿名的个体患者数据。我们使用一步和两步荟萃分析模型来检验侵入性通气总天数的差异。
我们筛选了 1605 条记录。6 项研究纳入了定量综合分析。共有 459 名（平均[标准差]年龄，62[15]岁；269[59%]男性）hARF 恢复期患者纳入分析（干预组 233 例，对照组 226 例）。与对照组相比，接受 NIV 的患者侵入性机械通气时间更短（平均差异，-3.43；95%CI-5.17 至-1.69 天，p<0.001），机械通气总天数更短（平均差异，-2.04；95%CI-3.82 至-0.27 天，p=0.024），呼吸机相关性肺炎的风险降低（比值比，0.24；95%CI0.08 至 0.71，p=0.014），ICU 时间（时间比，0.81；95%CI0.68 至 0.96，p=0.015）和住院时间（时间比，0.81；95%CI0.69 至 0.95，p=0.010）缩短，而 ICU 死亡率无差异。
尽管主要研究有限，但使用个体患者数据荟萃分析方法，早期拔管后使用 NIV 似乎可减少侵入性机械通气的总时间。
该方案于 2019 年 6 月 12 日在 PROSPERO 数据库中注册，并可在 PROSPERO 网站上通过插入研究代码（即 CRD42019133837）找到。
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