Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Crit Care Med. 2023 Jul 1;51(7):872-880. doi: 10.1097/CCM.0000000000005865. Epub 2023 Mar 30.
To identify factors associated with failure of noninvasive ventilation (NIV) in the post-extubation period.
We searched Embase Classic +, MEDLINE, and the Cochrane Database of Systematic Reviews from inception to February 28, 2022.
We included English language studies that provided predictors of post-extubation NIV failure necessitating reintubation.
Two authors conducted data abstraction and risk-of-bias assessments independently. We used a random-effects model to pool binary and continuous data and summarized estimates of effect using odds ratios (ORs) mean difference (MD), respectively. We used the Quality in Prognosis Studies tool to assess risk of bias and the Grading of Recommendations, Assessment, Development and Evaluations to assess certainty.
We included 25 studies ( n = 2,327). Illness-related factors associated with increased odds of post-extubation NIV failure were higher critical illness severity (OR, 3.56; 95% CI, 1.96-6.45; high certainty) and a diagnosis of pneumonia (OR, 6.16; 95% CI, 2.59-14.66; moderate certainty). Clinical and biochemical factors associated with moderate certainty of increased risk of NIV failure post-extubation include higher respiratory rate (MD, 1.54; 95% CI, 0.61-2.47), higher heart rate (MD, 4.46; 95% CI, 1.67-7.25), lower Pa o2 :F io2 (MD, -30.78; 95% CI, -50.02 to -11.54) 1-hour after NIV initiation, and higher rapid shallow breathing index (MD, 15.21; 95% CI, 12.04-18.38) prior to NIV start. Elevated body mass index was the only patient-related factor that may be associated with a protective effect (OR, 0.21; 95% CI, 0.09-0.52; moderate certainty) on post-extubation NIV failure.
We identified several prognostic factors before and 1 hour after NIV initiation associated with increased risk of NIV failure in the post-extubation period. Well-designed prospective studies are required to confirm the prognostic importance of these factors to help further guide clinical decision-making.
确定与拔管后无创通气（NIV）失败相关的因素。
我们检索了 Embase Classic+、MEDLINE 和 Cochrane 系统评价数据库，检索时间截至 2022 年 2 月 28 日。
我们纳入了提供拔管后 NIV 失败预测因素（需要重新插管）的英文研究。
两名作者独立进行数据提取和偏倚风险评估。我们使用随机效应模型对二分类和连续数据进行汇总，并分别使用优势比（ORs）和均数差值（MD）来总结效应估计值。我们使用预后研究质量工具（Quality in Prognosis Studies tool）评估偏倚风险，使用推荐、评估、制定和评估分级（Grading of Recommendations, Assessment, Development and Evaluations）评估确定性。
我们纳入了 25 项研究（n=2327）。与拔管后 NIV 失败风险增加相关的疾病相关因素包括更高的严重疾病程度（OR，3.56；95%CI，1.96-6.45；高确定性）和肺炎诊断（OR，6.16；95%CI，2.59-14.66；中等确定性）。与拔管后 NIV 失败风险增加具有中等确定性相关的临床和生化因素包括更高的呼吸频率（MD，1.54；95%CI，0.61-2.47）、更高的心率（MD，4.46；95%CI，1.67-7.25）、NIV 开始后 1 小时 Pa o2 :F io2 降低（MD，-30.78；95%CI，-50.02 至-11.54）和开始 NIV 前快速浅呼吸指数升高（MD，15.21；95%CI，12.04-18.38）。升高的体重指数是唯一与拔管后 NIV 失败保护作用相关的患者相关因素（OR，0.21；95%CI，0.09-0.52；中等确定性）。
我们确定了 NIV 开始前和开始后 1 小时与拔管后 NIV 失败风险增加相关的几个预后因素。需要进行设计良好的前瞻性研究来证实这些因素的预后重要性，以帮助进一步指导临床决策。
