Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, 400016, Chongqing, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, 400016, Chongqing, China.
BMC Pulm Med. 2024 Jan 22;24(1):48. doi: 10.1186/s12890-024-02839-8.
Noninvasive ventilation (NIV) is commonly used in patients with acute respiratory distress syndrome (ARDS). However, the incidence and distribution of treatment failure are unclear.
A comprehensive online search was conducted to select potentially eligible studies with reports of the rate of NIV failure in patients with ARDS. A manual search was also performed to identify additional studies. Data were extracted to calculate the pooled incidences of NIV failure and mortality. Based on oxygenation, the severity of the disease was classified as mild, moderate, or severe ARDS. Based on etiologies, ARDS was defined as being of pulmonary origin or extrapulmonary origin.
We enrolled 90 studies in this meta-analysis, involving 98 study arms. The pooled incidence of NIV failure was 48% (n = 5847, 95% confidence interval [CI]: 43-52%). The pooled incidence of ICU mortality was 29% (n = 2363, 95%CI: 22-36%), and that of hospital mortality was 33% (n = 2927, 95%CI: 27-40%). In patients with mild, moderate, and severe ARDS, the pooled incidence of NIV failure was 30% (n = 819, 95%CI: 21-39%), 51% (n = 1332, 95%CI: 43-60%), and 71% (n = 525, 95%CI: 62-79%), respectively. In patients with pulmonary ARDS, it was 45% (n = 2687, 95%CI: 39-51%). However, it was 30% (n = 802, 95%CI: 21-38%) in those with extrapulmonary ARDS. In patients with immunosuppression, the incidence of NIV failure was 62% (n = 806, 95%CI: 50-74%). However, it was 46% (n = 5041, 95%CI: 41-50%) in those without immunosuppression.
Nearly half of patients with ARDS experience NIV failure. The incidence of NIV failure increases with increasing ARDS severity. Pulmonary ARDS seems to have a higher rate of NIV failure than extrapulmonary ARDS. ARDS patients with immunosuppression have the highest rate of NIV failure.
无创通气（NIV）常用于急性呼吸窘迫综合征（ARDS）患者。然而，治疗失败的发生率和分布尚不清楚。
全面检索在线数据库，筛选出报告 ARDS 患者 NIV 失败率的潜在合格研究。还进行了手动搜索以确定其他研究。提取数据以计算 NIV 失败和死亡率的合并发生率。根据氧合情况，疾病严重程度分为轻度、中度或重度 ARDS。根据病因，ARDS 定义为肺源性或肺外源性。
本荟萃分析共纳入 90 项研究，涉及 98 个研究臂。NIV 失败的合并发生率为 48%（n=5847，95%置信区间[CI]：43-52%）。ICU 死亡率的合并发生率为 29%（n=2363，95%CI：22-36%），医院死亡率为 33%（n=2927，95%CI：27-40%）。在轻度、中度和重度 ARDS 患者中，NIV 失败的合并发生率分别为 30%（n=819，95%CI：21-39%）、51%（n=1332，95%CI：43-60%）和 71%（n=525，95%CI：62-79%）。在肺源性 ARDS 患者中，其发生率为 45%（n=2687，95%CI：39-51%）。然而，在肺外源性 ARDS 患者中，其发生率为 30%（n=802，95%CI：21-38%）。在免疫抑制患者中，NIV 失败的发生率为 62%（n=806，95%CI：50-74%）。然而，在无免疫抑制患者中，其发生率为 46%（n=5041，95%CI：41-50%）。
近一半的 ARDS 患者出现 NIV 失败。NIV 失败的发生率随着 ARDS 严重程度的增加而增加。肺源性 ARDS 似乎比肺外源性 ARDS 有更高的 NIV 失败率。免疫抑制的 ARDS 患者的 NIV 失败率最高。
