Institute of Anesthesia and Intensive Care, University Hospital of Padua, 13 Via Gallucci, 35121, Padua, Italy.
Department of Medicine, University of Padua, 2 Via Giustiniani, 35128, Padua, Italy.
Crit Care. 2024 May 8;28(1):152. doi: 10.1186/s13054-024-04924-0.
Re-intubation secondary to post-extubation respiratory failure in post-operative patients is associated with increased patient morbidity and mortality. Non-invasive respiratory support (NRS) alternative to conventional oxygen therapy (COT), i.e., high-flow nasal oxygen, continuous positive airway pressure, and non-invasive ventilation (NIV), has been proposed to prevent or treat post-extubation respiratory failure. Aim of the present study is assessing the effects of NRS application, compared to COT, on the re-intubation rate (primary outcome), and time to re-intubation, incidence of nosocomial pneumonia, patient discomfort, intensive care unit (ICU) and hospital length of stay, and mortality (secondary outcomes) in adult patients extubated after surgery.
A systematic review and network meta-analysis of randomized and non-randomized controlled trials. A search from Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from inception until February 2, 2024 was performed.
Thirty-three studies (11,292 patients) were included. Among all NRS modalities, only NIV reduced the re-intubation rate, compared to COT (odds ratio 0.49, 95% confidence interval 0.28; 0.87, p = 0.015, I = 60.5%, low certainty of evidence). In particular, this effect was observed in patients receiving NIV for treatment, while not for prevention, of post-extubation respiratory failure, and in patients at high, while not low, risk of post-extubation respiratory failure. NIV reduced the rate of nosocomial pneumonia, ICU length of stay, and ICU, hospital, and long-term mortality, while not worsening patient discomfort.
In post-operative patients receiving NRS after extubation, NIV reduced the rate of re-intubation, compared to COT, when used for treatment of post-extubation respiratory failure and in patients at high risk of post-extubation respiratory failure.
术后患者因拔管后呼吸衰竭而再次插管与患者发病率和死亡率增加相关。与传统氧疗（COT）相比，非侵入性呼吸支持（NRS），如高流量鼻氧、持续气道正压通气和无创通气（NIV），已被提议用于预防或治疗拔管后呼吸衰竭。本研究的目的是评估与 COT 相比，NRS 应用对再插管率（主要结局）和再插管时间、医院获得性肺炎发生率、患者不适、重症监护病房（ICU）和住院时间以及死亡率（次要结局）的影响在接受手术后拔管的成年患者中。
对随机和非随机对照试验进行系统评价和网络荟萃分析。从 Medline、Embase、Scopus、Cochrane 对照试验中心注册库和 Web of Science 进行了从开始到 2024 年 2 月 2 日的搜索。
共纳入 33 项研究（11292 名患者）。在所有 NRS 方式中，与 COT 相比，仅 NIV 降低了再插管率（比值比 0.49，95%置信区间 0.28；0.87，p = 0.015，I = 60.5%，证据质量低）。特别是，这种效果在接受 NIV 治疗拔管后呼吸衰竭的患者中观察到，而在预防拔管后呼吸衰竭的患者中没有观察到，在高风险的患者中观察到，而在低风险的患者中没有观察到。NIV 降低了医院获得性肺炎、ICU 住院时间以及 ICU、医院和长期死亡率的发生率，同时没有增加患者不适。
在接受 NRS 治疗的术后患者中，与 COT 相比，NIV 降低了再插管率，尤其是在治疗拔管后呼吸衰竭和高风险患者中。
