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VOLUME 17 , ISSUE 4 ( August, 2013 ) > List of Articles

META ANALYSIS

The role of non-invasive positive pressure ventilation in post-extubation respiratory failure: An evaluation using meta-analytic techniques

John L. Moran

Keywords : Bi-level positive airway pressure ventilation, continuous positive airway pressure ventilation, non-invasive ventilation, post-extubation, reintubation, respiratory failure

Citation Information : Moran JL. The role of non-invasive positive pressure ventilation in post-extubation respiratory failure: An evaluation using meta-analytic techniques. Indian J Crit Care Med 2013; 17 (4):253-261.

DOI: 10.4103/0972-5229.118477

License: CC BY-ND 3.0

Published Online: 01-08-2013

Copyright Statement:  Copyright © 2013; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: The use of non-invasive positive pressure ventilation (NIPPV) in post-extubation respiratory failure is not well-established. Meta-analytic techniques were used to assess the effects of prophylactic application of NIPPV (prior to the development of respiratory failure) and therapeutic application of NIPPV (subsequent to the development of respiratory failure). Materials and Methods: Randomized controlled trials (RCTs) from 1966 to May 2010 were identified using electronic databases. RCTs, which reported the use of NIPPV in post-extubation respiratory failure with defined assessable endpoints: reintubation, mortality and length of stay, were included. Results: Reintubation was the primary outcome, mortality and lengths of stay were the secondary outcomes. Risk ratios (RR) were calculated for discrete outcomes and weighted mean differences (WMD) for continuous measures. There were 13 trials with 1420 patients; 9 prophylactic with 861 patients and 4 therapeutic with 559 patients. In the prophylactic group, NIPPV was associated with lower rates of reintubation: RR 0.53 (95% confidence interval [CI], 0.28-0.98), P = 0.04. In the therapeutic group, NIPPV showed a null effect on reintubation: RR 0.79 (95% CI, 0.50-1.25), P = 0.31. The analysis on the secondary outcomes suggested significant reduction of hospital mortality with prophylactic application of NIPPV: RR 0.62 (95% CI 0.4-0.97), P = 0.03, with no effect on the other outcomes. Therapeutic application of NIPPV reduced intensive care unit length of stay: WMD −1.17 (95% CI −2.82 to −0.33), P = 0.006, but no effect on the other secondary outcomes. Conclusions: The results of this review suggested prophylactic NIPPV was beneficial with respect to reintubation and the therapeutic use of NIPPV showed a null effect.


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  1. Esteban A, Frutos F, Tobin MJ, Alía I, Solsona JF, Valverdú I, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 1995;332:345-50.
  2. Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 1994;150:896-903.
  3. Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996;335:1864-9.
  4. Esteban A, Alía I, Gordo F, Fernández R, Solsona JF, Vallverdú I, et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 1997;156:459-65.
  5. Esteban A, Alía I, Tobin MJ, Gil A, Gordo F, Vallverdú I, et al. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 1999;159:512-8.
  6. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997;112:186-92.
  7. Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 1998;158:489-93.
  8. Torres A, Gatell JM, Aznar E, el-Ebiary M, Puig de la Bellacasa J, González J, et al. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 1995;152:137-41.
  9. Seymour CW, Martinez A, Christie JD, Fuchs BD. The outcome of extubation failure in a community hospital intensive care unit: A cohort study. Crit Care 2004;8:R322-7.
  10. Hillberg RE, Johnson DC. Noninvasive ventilation. N Engl J Med 1997;337:1746-52.
  11. Kilger E, Briegel J, Haller M, Frey L, Schelling G, Stoll C, et al. Effects of noninvasive positive pressure ventilatory support in non-COPD patients with acute respiratory insufficiency after early extubation. Intensive Care Med 1999;25:1374-80.
  12. Lightowler JV, Wedzicha JA, Elliott MW, Ram FS. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 2003;326:185.
  13. Keenan SP, Sinuff T, Cook DJ, Hill NS. Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med 2003;138:861-70.
  14. Elliott MW. Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: A new gold standard? Intensive Care Med 2002;28:1691-4.
  15. Nava S, Carbone G, DiBattista N, Bellone A, Baiardi P, Cosentini R, et al. Noninvasive ventilation in cardiogenic pulmonary edema: A multicenter randomized trial. Am J Respir Crit Care Med 2003;168:1432-7.
  16. Crane SD, Elliott MW, Gilligan P, Richards K, Gray AJ. Randomised controlled comparison of continuous positive airways pressure, bilevel non-invasive ventilation, and standard treatment in emergency department patients with acute cardiogenic pulmonary oedema. Emerg Med J 2004;21:155-61.
  17. Bellone A, Monari A, Cortellaro F, Vettorello M, Arlati S, Coen D. Myocardial infarction rate in acute pulmonary edema: Noninvasive pressure support ventilation versus continuous positive airway pressure. Crit Care Med 2004;32:1860-5.
  18. Hilbert G, Gruson D, Portel L, Gbikpi-Benissan G, Cardinaud JP. Noninvasive pressure support ventilation in COPD patients with postextubation hypercapnic respiratory insufficiency. Eur Respir J 1998;11:1349-53.
  19. Keenan SP, Powers C, McCormack DG, Block G. Noninvasive positive-pressure ventilation for postextubation respiratory distress: A randomized controlled trial. JAMA 2002;287:3238-44.
  20. Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguía C, González M, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 2004;350:2452-60.
  21. Nava S, Gregoretti C, Fanfulla F, Squadrone E, Grassi M, Carlucci A, et al. Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med 2005;33:2465-70.
  22. Ferrer M, Valencia M, Nicolas JM, Bernadich O, Badia JR, Torres A. Early noninvasive ventilation averts extubation failure in patients at risk: A randomized trial. Am J Respir Crit Care Med 2006;173:164-70.
  23. Burns KE, Adhikari NK, Meade MO. Noninvasive positive pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev 2003;4:CD004127.
  24. Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Role of noninvasive positive-pressure ventilation in postextubation respiratory failure: A meta-analysis. Respir Care 2007;52:1472-9.
  25. Burns KE, Adhikari NK, Keenan SP, Meade M. Use of non-invasive ventilation to wean critically ill adults off invasive ventilation: Meta-analysis and systematic review. BMJ 2009;338:b1574.
  26. Pinilla JC, Oleniuk FH, Tan L, Rebeyka I, Tanna N, Wilkinson A, et al. Use of a nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery. Crit Care Med 1990;18:836-40.
  27. Jiang JS, Kao SJ, Wang SN. Effect of early application of biphasic positive airway pressure on the outcome of extubation in ventilator weaning. Respirology 1999;4:161-5.
  28. Fagevik Olsén M, Wennberg E, Johnsson E, Josefson K, Lönroth H, Lundell L. Randomized clinical study of the prevention of pulmonary complications after thoracoabdominal resection by two different breathing techniques. Br J Surg 2002;89:1228-34.
  29. Böhner H, Kindgen-Milles D, Grust A, Buhl R, Lillotte WC, Müller BT, et al. Prophylactic nasal continuous positive airway pressure after major vascular surgery: Results of a prospective randomized trial. Langenbecks Arch Surg 2002;387:21-6.
  30. Ebeo CT, Benotti PN, Byrd RP Jr, Elmaghraby Z, Lui J. The effect of bi-level positive airway pressure on postoperative pulmonary function following gastric surgery for obesity. Respir Med 2002;96:672-6.
  31. Kindgen-Milles D, Müller E, Buhl R, Böhner H, Ritter D, Sandmann W, et al. Nasal-continuous positive airway pressure reduces pulmonary morbidity and length of hospital stay following thoracoabdominal aortic surgery. Chest 2005;128:821-8.
  32. Auriant I, Jallot A, Hervé P, Cerrina J, Le Roy Ladurie F, Fournier JL, et al. Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med 2001;164:1231-5.
  33. Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P, et al. Continuous positive airway pressure for treatment of postoperative hypoxemia: A randomized controlled trial. JAMA 2005;293:589-95.
  34. Krishna B, Sampath S, Moran JL, Biradar V. The role of non-invasive positive pressure ventilation (NIPPV) in post-extubation respiratory failure: An evaluation using meta-analytic techniques. Paper presented at: ESICM 2007.Proceedings of the 20 th ESICM Annual Congress; 2007 Oct 7-10; Berlin, Germany: Intensive Care Med; 2007:33:S97.
  35. Robinson KA, Dickersin K. Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol 2002;31:150-3.
  36. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998;52:377-84.
  37. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-60.
  38. Harris R, Bradburn M, Deeks J, Harbord R, Altman D, Sterne J. Metan: Fixed- and random-effects meta-analysis. Stata J 2008;8:3-28.
  39. Harbord RM, Higgins JP. Meta-regression in Stata. Stata J 2008;8:493-519.
  40. Harbord RM, Harris RJ, Sterne JA. Updated tests for small-study effects inmeta-analyses. Stata J 2009;9:197-210.
  41. Ferrer M, Sellarés J, Valencia M, Carrillo A, Gonzalez G, Badia JR, et al. Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: Randomised controlled trial. Lancet 2009;374:1082-8.
  42. Thomas JA, McIntosh JM. Are incentive spirometry, intermittent positive pressure breathing, and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery? A systematic overview and meta-analysis. Phys Ther 1994;74:3-10.
  43. Ferreyra GP, Baussano I, Squadrone V, Richiardi L, Marchiaro G, Del Sorbo L, et al. Continuous positive airway pressure for treatment of respiratory complications after abdominal surgery: A systematic review and meta-analysis. Ann Surg 2008;247:617-26.
  44. Jaber S, Chanques G, Jung B. Postoperative noninvasive ventilation. Anesthesiology 2010;112:453-61.
  45. Joris JL, Sottiaux TM, Chiche JD, Desaive CJ, Lamy ML. Effect of bi-level positive airway pressure (BiPAP) nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty. Chest 1997;111:665-70.
  46. Hess DR, Stelfox HT, Schmidt U. Noninvasive positive-pressure ventilation: A silver bullet for extubation failure? Respir Care 2007;52:1454-6.
  47. Flather MD, Farkouh ME, Pogue JM, Yusuf S. Strengths and limitations of meta-analysis: Larger studies may be more reliable. Control Clin Trials
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