Citation Information :
Maitra S, Bhattacharjee S, Som A. Noninvasive Ventilation and Oxygen Therapy after Extubation in Patients with Acute Respiratory Failure: A Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2019; 23 (9):414-422.
Background: Role of noninvasive ventilation (NIV) following extubation in patients with acute respiratory failure is debatable. NIV may provide benefit in post surgical patients, but its role in nonsurgical patients is controversial.
Materials and methods: PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) were searched (from 1946 to 20th November 2017) to identify prospective randomized controlled trials, where postextubation NIV has been compared with standard oxygen therapy in adult patients with acute respiratory failure.
Results: Data of 1525 patients from 11 randomized trials have been included in this meta-analysis. Two trials used NIV to manage post-extubation respiratory failure. Pooled analysis found that mortality rate at longest available follow-up [OR (95% CI) 0.84 (0.50, 1.42); p = 0.52] and reintubation rate [OR (95% CI) 0.75 (0.51, 1.09); p = 0.13] were similar between NIV and standard oxygen therapy. NIV did not decrease intubation rate when used as preventive modality [OR (95% CI) 0.65 (0.40, 1.06); p = 0.08]. Duration of ICU stay was also similar in the two groups [MD (95% CI) 0.46 (-0.43, 1.36) days; p = 0.3]
Conclusion: Post extubation NIV in non- surgical patients with acute respiratory failure does not provide any benefit over conventional oxygen therapy.
Colinas L, Canabal A, Hernández G. Reducing reintubation and postextubation respiratory failure: improving high-flow oxygen support performance. J Thorac Dis. 2016;8:E1429–E1431.
Demoule A, Chevret S, Carlucci A, Kouatchet A, Jaber S, Meziani F, et al.; oVNI Study Group; REVA Network (Research Network in Mechanical Ventilation). Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophone countries. Intensive Care Med. 2016;42:82–92.
Schnell D, Timsit JF, Darmon M, Vesin A, Goldgran-Toledano D, Dumenil AS, et al. Noninvasive mechanical ventilation in acute respiratory failure: trends in use and outcomes. Intensive Care Med. 2014;40:582–591.
Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017;7:CD004104.
Lin C, Yu H, Fan H, Li Z. The efficacy of noninvasive ventilation in managing postextubation respiratory failure: a meta-analysis. Heart Lung. 2014;43:99–104.
Vargas F, Clavel M, Sanchez-Verlan P, Garnier S, Boyer A, Bui HN. Intermittent noninvasive ventilation after extubation in patients with chronic respiratory disorders: a multicenter randomized controlled trial (VHYPER). Intensive Care Med. 2017;43:1626–1636.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.
Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005;5:13.
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;4:161–165.
Keenan SP, Powers C, McCormack DG, Block G. Noninvasive positive-pressure ventilation for postextubation respiratory distress: a randomized controlled trial. JAMA. 2002;287:3238–3244.
Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguía C, González M. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med. 2004;350:2452–2460.
Nava S, Gregoretti C, Fanfulla F, Squadron E, Fatty M, Carlucci A. Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med. 2005;33:2465–2470.
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;173:164–170.
Ferrer M, Sellarés J, Valencia M, Carrillo A, Gonzalez G, Badia JR. Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial. Lancet. 2009;374:1082–1088.
Khilnani GC, Galle AD, Hadda V, Sharma SK. Non-invasive ventilation after extubation in patients with chronic obstructive airways disease: a randomised controlled trial. Anaesth Intensive Care. 2011;39:217–223.
Su CL, Chiang LL, Yang SH, Lin HI, Cheng KC, Huang YC. Preventive use of noninvasive ventilation after extubation: a prospective, multicenter randomized controlled trial. Respir Care. 2012;57:204–210.
Ornico SR, Lobo SM, Sanches HS, Deberaldini M, Tófoli LT, Vidal AM et al. Noninvasive ventilation immediately after extubation improves weaning outcome after acute respiratory failure: a randomized controlled trial. Crit Care. 2013;17:R39.
Vargas F, Clavel M, Sanchez-Verlan P, Garnier S, Boyer A, Bui HN et al. Intermittent noninvasive ventilation after extubation in patients with chronic respiratory disorders: a multicenter randomized controlled trial (VHYPER). Intensive Care Med. 2017;43:1626–1636.
Frutos-Vivar F, Esteban A, Apezteguia C, González M, Arabi Y, Restrepo MI. Outcome of reintubated patients after scheduled extubation. J Crit Care. 2011;26:502–509.
Kondo Y, Kumasawa J, Kawaguchi A, Seo R, Nango E, Hashimoto S. Effects of non-invasive ventilation in patients with acute respiratory failure excluding post-extubation respiratory failure, cardiogenic pulmonary edema and exacerbation of COPD: a systematic review and meta-analysis. J Anesth. 2017;31:714–725.
Glossop AJ, Shephard N, Bryden DC, Mills GH. Non-invasive ventilation for weaning, avoiding reintubation after extubation and in the postoperative period: a meta-analysis. Br J Anaesth. 2012;109:305–314. Erratum in: Br J Anaesth. 2013;110:164.
Demoule A, Girou E, Richard JC, Taille S, Brochard L. Benefits and risks of success or failure of noninvasive ventilation. Intensive Care Med 2006;32:1756–1765.
Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S et al. Members of the Task Force. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50.pii: 1602426.
Ouellette DR, Patel S, Girard TD, Morris PE, Schmidt GA, Truwit JD, et al. Liberation From Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: Inspiratory Pressure Augmentation During Spontaneous Breathing Trials, Protocols Minimizing Sedation, and Noninvasive Ventilation Immediately After Extubation. Chest. 2017;151:166–180.
Krishna B, Sampath S, 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;17:253–261.