Role of noninvasive ventilation in acute lung injury/acute respiratory distress syndrome: a proportion meta-analysis

Respir Care. 2010 Dec;55(12):1653-60.


Background: The role of noninvasive ventilation (NIV) in the management of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is controversial.

Objective: To assess the efficacy of NIV in patients with ALI/ARDS, using a meta-analytic technique.

Methods: We searched the PubMed and Embase databases for relevant studies published between 1995 and 2009, and included studies that reported endotracheal intubation rate and/or mortality in patients with ALI/ARDS treated with NIV. We calculated the proportions and 95% CIs to assess the outcomes in the individual studies and pooled the results with a random effects model.

Results: Our search yielded 13 eligible studies (540 patients). The intubation rate ranged from 30% to 86%, and the pooled intubation rate was 48% (95% CI 39-58%). The mortality rate ranged from 15% to 71%, and the pooled mortality rate was 35% (95% CI 26-45%). There was significant statistical heterogeneity (assessed via the I(2) test and Cochran Q statistic) in both intubation rate and mortality. There was no evidence of publication bias.

Conclusions: Our results suggest an almost 50% NIV failure rate in patients with ALI/ARDS, so NIV should be cautiously used in patients with ALI/ARDS. There is a need for a uniform NIV protocol for patients with ALI/ARDS.

Publication types

  • Meta-Analysis

MeSH terms

  • Acute Lung Injury / mortality
  • Acute Lung Injury / therapy*
  • Clinical Protocols
  • Humans
  • Positive-Pressure Respiration* / adverse effects
  • Positive-Pressure Respiration* / mortality
  • Respiratory Distress Syndrome / mortality
  • Respiratory Distress Syndrome / therapy*
  • Treatment Failure