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Review
. 2014 Feb 18;186(3):E112-22.
doi: 10.1503/cmaj.130974. Epub 2013 Dec 9.

Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review

Karen E A Burns, Maureen O Meade, Azra Premji, Neill K J Adhikari
Review

Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review

Karen E A Burns et al. CMAJ. .

Abstract

Background: Noninvasive ventilation has been studied as a means of reducing complications among patients being weaned from invasive mechanical ventilation. We sought to summarize evidence comparing noninvasive and invasive weaning and their effects on mortality.

Methods: We identified relevant randomized and quasirandomized trials through searches of databases, conference proceedings and grey literature. We included trials comparing extubation and immediate application of noninvasive ventilation with continued invasive weaning in adults on mechanical ventilation. Two reviewers each independently screened citations, assessed trial quality and abstracted data. Our primary outcome was mortality.

Results: We identified 16 trials involving 994 participants, most of whom had chronic obstructive pulmonary disease (COPD). Compared with invasive weaning, noninvasive weaning significantly reduced mortality (risk ratio [RR] 0.53, 95% confidence interval [CI] 0.36 to 0.80), weaning failures (RR 0.63, 95% CI 0.42 to 0.96), ventilator-associated pneumonia (RR 0.25, 95% CI 0.15 to 0.43), length of stay in the intensive care unit (mean difference [MD] -5.59 d, 95% CI -7.90 to -3.28) and in hospital (MD -6.04 d, 95% CI -9.22 to -2.87), and total duration of mechanical ventilation (MD -5.64 d, 95% CI -9.50 to -1.77). Noninvasive weaning had no significant effect on the duration of ventilation related to weaning, but significantly reduced rates of tracheostomy (RR 0.19, 95% CI 0.08 to 0.47) and reintubation (RR 0.65, 95% CI 0.44 to 0.97). Mortality benefits were significantly greater in trials enrolling patients with COPD than in trials enrolling mixed patient populations (RR 0.36 [95% CI 0.24 to 0.56] v. RR 0.81 [95% CI 0.47 to 1.40]).

Interpretation: Noninvasive weaning reduces rates of death and pneumonia without increasing the risk of weaning failure or reintubation. In subgroup analyses, mortality benefits were significantly greater in patients with COPD.

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Figures

Figure 1:
Figure 1:
Selection of included studies. This review represents an update of a previously conducted systematic review and meta-analysis.
Figure 2:
Figure 2:
Effect of noninvasive weaning on mortality. CI = confidence interval, COPD = chronic obstructive pulmonary disease, CRGNMV = Collaborating Research Group for Noninvasive Mechanical Ventilation, RR = risk ratio.
Figure 3:
Figure 3:
Effect of noninvasive weaning on weaning failures. CI = confidence interval, COPD = chronic obstructive pulmonary disease, CRGNMV = Collaborating Research Group for Noninvasive Mechanical Ventilation, RR = risk ratio.
Figure 4:
Figure 4:
Effect of noninvasive weaning on ventilator associated pneumonia. CI = confidence interval, COPD = chronic obstructive pulmonary disease, CRGNMV = Collaborating Research Group for Noninvasive Mechanical Ventilation, RR = risk ratio.
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References

    1. Pingleton SK. Complications of acute respiratory failure. Am Rev Respir Dis 1988;137:1463–93 - PubMed
    1. Niederman MS, Ferranti RD, Ziegler A, et al. Respiratory infection complicating long-term tracheostomy: the implication of persistent gram-negative tracheobronchial colonization. Chest 1984;85:39–44 - PubMed
    1. Heyland DK, Cook DJ, Griffith L, et al. The attributable morbidity and mortality of ventilator associated pneumonia in the critically ill patient. The Canadian Critical Care Trials Group Am J Respir Crit Care Med 1999;159:1249–56 - PubMed
    1. MacIntyre NR, Cook DJ, Ely EW, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support. A collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001; 120(Suppl 6):375S–95S - PubMed
    1. Appendini L, Patessio A, Zanaboni S, et al. Physiological effects of positive end expiratory pressure and mask pressure support during exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1994;149:1069–76 - PubMed

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