Biomaterial Database

Non-invasive ventilation versus invasive weaning in critically ill adults: a systematic review and meta-analysis. 2022

Karen E A Burns, and James Stevenson, and Matthew Laird, and Neill K J Adhikari, and Yuchong Li, and Cong Lu, and Xiaolin He, and Wentao Wang, and Zhenting Liang, and Lu Chen, and Haibo Zhang, and Jan O Friedrich

Interdepartmental Division of Critical Care Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada karen.burns@unityhealth.to.

Extubation to non-invasive ventilation (NIV) has been investigated as a strategy to wean critically ill adults from invasive ventilation and reduce ventilator-related complications. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, proceedings of four conferences and bibliographies (to June 2020) for randomised and quasi-randomised trials that compared extubation with immediate application of NIV to continued invasive weaning in intubated adults and reported mortality (primary outcome) or other outcomes. Two reviewers independently screened citations, assessed trial quality and abstracted data. We identified 28 trials, of moderate-to-good quality, involving 2066 patients, 44.6% with chronic obstructive pulmonary disease (COPD). Non-invasive weaning significantly reduced mortality (risk ratio (RR) 0.57, 95% CI 0.44 to 0.74; high quality), weaning failures (RR 0.59, 95% CI 0.43 to 0.81; high quality), pneumonia (RR 0.30, 95% CI 0.22 to 0.41; high quality), intensive care unit (ICU) (mean difference (MD) -4.62 days, 95% CI -5.91 to -3.34) and hospital stay (MD -6.29 days, 95% CI -8.90 to -3.68). Non-invasive weaning also significantly reduced the total duration of ventilation, duration of invasive ventilation and duration of ventilation related to weaning (MD -0.57, 95% CI -1.08 to -0.07) and tracheostomy rate. Mortality, pneumonia, reintubation and ICU stay were significantly lower in trials enrolling COPD (vs mixed) populations. Non-invasive weaning significantly reduced mortality, pneumonia and the duration of ventilation related to weaning, particularly in patients with COPD. Beneficial effects are less clear (or more careful patient selection is required) in non-COPD patients. CRD42020201402.

UI	MeSH Term	Description	Entries
D007362	Intensive Care Units	Hospital units providing continuous surveillance and care to acutely ill patients.	ICU Intensive Care Units,Intensive Care Unit,Unit, Intensive Care
D012121	Respiration, Artificial	Any method of artificial breathing that employs mechanical or non-mechanical means to force the air into and out of the lungs. Artificial respiration or ventilation is used in individuals who have stopped breathing or have RESPIRATORY INSUFFICIENCY to increase their intake of oxygen (O2) and excretion of carbon dioxide (CO2).	Ventilation, Mechanical,Mechanical Ventilation,Artificial Respiration,Artificial Respirations,Mechanical Ventilations,Respirations, Artificial,Ventilations, Mechanical
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328	Adult	A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available.	Adults
D015300	Ventilator Weaning	Techniques for effecting the transition of the respiratory-failure patient from mechanical ventilation to spontaneous ventilation, while meeting the criteria that tidal volume be above a given threshold (greater than 5 ml/kg), respiratory frequency be below a given count (less than 30 breaths/min), and oxygen partial pressure be above a given threshold (PaO2 greater than 50mm Hg). Weaning studies focus on finding methods to monitor and predict the outcome of mechanical ventilator weaning as well as finding ventilatory support techniques which will facilitate successful weaning. Present methods include intermittent mandatory ventilation, intermittent positive pressure ventilation, and mandatory minute volume ventilation.	Mechanical Ventilator Weaning,Respirator Weaning,Ventilator Weaning, Mechanical,Weaning, Mechanical Ventilator,Weaning, Respirator,Weaning, Ventilator
D016638	Critical Illness	A disease or state in which death is possible or imminent.	Critically Ill,Critical Illnesses,Illness, Critical,Illnesses, Critical
D029424	Pulmonary Disease, Chronic Obstructive	A disease of chronic diffuse irreversible airflow obstruction. Subcategories of COPD include CHRONIC BRONCHITIS and PULMONARY EMPHYSEMA.	Airflow Obstruction, Chronic,COAD,COPD,Chronic Airflow Obstruction,Chronic Obstructive Airway Disease,Chronic Obstructive Lung Disease,Chronic Obstructive Pulmonary Disease,Chronic Obstructive Pulmonary Diseases,Airflow Obstructions, Chronic,Chronic Airflow Obstructions
D063087	Noninvasive Ventilation	Techniques for administering artificial respiration without the need for INTRATRACHEAL INTUBATION.	Non Invasive Ventilation,Non-Invasive Ventilation,Non Invasive Ventilations,Non-Invasive Ventilations,Noninvasive Ventilations,Ventilation, Non Invasive,Ventilation, Non-Invasive,Ventilation, Noninvasive,Ventilations, Non Invasive,Ventilations, Non-Invasive,Ventilations, Noninvasive