Prophylactic non-invasive positive pressure ventilation reduces complications and length of hospital stay after invasive thoracic procedures: a systematic review

In patients undergoing invasive thoracic procedures, what are the effects of prophylactic non-invasive positive pressure ventilation (NIV)? Systematic review with meta-analysis of randomised trials. Methodological quality was assessed using the PEDro scale and the certainty of evidence with the GRADE approach. Patients undergoing invasive thoracic procedures. Continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP). Length of hospital stay, postoperative pulmonary complications, need for tracheal intubation, mortality, hypoxaemia, pulmonary function and adverse events. Meta-analysis was performed for all outcomes. Subgroup analyses estimated the effects of CPAP and BIPAP independently. Sixteen trials with 1,814 participants were included. The average quality of the included studies was fair. Moderate certainty evidence indicated that NIV reduces postoperative pulmonary complications (RD –0.09, 95% CI –0.15 to –0.04) without increasing the rate of adverse events (RD 0.01, 95% CI –0.02 to 0.04). Low certainty evidence indicated that NIV reduces length of hospital stay (MD –1.4 days, 95% CI –2.2 to –0.5) compared with usual care. The effects on intubation and mortality rates were very close to no effect, indicating that NIV is safe. Subgroup analyses showed that the evidence for CPAP had more precise estimates that that for BiPAP. NIV reduces postoperative pulmonary complications and length of stay after invasive chest procedures without increasing the risk of adverse events. PROSPERO CRD42015019004.