Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review
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. We identified relevant randomized and quasirandom...
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| Veröffentlicht in: | Canadian Medical Association journal (CMAJ) 2014-02, Vol.186 (3), p.E112-E122 |
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| creator | Burns, Karen E A Meade, Maureen O Premji, Azra Adhikari, Neill K J |
| description | 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.
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.
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]).
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. |
| doi_str_mv | 10.1503/cmaj.130974 |
| format | Article |
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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.
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]).
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.</description><identifier>ISSN: 0820-3946</identifier><identifier>EISSN: 1488-2329</identifier><identifier>DOI: 10.1503/cmaj.130974</identifier><identifier>PMID: 24324020</identifier><identifier>CODEN: CMAJAX</identifier><language>eng</language><publisher>Canada: Joule Inc</publisher><subject>Adult ; Adults ; Analysis ; Bacterial pneumonia ; Comparative studies ; Complications and side effects ; Humans ; Lung diseases, Obstructive ; Mortality ; Noninvasive Ventilation - methods ; Pneumonia ; Pulmonary Disease, Chronic Obstructive - complications ; Respiration, Artificial - methods ; Respiratory diseases ; Respiratory Insufficiency - etiology ; Respiratory Insufficiency - therapy ; Systematic review ; Ventilation ; Ventilator Weaning - methods ; Ventilators</subject><ispartof>Canadian Medical Association journal (CMAJ), 2014-02, Vol.186 (3), p.E112-E122</ispartof><rights>COPYRIGHT 2014 Joule Inc.</rights><rights>Copyright Canadian Medical Association Feb 18, 2014</rights><rights>1995-2014, Canadian Medical Association 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c673t-7df1ab97127a3fd5479d6758bd762cedcca3caa9bd713d872cecad30e3106e803</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928231/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928231/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24324020$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Burns, Karen E A</creatorcontrib><creatorcontrib>Meade, Maureen O</creatorcontrib><creatorcontrib>Premji, Azra</creatorcontrib><creatorcontrib>Adhikari, Neill K J</creatorcontrib><title>Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review</title><title>Canadian Medical Association journal (CMAJ)</title><addtitle>CMAJ</addtitle><description>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.
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.
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]).
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.</description><subject>Adult</subject><subject>Adults</subject><subject>Analysis</subject><subject>Bacterial pneumonia</subject><subject>Comparative studies</subject><subject>Complications and side effects</subject><subject>Humans</subject><subject>Lung diseases, Obstructive</subject><subject>Mortality</subject><subject>Noninvasive Ventilation - methods</subject><subject>Pneumonia</subject><subject>Pulmonary Disease, Chronic Obstructive - complications</subject><subject>Respiration, Artificial - methods</subject><subject>Respiratory diseases</subject><subject>Respiratory Insufficiency - etiology</subject><subject>Respiratory Insufficiency - therapy</subject><subject>Systematic review</subject><subject>Ventilation</subject><subject>Ventilator Weaning - methods</subject><subject>Ventilators</subject><issn>0820-3946</issn><issn>1488-2329</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqV092L1DAQAPAiineePvkuxQNRpGs-2qb1QTgWPw6OE_x4Dtl02mZpm70k3XX_BP9rZ9nz3Mo-aPtQOvnN0EkzUfSUkhnNCH-je7WcUU5Kkd6LTmlaFAnjrLwfnZKCkYSXaX4SPfJ-SfDiTDyMTljKWUoYOY1-XtvBDGvlzRriNQzBdCoYO8TKxyregMLVJvbBqQDNNq6ti3vQLYa16iYJBnOqsQs-3pjQxg78ymCWdZilTDc6eIsV51a3Tg0Q-60P0GOqRro2sHkcPahV5-HJ7fMs-v7h_bf5p-Tq88fL-cVVonPBQyKqmqpFKSgTitdVloqyykVWLCqRMw2V1oprpUp8p7wqBMa0qjgBTkkOBeFn0bt93dW46NFjC051cuVMr9xWWmXkdGUwrWzsWvKSFYxTLPDytoCzNyP4IHvjNXQdtmVHL2lG05QRSrN_oITkRUlYjvT8L7q0oxtwJ3ZKZDkXlPxRjepAmqG2-Il6V1Re8JyRPKO0QJUcUQ0MgP3YAWqD4Yl_fsTrlbmRh2h2BOFdQW_00aqvJgloAvwIjRq9l5dfv_yHvZ7aFwe2BdWF1ttu3J1CP4Wv91A7672D-u4nU7LbVC53oyP3o4P62eG5uLO_Z4X_AorJEpA</recordid><startdate>20140218</startdate><enddate>20140218</enddate><creator>Burns, Karen E A</creator><creator>Meade, Maureen O</creator><creator>Premji, Azra</creator><creator>Adhikari, Neill K J</creator><general>Joule Inc</general><general>CMA Impact, Inc</general><general>Canadian Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>8FV</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M3G</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140218</creationdate><title>Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review</title><author>Burns, Karen E A ; Meade, Maureen O ; Premji, Azra ; Adhikari, Neill K J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c673t-7df1ab97127a3fd5479d6758bd762cedcca3caa9bd713d872cecad30e3106e803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Adults</topic><topic>Analysis</topic><topic>Bacterial pneumonia</topic><topic>Comparative studies</topic><topic>Complications and side effects</topic><topic>Humans</topic><topic>Lung diseases, Obstructive</topic><topic>Mortality</topic><topic>Noninvasive Ventilation - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Canadian Medical Association journal (CMAJ)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Burns, Karen E A</au><au>Meade, Maureen O</au><au>Premji, Azra</au><au>Adhikari, Neill K J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review</atitle><jtitle>Canadian Medical Association journal (CMAJ)</jtitle><addtitle>CMAJ</addtitle><date>2014-02-18</date><risdate>2014</risdate><volume>186</volume><issue>3</issue><spage>E112</spage><epage>E122</epage><pages>E112-E122</pages><issn>0820-3946</issn><eissn>1488-2329</eissn><coden>CMAJAX</coden><abstract>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.
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.
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]).
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.</abstract><cop>Canada</cop><pub>Joule Inc</pub><pmid>24324020</pmid><doi>10.1503/cmaj.130974</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Canadian Medical Association journal (CMAJ), 2014-02, Vol.186 (3), p.E112-E122 |
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| subjects | Adult Adults Analysis Bacterial pneumonia Comparative studies Complications and side effects Humans Lung diseases, Obstructive Mortality Noninvasive Ventilation - methods Pneumonia Pulmonary Disease, Chronic Obstructive - complications Respiration, Artificial - methods Respiratory diseases Respiratory Insufficiency - etiology Respiratory Insufficiency - therapy Systematic review Ventilation Ventilator Weaning - methods Ventilators |
| title | Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review |
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