Non-invasive ventilation in children and adults in low- and low-middle income countries: A systematic review and meta-analysis

Keren Mandelzweig; Aleksandra Leligdowicz; Srinivas Murthy; Rejani Lalitha; Robert A Fowler; Neill K J Adhikari

doi:10.1016/j.jcrc.2018.01.007

Non-invasive ventilation in children and adults in low- and low-middle income countries: A systematic review and meta-analysis

J Crit Care. 2018 Oct:47:310-319. doi: 10.1016/j.jcrc.2018.01.007. Epub 2018 Jan 12.

Authors

Keren Mandelzweig¹, Aleksandra Leligdowicz², Srinivas Murthy³, Rejani Lalitha⁴, Robert A Fowler⁵, Neill K J Adhikari⁶

Affiliations

¹ Division of Critical Care, Department of Medicine, Humber River Regional Hospital, 1235 Wilson Avenue Toronto, ON, M3M 0B2, Canada.
² Toronto Western Hospital MSNICU, 2nd Flr McLaughlin Room 411-Q, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada.
³ Division of Critical Care, BC Children's Hospital, 4500 Oak Street, Vancouver, BC V6H 3V4, Canada.
⁴ Makerere University College of Health Sciences, Department of Medicine, PO Box 7072, Kampala, Uganda.
⁵ Department of Critical Care Medicine, Room D1.08, Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. Electronic address: rob.fowler@sunnybrook.ca.
⁶ Department of Critical Care Medicine, Room D1.08, Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. Electronic address: neill.adhikari@utoronto.ca.

PMID: 29426584
DOI: 10.1016/j.jcrc.2018.01.007

Abstract

Purpose: We systematically reviewed the effects of NIV for acute respiratory failure (ARF) in low- and low-middle income countries.

Materials and methods: We searched MEDLINE, CENTRAL, and EMBASE (to January 2016) for observational studies and trials of NIV for ARF or in the peri-extubation period in adults and post-neonatal children. We abstracted outcomes data and assessed quality. Meta-analyses used random-effect models.

Results: Fifty-four studies (ten pediatric/n=1099; 44 adult/n=2904), mostly South Asian, were included. Common diagnoses were pneumonia and chronic obstructive pulmonary disease (COPD). Considering observational studies and the NIV arm of trials, NIV was associated with moderate risks of mortality (pooled risk 9.5%, 95% confidence interval (CI) 4.6-14.5% in children; 16.2% [11.2-21.2%] in adults); NIV failure (10.5% [4.6-16.5%] in children; 28.5% [22.4-34.6%] in adults); and intubation (5.3% [0.8-9.7%] in children; 28.8% [21.9-35.8%] in adults). The risk of mortality was greater (p=0.035) in adults with hypoxemic (25.7% [15.2-36.1%]) vs. hypercapneic (12.8% [7.0-18.6%]) ARF. NIV reduced mortality in COPD (relative risk [RR] 0.47 [0.27-0.79]) and in patients weaning from ventilation (RR 0.48 [0.28-0.80]). The pooled pneumothorax risk was 2.4% (0.8-3.9%) in children and 5.2% (1.0-9.4%) in adults. Meta-analyses had high heterogeneity.

Conclusions: NIV for ARF in these settings appears to be effective.

Keywords: Acute respiratory failure; Low middle-income country; Low-income country; Non-invasive ventilation; Systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Airway Extubation / methods
Child
Developing Countries
Humans
Intubation / methods
Noninvasive Ventilation / methods*
Observational Studies as Topic
Poverty
Pulmonary Disease, Chronic Obstructive / mortality
Pulmonary Disease, Chronic Obstructive / therapy
Randomized Controlled Trials as Topic
Respiratory Distress Syndrome / mortality
Respiratory Distress Syndrome / therapy
Respiratory Insufficiency / mortality*
Respiratory Insufficiency / therapy*
Risk