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J Crit Care. 2019 Feb;49:84-91. doi: 10.1016/j.jcrc.2018.10.012. Epub 2018 Oct 19.

Noninvasive ventilation in acute hypoxemic respiratory failure: A systematic review and meta-analysis.

Author information

1
Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil.
2
Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
3
Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil; CEPI - Centro de Ensino Pesquisa e Inovação, Hospital Marcelino Champagnat, Curitiba, Brazil. Electronic address: cristina.baena@pucpr.br.

Abstract

PURPOSE:

Evaluate current recommendation for the use of noninvasive ventilation (Bi-level positive airway pressure- BiPAP modality) in hypoxemic acute respiratory failure, excluding chronic obstructive pulmonary disease.

METHODS:

Electronic searches in MEDLINE, Web of Science, Clinical Trials, and The Cochrane Central Register of Controlled Clinical Trials. We searched for randomized controlled trials comparing BiPAP to a control group in patients with hypoxemic acute respiratory failure. Endotracheal intubation and death were the assessed outcomes.

RESULTS:

Of the 563 studies found, nine met the inclusion criteria for this systematic review. The pooled RR (95% CI) for intubation in patients with acute pulmonary edema (APE)/community acquired pneumonia (CAP) and in immunosuppressed patients (cancer and transplants) were 0.61 (0.39-0.84) and 0.77 (0.60-0.93), respectively. For Intensive Care Units (ICU) mortality, the RR (95% CI) in patients with APE/CAP was 0.51 (0.22-0.79). The heterogeneity was low in all comparisons.

CONCLUSIONS:

NIV showed a significant protective effect for intubation in immunosuppressed patients (cancer and transplants) and in patients with APE/CAP. However, the benefits of NIV for other etiologies are not clear and more trials are needed to prove these effects.

KEYWORDS:

Death; Endotracheal intubation; Noninvasive ventilation; Respiratory insufficiency

PMID:
30388493
DOI:
10.1016/j.jcrc.2018.10.012

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