Use of non-invasive ventilation to wean critically ill adults off invasive ventilation: meta-analysis and systematic review

被引:88
作者
Burns, Karen E. A. [1 ,2 ,3 ,4 ]
Adhikari, Neill K. J. [5 ,6 ,7 ]
Keenan, Sean P. [8 ,9 ]
Meade, Maureen [10 ]
机构
[1] St Michaels Hosp, Interdepartmental Div Crit Care, Toronto, ON M5B 1W8, Canada
[2] Li Ka Shing Knowledge Inst, Keenan Res Ctr, Toronto, ON, Canada
[3] Univ Toronto, Div Resp, Toronto, ON, Canada
[4] Univ Toronto, Div Crit Care Med, Toronto, ON, Canada
[5] Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
[6] Sunnybrook Res Inst, Toronto, ON, Canada
[7] Univ Toronto, Interdepartmental Div Crit Care, Toronto, ON, Canada
[8] Royal Columbian Hosp, Dept Crit Care, New Westminster, BC, Canada
[9] Dept Med, Div Crit Care Med, Vancouver, BC, Canada
[10] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada
来源
BMJ-BRITISH MEDICAL JOURNAL | 2009年 / 338卷
基金
加拿大健康研究院;
关键词
POSITIVE-PRESSURE VENTILATION; MECHANICAL VENTILATION; SUPPORT VENTILATION; PROTOCOL; DURATION; TRIAL; EXTUBATION; PNEUMONIA; DISEASE; RISK;
D O I
10.1136/bmj.b1574
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective To summarise the evidence for early extubation with immediate application of non-invasive ventilation compared with continued invasive weaning on important outcomes in intubated adults with respiratory failure. Design Systematic review and meta-analysis of randomised and quasi-randomised controlled trials. Setting Intensive care units. Participants Critically ill adults receiving invasive ventilation. Study selection criteria We searched Medline, Embase, and CENTRAL, proceedings from four conferences, and reference lists of relevant studies to identify relevant trials. Two reviewers independently selected trials, assessed trial quality, and abstracted data. Results We identified 12 trials enrolling 530 participants, mostly with chronic obstructive pulmonary disease. Compared with invasive weaning, non-invasive weaning was significantly associated with reduced mortality (relative risk 0.55, 95% confidence interval 0.38 to 0.79), ventilator associated pneumonia (0.29, 95% 0.19 to 0.45), length of stay in intensive care unit (weighted mean difference -6.27 days, -8.77 to -3.78) and hospital (-7. 19 days, -10.80 to -3.58), total duration of ventilation, and duration of invasive ventilation. Non-invasive weaning had no effect on weaning failures or weaning time. Benefits on mortality and weaning failures were non-significantly greater in trials that exclusively enrolled patients with chronic obstructive pulmonary disease versus mixed populations. Conclusions Current trials in critically ill adults show a consistent positive effect of non-invasive weaning on mortality and ventilator associated pneumonia, though the net clinical benefits remain to be fully elucidated. Non-invasive ventilation should preferentially be used in patients with chronic obstructive pulmonary disease in a highly monitored environment.
引用
收藏
页码:1305 / 1308
页数:9
相关论文
共 34 条
[1]   A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure [J].
Antonelli, M ;
Conti, G ;
Rocco, M ;
Bufi, M ;
De Blasi, RA ;
Vivino, G ;
Gasparetto, A ;
Meduri, GU .
NEW ENGLAND JOURNAL OF MEDICINE, 1998, 339 (07) :429-435
[2]   A COMPARISON OF STATISTICAL-METHODS FOR COMBINING EVENT RATES FROM CLINICAL-TRIALS [J].
BERLIN, JA ;
LAIRD, NM ;
SACKS, HS ;
CHALMERS, TC .
STATISTICS IN MEDICINE, 1989, 8 (02) :141-151
[3]   Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation [J].
Brook, AD ;
Ahrens, TS ;
Schaiff, R ;
Prentice, D ;
Sherman, G ;
Shannon, W ;
Kollef, MH .
CRITICAL CARE MEDICINE, 1999, 27 (12) :2609-2615
[4]  
Burns KE, 2013, COCHRANE DB SYST REV, V12, DOI DOI 10.1002/14651858.CD004127
[5]   SOME METHODS FOR STRENGTHENING THE COMMON X2 TESTS [J].
COCHRAN, WG .
BIOMETRICS, 1954, 10 (04) :417-451
[6]   METAANALYSIS IN CLINICAL-TRIALS [J].
DERSIMONIAN, R ;
LAIRD, N .
CONTROLLED CLINICAL TRIALS, 1986, 7 (03) :177-188
[7]  
Devereaux PJ, 2004, CAN MED ASSOC J, V171, P245, DOI 10.1503/cmaj.1031619
[8]   Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously [J].
Ely, EW ;
Baker, AM ;
Dunagan, DP ;
Burke, HL ;
Smith, AC ;
Kelly, PT ;
Johnson, MM ;
Browder, RW ;
Bowton, DL ;
Haponik, EF .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 335 (25) :1864-1869
[9]   Mechanical ventilator weaning protocols driven by nonphysician health-care professionals - Evidence-based clinical practice guidelines [J].
Ely, EW ;
Meade, MO ;
Haponik, EF ;
Kollef, MH ;
Cook, DJ ;
Guyatt, GH ;
Stoller, JK .
CHEST, 2001, 120 (06) :454S-463S
[10]   Effect of failed extubation on the outcome of mechanical ventilation [J].
Epstein, SK ;
Ciubotaru, RL ;
Wong, JB .
CHEST, 1997, 112 (01) :186-192