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Use of noninvasive ventilation at the pulmonary infection control window for acute respiratory failure in AECOPD patients

View Article: PubMed Central - PubMed

ABSTRACT

The aim of the study was to comprehensively examine the efficacy and safety of noninvasive ventilation used at the pulmonary infection control (PIC) window for acute respiratory failure (ARF) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Seven electronic databases and relevant resources were searched to identify randomized controlled trials (RCTs) comparing patients using noninvasive ventilation at PIC window with those continuing receiving invasive ventilation. Retrieved citations were screened, risk of bias was assessed, and data were extracted by 2 independent review authors. Overall effect sizes were synthesized by using meta-analyses. Quality of evidence was rated by using Grading of Recommendations, Assessment, Development and Evaluation approach.

A total of 17 trials involving 959 participants were included for this review. Compared with continuous invasive ventilation, noninvasive ventilation used at PIC window significantly reduced mortality, ventilator-associated pneumonia, weaning failures, reintubations, duration of invasive ventilation, total duration of mechanical ventilation, length of stay (LOS) in intensive care unit, and LOS in hospital as well as hospital costs. Of these, mortality significantly decreased (risk ratio = 0.27, 95% confidence interval: 0.17–0.42, P < 0.001) without significant heterogeneity (I2 = 0%, P = 0.99). Quality of evidence regarding the 9 outcomes across the included studies was rated from moderate to low.

Use of noninvasive ventilation at PIC window showed beneficial effects across identified trials for ARF in AECOPD patients. Considering the absence of high quality of available evidence and the uncertainty of long-term effect of this intervention, a weak recommendation for clinical practice was generated, and further well-designed and adequately powered RCTs are required to validate this conclusion.

No MeSH data available.


Related in: MedlinePlus

Flow diagram of the selection process. CBM = Chinese Biomedicine Database, CENTRAL = Cochrane Central Register of Controlled Trials, CNKI = China National Knowledge Infrastructure, COPD = chronic obstructive pulmonary disease.
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Figure 1: Flow diagram of the selection process. CBM = Chinese Biomedicine Database, CENTRAL = Cochrane Central Register of Controlled Trials, CNKI = China National Knowledge Infrastructure, COPD = chronic obstructive pulmonary disease.

Mentions: The primary search identified 1723 citations using predefined criteria, of which 1719 references were from electronic databases, other 4 references were identified from relevant reference lists, and no references were obtained from conference proceedings or dissertation abstracts. Finally, a total of 17 studies[30–46] from electronic databases were included in this review. Further details were shown in Figure 1.


Use of noninvasive ventilation at the pulmonary infection control window for acute respiratory failure in AECOPD patients
Flow diagram of the selection process. CBM = Chinese Biomedicine Database, CENTRAL = Cochrane Central Register of Controlled Trials, CNKI = China National Knowledge Infrastructure, COPD = chronic obstructive pulmonary disease.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998464&req=5

Figure 1: Flow diagram of the selection process. CBM = Chinese Biomedicine Database, CENTRAL = Cochrane Central Register of Controlled Trials, CNKI = China National Knowledge Infrastructure, COPD = chronic obstructive pulmonary disease.
Mentions: The primary search identified 1723 citations using predefined criteria, of which 1719 references were from electronic databases, other 4 references were identified from relevant reference lists, and no references were obtained from conference proceedings or dissertation abstracts. Finally, a total of 17 studies[30–46] from electronic databases were included in this review. Further details were shown in Figure 1.

View Article: PubMed Central - PubMed

ABSTRACT

The aim of the study was to comprehensively examine the efficacy and safety of noninvasive ventilation used at the pulmonary infection control (PIC) window for acute respiratory failure (ARF) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Seven electronic databases and relevant resources were searched to identify randomized controlled trials (RCTs) comparing patients using noninvasive ventilation at PIC window with those continuing receiving invasive ventilation. Retrieved citations were screened, risk of bias was assessed, and data were extracted by 2 independent review authors. Overall effect sizes were synthesized by using meta-analyses. Quality of evidence was rated by using Grading of Recommendations, Assessment, Development and Evaluation approach.

A total of 17 trials involving 959 participants were included for this review. Compared with continuous invasive ventilation, noninvasive ventilation used at PIC window significantly reduced mortality, ventilator-associated pneumonia, weaning failures, reintubations, duration of invasive ventilation, total duration of mechanical ventilation, length of stay (LOS) in intensive care unit, and LOS in hospital as well as hospital costs. Of these, mortality significantly decreased (risk ratio = 0.27, 95% confidence interval: 0.17–0.42, P < 0.001) without significant heterogeneity (I2 = 0%, P = 0.99). Quality of evidence regarding the 9 outcomes across the included studies was rated from moderate to low.

Use of noninvasive ventilation at PIC window showed beneficial effects across identified trials for ARF in AECOPD patients. Considering the absence of high quality of available evidence and the uncertainty of long-term effect of this intervention, a weak recommendation for clinical practice was generated, and further well-designed and adequately powered RCTs are required to validate this conclusion.

No MeSH data available.


Related in: MedlinePlus