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Non-invasive ventilation in acute respiratory failure: a meta-analysis

Yu-Jing Liu, Jing Zhao and Hui Tang
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DOI: https://doi.org/10.7861/clinmedicine.16-6-514
Clin Med December 2016
Yu-Jing Liu
ADepartment of Medical Engineering, Army General Hospital, Beijing, China
Roles: director
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Jing Zhao
BDepartment of Thoracic Surgery, Army General Hospital, Beijing, China
Roles: director
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  • For correspondence: 13910224230@139.com
Hui Tang
CDepartment of Medical Engineering, Army General Hospital, Beijing, China
Roles: senior technician
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    Fig 1.

    PRISMA flow diagram.

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    Fig 2.

    Rate of intubation. NPPV = non-invasive positive-pressure ventilation; RCT = randomised controlled trial.

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    Fig 3.

    In-ICU (A) and in-hospital (B) mortality rates. NPPV = non-invasive positive-pressure ventilation; RCT = randomised controlled trial.

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    Fig 4.

    Length of ICU (A) and hospital (B) stay. NPPV = non-invasive positive-pressure ventilation; RCT = randomised controlled trial.

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    Table 1.

    Summary of basic characteristics of studies selected for inclusion in meta-analysis

    StudyStudy designDiseaseCausesPatients, nInterventionsContent of therapyMean age, yearsMaleSeverity of illnessPaO 2/FiO 2, mmHgComorbidity
    Zhu32RCTARFACPE, ALI, lobar atelectasis, pneumonia, COPD, RMF48NPPVBilevel positive airways pressure S/T mode (BiPAP) via a face mask via a face mask6267%17.2*NAHT, DM
    47ControlStandard medical care and oxygen therapy as needed6157%17.6*
    Zhan24RCTALIPulmonary infection, acute pancreatitis, multiple trauma, sepsis21NPPVBilevel positive airways pressure S/T mode (BiPAP) via a face mask4476%11.8*225.4 (17.4)HT, immunosuppres-sion, DM, chronic renal insufficiency, cancer
    19ControlHigh-concentration oxygen therapy through a Venturi mask4942%13.4*234.4 (26.6)
    Uçgun25ProspectiveARDSNA10NPPVA BiPAP vision ventilator device was used in BIPAP mode via a CPAP full-face mask4390%17.4*110NA
    10ControlStandard therapy (such as oxygen, antibiotics, and bronchodilators)4780%18.8*103.3
    De Santo26ProspectiveARFPost-cardiopulmonary bypass lung injury, cardiogenic oedema, pneumonia43NPPVHelmet6674%NA357 (60.4)DM, COPD, low LVEF
    422ControlNA6269%NA381 (41)
    Yañez31RCTARFNA25NIVPositive airways pressure STD 30 mode (BiPAP) via a face mask1668%NAMedian (IQR): 150 (110-383)Moderate asthma, viral pneumonia and/or bronchiolitis, bacterial pneumonia, RSV pneumonia, bronchiolitis, parainfluenza, pneumonia
    25ControlStandard treatment (mask oxygen)1852%NAMedian (IQR): 190 (101-400)
    Thys28RCTARFAcute pulmonary oedema, acute exacerbation of COPD10NPPVBilevel positive airways pressure S/TD 30 mode (BiPAP) via a face mask via a face mask7170%NANANA
    10ControlOxygen therapy + Placebo-device7640%
    Auriant34RCTARFInterstitial pulmonary oedema, atelectasis, documented pneumonia24NPPVBilevel positive airways pressure S/TD 30 mode (BiPAP) via an nasal mask59NA16.9^126.8 (42.1)NA
    24ControlStandard therapy (oxygen, bronchodilatators, patient controlled analgesia, chest physiotherapy)63NA16.8^127.1 (42.5)
    Antonelli16RCTARFPneumonia, ACPE, ARDS, mucous plugging or atelectasis, pulmonary embolism20NPPVBilevel positive airway pressure via a full face mask4565%13^129 (30)NA
    20ControlOxygen supplementation4460%13^129 (30)
    Martin33RCTARFHypercapnic, hypoxemic32NPPVBilevel positive airways pressure S/TD mode (BiPAP) via an nasal mask6447%58#Hypercapnic ARF: 190(68) Hypoxemic ARF:103 (35)COPD, Non-COPD-related pulmonary disease
    29ControlUsual medical care5848%65#Hypercapnic ARF: 208 (90) Hypoxemic ARF:110 (43)
    Confalonieri27RCTARFSevere community-acquired pneumonia28NPPVContinuous positive airway pressure through full-face mask6682%20*183 (36)COPD
    28ControlStandard treatment with oxygen supplementation delivered by a Venturi mask6161%18*167 (47)
    Wood29RCTARDSACPE, COPD, pneumonia, interstitial lung disease, sepsis16NPPVHospital-grade ventilatory support systems (BiPAP) stationed in the ED. via an nasal mask5669%18.1*NANA
    11ControlConventional medical therapy (supplemental oxygen and pharmacologic therapy)6246%15.6*
    Wysocki30RCTARFPneumonia, ACPE, Laryngeal dyspnea, chest wall impairment21NIPSVNIPSV was delivered to the patient through a full-face mask6457%17^NANA
    20ControlMedications related to the cause of respiratory distress (antibiotics, diuretics, inotropics, etc) and oxygen supplementation6260%12^
    • ↵*APACHE (Acute Physiology and Chronic Health Evaluation) II score

    • ^SAPS II (Simplified Acute Physiology Score)

    • ↵#APACHE III score

    • ACPE = acute cardiogenic pulmonary oedema; ALI = acute lung injury; ARDS = acute respiratory distress syndrome; ARF = acute respiratory failure; COPD = chronic obstructive pulmonary disease; DM = diabetes mellitus; HT = hypertension; LVEF = left ventricular ejection fraction; NA = not available; NIV = non-invasive ventilation; NIPSV = non-invasive pressure support ventilation; NPPV = non-invasive positive-pressure ventilation; RCT = randomised controlled trial; RMF = respiratory muscle fatigue; RSV = respiratory syncytial virus

Additional Files

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    • S1 - Supplementary tables
    • Fig S1. Analysis of publication bias
    • Fig S2. Risk of bias assessment
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Non-invasive ventilation in acute respiratory failure: a meta-analysis
Yu-Jing Liu, Jing Zhao, Hui Tang
Clinical Medicine Dec 2016, 16 (6) 514-523; DOI: 10.7861/clinmedicine.16-6-514

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Non-invasive ventilation in acute respiratory failure: a meta-analysis
Yu-Jing Liu, Jing Zhao, Hui Tang
Clinical Medicine Dec 2016, 16 (6) 514-523; DOI: 10.7861/clinmedicine.16-6-514
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