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Noninvasive Ventilation as a Weaning Strategy in Subjects with Acute Hypoxemic Respiratory Failure

Mengtian Shan, Xiaoqian Pang, Wei Wang, Chao Lan, Rongchang Chen, Changju Zhu and Qi Liu
Respiratory Care October 2020, 65 (10) 1574-1584; DOI: https://doi.org/10.4187/respcare.07542
Mengtian Shan
Emergency Intensive Care Ward, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan Province, China.
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Xiaoqian Pang
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Wei Wang
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Chao Lan
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Rongchang Chen
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Changju Zhu
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Qi Liu
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Abstract

BACKGROUND: Weaning through noninvasive ventilation (NIV) after early extubation may facilitate invasive ventilation withdrawal and reduce related complications in patients with hypercapnic respiratory failure. However, the effects of NIV weaning are uncertain in patients with acute hypoxemic respiratory failure (AHRF). We aimed to investigate whether NIV weaning could reduce hospital mortality and other outcomes compared with invasive weaning in subjects with hypoxemic AHRF.

METHODS: We searched medical literature databases for relevant articles published from inception to February 2019. Randomized controlled trials that adopted NIV as a weaning strategy compared with invasive weaning in hypoxemic AHRF were included. The primary outcome was hospital mortality. The secondary outcomes included ICU mortality, the ICU stay, weaning time, duration of ventilation, extubation failure, and adverse events.

RESULTS: Six relevant studies, which involved 718 subjects, were included. There was no significant effect of NIV weaning on hospital mortality compared with invasive weaning (risk ratio 0.94, 95% CI 0.65–1.36; P = .74), whereas there was a significant effect of NIV weaning on shortening the ICU stay (mean difference −3.95, 95% CI −6.49 to −1.40, P = .002) and on decreasing adverse events without affecting the weaning time (standardized MD −0.04, 95% CI −0.21 to 0.14; P = .68).

CONCLUSIONS: The strategy of NIV weaning did not decrease hospital mortality in subjects with hypoxemic AHRF, but it did shorten the ICU lengths of stay and reduce adverse events.

  • noninvasive ventilation
  • invasive ventilation
  • weaning
  • hypoxemic respiratory failure
  • systematic review
  • meta-analysis

Footnotes

  • Correspondence: Qi Liu MD, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province 450052, China. E-mail: qi.liu{at}vip.163.com or Changju Zhu MD, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province 450052, China. E-mail: zhuchangju98{at}163.com
  • This work was supported by the National Natural Science Foundation of China (grant 81400051) and the Key Project of Henan Higher Education (grant 19A320073).

  • The authors have disclosed no conflicts of interest.

  • Registered in PROSPERO (CRD42019125519).

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (10)
Respiratory Care
Vol. 65, Issue 10
1 Oct 2020
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Noninvasive Ventilation as a Weaning Strategy in Subjects with Acute Hypoxemic Respiratory Failure
Mengtian Shan, Xiaoqian Pang, Wei Wang, Chao Lan, Rongchang Chen, Changju Zhu, Qi Liu
Respiratory Care Oct 2020, 65 (10) 1574-1584; DOI: 10.4187/respcare.07542

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Noninvasive Ventilation as a Weaning Strategy in Subjects with Acute Hypoxemic Respiratory Failure
Mengtian Shan, Xiaoqian Pang, Wei Wang, Chao Lan, Rongchang Chen, Changju Zhu, Qi Liu
Respiratory Care Oct 2020, 65 (10) 1574-1584; DOI: 10.4187/respcare.07542
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Keywords

  • noninvasive ventilation
  • invasive ventilation
  • weaning
  • hypoxemic respiratory failure
  • systematic review
  • meta-analysis

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