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Intensive Care Medicine
Published in: Intensive Care Medicine 12/2018

Open Access 01-12-2018 | Systematic Review

Non-invasive ventilation as a strategy for weaning from invasive mechanical ventilation: a systematic review and Bayesian meta-analysis

Authors: Joyce Yeung, Keith Couper, Elizabeth G. Ryan, Simon Gates, Nick Hart, Gavin D. Perkins

Published in: Intensive Care Medicine | Issue 12/2018

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Abstract

Purpose

A systematic review and meta-analysis was conducted to answer the question ‘In adults with respiratory failure requiring invasive ventilation for more than 24 h, does a weaning strategy with early extubation to non-invasive ventilation (NIV) compared to invasive ventilation weaning reduce all-cause hospital mortality?’

Methods

We included randomised and quasi-randomised controlled trials that evaluated the use of non-invasive ventilation, compared to invasive ventilation, as a weaning strategy in adults mechanically ventilated for at least 24 h. The EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) bibliographic databases were searched from inception to February 2018. Bayesian hierarchical models were used to perform the meta-analysis. The primary outcome was mortality at hospital discharge. Secondary outcomes included mortality (30, 60, 90 and 180 days), quality of life, duration of invasive ventilation, weaning failure, length of stay [intensive care unit (ICU) and hospital] and adverse events.

Results

Twenty-five relevant studies involving 1609 patients were included in the quantitative analysis. Studies had moderate to high risk of bias due to risk of performance and detection bias. Mortality at hospital discharge was lower in the NIV weaning group compared to the invasive weaning group [pooled odds ratio (OR) 0.58, 95% highest density interval (HDI) 0.29–0.89]. Subgroup analyses showed lower pooled mortality at hospital discharge rates in NIV weaning than those in the control group in chronic obstructive pulmonary disease (COPD) patients (pooled OR 0.43, 95% HDI 0.13–0.81) and the effect is less certain in the mixed ICU population (pooled OR 0.88, 95% HDI 0.25–1.48). NIV weaning reduced the duration of invasive ventilation in patients [standardised mean difference (SMD) − 1.34, 95% HDI − 1.92 to − 0.77] and ICU length of stay (SMD − 0.70, 95% HDI − 0.94 to − 0.46). Reported rates of ventilator associated pneumonia (VAP) were lower in the NIV group. NIV weaning did not reduce overall hospital length of stay or long-term mortality. There were insufficient data to compare other adverse events and health-related quality of life.

Conclusions

The use of NIV in weaning from mechanical ventilation decreases hospital mortality, the incidence of VAP and ICU length of stay. NIV as a weaning strategy appears to be most beneficial in patients with COPD.
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Literature
1.
2.
Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguía C, Nightingale P (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355CrossRefPubMed
3.
Jeong BH, Ko MG, Nam J, Yoo H, Chung CR, Suh GY, Jeon K (2015) Differences in clinical outcomes according to weaning classifications in medical intensive care units. PLoS One 10:e0122810CrossRefPubMedPubMedCentral
4.
Girard TD, Alhazzani W, Kress JP, Ouellette DR, Schmidt GA, Truwit JD, Burns SM, Epstein SK, Esteban A, Fan E, Ferrer M, Fraser GL, Gong MN, Hough CL, Mehta S, Nanchal R, Patel S, Pawlik AJ, Schweickert WD, Sessler CN, Strom T, Wilson KC, Morris PE (2017) An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: liberation from mechanical ventilation in critically ill adults. rehabilitation protocols, ventilator liberation protocols, and cuff leak tests. Am J Respir Crit Care Med 195:120–133CrossRefPubMed
5.
Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T (2007) Weaning from mechanical ventilation. Eur Respir J 29:1033–1056CrossRefPubMed
6.
Landsberg JW (2018) Chapter 19e—Liberation from mechanical ventilation. In: Landsberg JW (ed) Clinical practice manual for pulmonary and critical care medicine. Elsevier, Philadelphia, pp e1–e13
7.
Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA (2001) Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 120:1262–1270CrossRefPubMed
8.
Béduneau G, Pham T, Schortgen F, Piquilloud L, Zogheib E, Jonas M, Grelon F, Runge I, Terzi N, Grangé S, Barberet G, Guitard P-G, Frat J-P, Constan A, Chretien J-M, Mancebo J, Mercat A, Richard J-CM, Brochard L (2017) Epidemiology of weaning outcome according to a new definition. WIND Study 195:772–783
9.
10.
Frutos-Vivar F, Ferguson ND, Esteban A, Epstein SK, Arabi Y, Apezteguía C, González M, Hill NS, Nava S, D’Empaire G, Anzueto A (2006) Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 130:1664–1671CrossRefPubMed
11.
Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P, Antonelli M, Brozek J, Conti G, Ferrer M, Guntupalli K, Jaber S, Keenan S, Mancebo J, Mehta S, Raoof S (2017) Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 50(2):1602426. https://​doi.​org/​10.​1183/​13993003.​02426-2016 CrossRefPubMed
12.
13.
14.
Gelman ACJ, Stern HS, Rubin DB (2003) Bayesian data analysis. Chapman and Hall/CRC, Boca Raton
15.
Lv H (1981) Distribution theory for Glass’s estimator of effect size and related estimators. J Educ Stat 6:107–128CrossRef
16.
Gelman A, Rubin DB (1992) Inference from iterative simulation using multiple sequences. Stat Sci 7:457–472CrossRef
17.
Burns KE, Adhikari NK, Meade MO (2003) Noninvasive positive pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev (4):CD004127
18.
Keenan SP, Sinuff T, Burns KE, Muscedere J, Kutsogiannis J, Mehta S, Cook DJ, Ayas N, Adhikari NK, Hand L, Scales DC, Pagnotta R, Lazosky L, Rocker G, Dial S, Laupland K, Sanders K, Dodek P (2011) Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ 183:E195–E214CrossRefPubMedPubMedCentral
19.
Girault C, Daudenthun I, Chevron V, Tamion F, Leroy J, Bonmarchand G (1999) Noninvasive ventilation as a systematic extubation and weaning technique in acute-on-chronic respiratory failure: a prospective, randomized controlled study. Am J Respir Crit Care Med 160:86–92CrossRefPubMed
20.
Chen J, Qiu D, Tao D (2001) Time for extubation and sequential noninvasive mechanical ventilation in COPD patients with exacerbated respiratory failure who received invasive ventilation. Zhonghua Jie He He Hu Xi Za Zhi 24:99–100PubMed
21.
Wang X, Du X, Zhang W (2004) Observation of the results and discussion on the timing of transition from invasive mechanical ventilation to noninvasive ventilation in COPD patients with concomitant acute respiratory failure. Shandong Med J 44:4–6
22.
Wang C, Zhan QY, Cao ZX, Wei LQ, Cheng ZZ, Liu S, Zhang JI, Chen RC, Luo Q, Niu SF, Zhu L, Wu DW, Fang BM, Wu TH, Wang CZ, Ablinimit A, Liu YN (2005) Pulmonary infection control window in treatment of severe respiratory failure of chronic obstructive pulmonary diseases: a prospective, randomized controlled, multi-centred study. Chin Med J 118:1589–1594
23.
Liu L, Qiu HB, Zheng RQ, Yang Y (2005) Prospective randomized controlled clinical study of early use of noninvasive positive pressure ventilation in the treatment for acute exacerbation of chronic obstructive pulmonary disease. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 17:477–480PubMed
24.
Zou SH, Zhou R, Chen P, Luo H, Xiang XD, Lu YD, Zhu LY (2006) Application of sequential noninvasive following invasive mechanical ventilation in COPD patients with severe respiratory failure by investigating the appearance of pulmonary-infection-control-window. Zhong Nan Da Xue Xue Bao Yi Xue Ban 31:120–124PubMed
25.
Trevisan CE, Vieira SR, Research Group in Mechanical Ventilation Weaning (2008) Noninvasive mechanical ventilation may be useful in treating patients who fail weaning from invasive mechanical ventilation: a randomized clinical trial. Crit Care 12:R51CrossRefPubMedPubMedCentral
26.
Charra B, Hachimi A, Benslama A, Motaouakkil S (2009) Contribution of noninvasive ventilation in the precocious extubation in the medical ICU. Crit Care 13:S5–S6CrossRef
27.
Girault C, Bubenheim M, Abroug F, Diehl JL, Elatrous S, Beuret P, Richecoeur J, L’Her E, Hilbert G, Capellier G, Rabbat A, Besbes M, Guérin C, Guiot P, Bénichou J, Bonmarchand G, VENISE Trial Group (2011) Noninvasive ventilation and weaning in patients with chronic hypercapnic respiratory failure: a randomized multicenter trial. Am J Respir Crit Care Med 184:672–679CrossRefPubMed
28.
Mohamed AI (2012) Elective early noninvasive ventilation as a weaning method of COPD patients. Eur Respir J 40(Suppl 56):P2041
29.
Vaschetto R, Turucz E, Dellapiazza F, Guido S, Colombo D, Cammarota G, Della Corte F, Antonelli M, Navalesi P (2012) Noninvasive ventilation after early extubation in patients recovering from hypoxemic acute respiratory failure: a single-centre feasibility study. Intensive Care Med 38:1599–1606CrossRefPubMed
30.
Rong F (2012) Application of treating chronic obstructive pulmonary disease patients with respiratory failure with the sequential noninvasive and invasive ventilation. J Bengbu Med Coll 37:442–444
31.
Carron M, Rossi S, Carollo C, Ori C (2014) Comparison of invasive and noninvasive positive pressure ventilation delivered by means of a helmet for weaning of patients from mechanical ventilation. J Crit Care 29:580–585CrossRefPubMed
32.
Mishra M, Chaudhri S, Tripathi V, Verma AK, Sampath A, Chauhan NK (2014) Weaning of mechanically ventilated chronic obstructive pulmonary disease patients by using non-invasive positive pressure ventilation: a prospective study. Lung India 31:127–133CrossRefPubMedPubMedCentral
33.
Wang X, Xu S, Liu G, Caikai S (2014) Study of timing of invasive and noninvasive sequential ventilation in patients with acute respiratory distress syndrome. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 26:330–334PubMed
34.
Tawfeek ME, Elnabtity AMA (2012) Noninvasive proportional assist ventilation may be useful in weaning patients who failed spontaneous breathing trial. Egypt J Anaesth 28:89–94CrossRef
35.
Guo F, Xu S, Liu G, Wang X (2015) An investigation of the efficacy of invasive-noninvasive sequential mechanical ventilation in senile patients with severe community-acquired pneumonia. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 27:595–600PubMed
36.
Prasad SB, Chaudhry D, Khanna R (2009) Role of noninvasive ventilation in weaning from mechanical ventilation in patients of chronic obstructive pulmonary disease: an Indian experience. Indian J Crit Care Med 13:207–212CrossRefPubMedPubMedCentral
37.
El-Shimy WS, Barima MA, El-Magd GHA, Mansour SA (2013) Non invasive ventilation versus synchronized intermittent mandatory ventilation with pressure support in weaning of COPD patients: comparative study. Egypt J Chest Dis Tuberc 62:159–166CrossRef
38.
Ferrer M, Esquinas A, Arancibia F, Bauer TT, Gonzalez G, Carrillo A, Rodriguez-Roisin R, Torres A (2003) Noninvasive ventilation during persistent weaning failure: a randomized controlled trial. Am J Respir Crit Care Med 168:70–76CrossRefPubMed
39.
Nava S, Ambrosino N, Clini E, Prato M, Orlando G, Vitacca M, Brigada P, Fracchia C, Rubini F (1998) Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial. Ann Intern Med 128:721–728CrossRefPubMed
40.
Trevisan CE, Vieira SR, Research Group in Mechanical Ventilation Weaning (2008) Noninvasive mechanical ventilation may be useful in treating patients who fail weaning from invasive mechanical ventilation: a randomized clinical trial. Crit Care 12:R51CrossRefPubMedPubMedCentral
41.
Chaudhri S, Mishra M, Verma A, Sampath A, Rai O (2009) Utility of non invasive pressure ventilation (NIPPV) for weaning COPD patients from invasive mechanical ventilation (IMV). In: European Respiratory Society Annual Congress, Vienna, Austria, 12–16 September 2009
42.
Laiq N, Khan RA, Malik A (2013) Non-invasive positive pressure ventilation facilitates early extubation in post operative cardiac patients. J Postgrad Med Inst 27(4):361–365
43.
Matic I, Sakic-Zdravcevic K, Jurjevic M (2007) Comparison of invasive and noninvasive mechanical ventilation for patients with chronic obstructive pulmonary disease: randomized prospective study. Period Biologorum 109:137–145
44.
Burns KE, Meade MO, Premji A, Adhikari NK (2014) Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review. CMAJ 186:E112–E122CrossRefPubMedPubMedCentral
45.
46.
Vincent J-L, Marshall JC, Ñamendys-Silva SA, François B, Martin-Loeches I, Lipman J, Reinhart K, Antonelli M, Pickkers P, Njimi H, Jimenez E, Sakr Y (2014) Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit. Lancet Respir Med 2:380–386CrossRefPubMed
47.
48.
Mayr VD, Dünser MW, Greil V, Jochberger S, Luckner G, Ulmer H, Friesenecker BE, Takala J, Hasibeder WR (2006) Causes of death and determinants of outcome in critically ill patients. Crit Care 10(6):R154CrossRefPubMedPubMedCentral
49.
Orban J-C, Walrave Y, Mongardon N, Allaouchiche B, Argaud L, Aubrun F, Barjon G, Constantin J-M, Dhonneur G, Durand-Gasselin J, Dupont H, Genestal M, Goguey C, Goutorbe P, Guidet B, Hyvernat H, Jaber S, Lefrant J-Y, Mallédant Y, Morel J, Ouattara A, Pichon N, Guérin Robardey A-M, Sirodot M, Theissen A, Wiramus S, Zieleskiewicz L, Leone M, Ichai C (2017) Causes and characteristics of death in intensive care units: a prospective multicenter study. Anesthesiology 126:882–889CrossRefPubMed
50.
51.
Langer M, Cigada M, Mandelli M, Mosconi P, Tognoni G (1987) Early onset pneumonia: a multicenter study in intensive care units. Intensive Care Med 13:342–346CrossRefPubMed
52.
Chastre J, Fagon J-Y (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903CrossRefPubMed
53.
Lightowler JV, Wedzicha JA, Elliott MW, Ram FSF (2003) Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 326:185CrossRefPubMedPubMedCentral
54.
Ibrahim JG, Chen M-H, Chu H (2012) Bayesian methods in clinical trials: a Bayesian analysis of ECOG trials E1684 and E1690. BMC Med Res Methodol 12:183CrossRefPubMedPubMedCentral
55.
Babapulle MN, Joseph L, Bélisle P, Brophy JM, Eisenberg MJ (2004) A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents. Lancet 364:583–591CrossRefPubMed
56.
Blackwood B, Ringrow S, Clarke M, Marshall J, Rose L, Williamson P, McAuley D (2015) Core Outcomes in Ventilation Trials (COVenT): protocol for a core outcome set using a Delphi survey with a nested randomised trial and observational cohort study. Trials 16:368CrossRefPubMedPubMedCentral
57.
Ringrow S, McAuley D, Clarke M, Marshall J, Connolly B, Rose L, Blackwood B (2017) S133 A core outcome set for mechanical ventilation trials: the covent study. Thorax 72:A79–A80
58.
Hatch R, Young D, Barber V, Harrison DA, Watkinson P (2017) The effect of postal questionnaire burden on response rate and answer patterns following admission to intensive care: a randomised controlled trial. BMC Med Res Methodol 17:49CrossRefPubMedPubMedCentral
59.
60.
Reay H, Arulkumaran N, Brett SJ (2014) Priorities for future intensive care research in the UK: results of a James Lind Alliance Priority Setting Partnership. J Intensive Care Soc 15:288–296CrossRef
61.
Lv Y, Lv Q, Lv Q, Lai T (2017) Pulmonary infection control window as a switching point for sequential ventilation in the treatment of COPD patients: a meta-analysis. Int J Chron Obstruct Pulmon Dis 12:1255–1267CrossRefPubMedPubMedCentral
Metadata
Title
Non-invasive ventilation as a strategy for weaning from invasive mechanical ventilation: a systematic review and Bayesian meta-analysis
Authors
Joyce Yeung
Keith Couper
Elizabeth G. Ryan
Simon Gates
Nick Hart
Gavin D. Perkins
Publication date
01-12-2018
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 12/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-018-5434-z

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