Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2021

Open Access 01-12-2021 | Acute Respiratory Distress-Syndrome | Research

Efficacy of non-invasive and invasive respiratory management strategies in adult patients with acute hypoxaemic respiratory failure: a systematic review and network meta-analysis

Authors: Masaaki Sakuraya, Hiromu Okano, Tomoyuki Masuyama, Shunsuke Kimata, Satoshi Hokari

Published in: Critical Care | Issue 1/2021

Login to get access

Abstract

Background

Although non-invasive respiratory management strategies have been implemented to avoid intubation, patients with de novo acute hypoxaemic respiratory failure (AHRF) are high risk of treatment failure. In the previous meta-analyses, the effect of non-invasive ventilation was not evaluated according to ventilation modes in those patients. Furthermore, no meta-analyses comparing non-invasive respiratory management strategies with invasive mechanical ventilation (IMV) have been reported. We performed a network meta-analysis to compare the efficacy of non-invasive ventilation according to ventilation modes with high-flow nasal oxygen (HFNO), standard oxygen therapy (SOT), and IMV in adult patients with AHRF.

Methods

The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults with AHRF and randomized controlled trials (RCTs) comparing two different respiratory management strategies (continuous positive airway pressure (CPAP), pressure support ventilation (PSV), HFNO, SOT, or IMV) were reviewed.

Results

We included 25 RCTs (3,302 participants: 27 comparisons). Using SOT as the reference, CPAP (risk ratio [RR] 0.55; 95% confidence interval [CI] 0.31–0.95; very low certainty) was associated significantly with a lower risk of mortality. Compared with SOT, PSV (RR 0.81; 95% CI 0.62–1.06; low certainty) and HFNO (RR 0.90; 95% CI 0.65–1.25; very low certainty) were not associated with a significantly lower risk of mortality. Compared with IMV, no non-invasive respiratory management was associated with a significantly lower risk of mortality, although all certainties of evidence were very low. The probability of being best in reducing short-term mortality among all possible interventions was higher for CPAP, followed by PSV and HFNO; IMV and SOT were tied for the worst (surface under the cumulative ranking curve value: 93.2, 65.0, 44.1, 23.9, and 23.9, respectively).

Conclusions

When performing non-invasive ventilation among patients with de novo AHRF, it is important to avoid excessive tidal volume and lung injury. Although pressure support is needed for some of these patients, it should be applied with caution because this may lead to excessive tidal volume and lung injury.
Trial registration protocols.io (Protocol integer ID 49375, April 23, 2021). https://​doi.​org/​10.​17504/​protocols.​io.​buf7ntrn.
Appendix
Available only for authorised users
Literature
1.
Vincent J-L, Akça S, de Mendonça A, Haji-Michael P, Sprung C, Moreno R, et al. The epidemiology of acute respiratory failure in critically ill patients. Chest. 2002;12:1602–9.CrossRef
2.
Berbenetz N, Wang Y, Brown J, Godfrey C, Ahmad M, Vital FM, et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev. 2019;4:Cd005351.PubMed
3.
Rochwerg B, Einav S, Chaudhuri D, Mancebo J, Mauri T, Helviz Y, et al. The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline. Intensive Care Med. 2020;46:2226–37.PubMedCrossRef
4.
Bellani G, Laffey JG, Pham T, Madotto F, Fan E, Brochard L, et al. Noninvasive ventilation of patients with acute respiratory distress syndrome. insights from the LUNG SAFE study. Am J Respir Crit Care Med. 2017;195:67–77.PubMedCrossRef
5.
Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307:2526–33.
6.
Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50:1602426.PubMedCrossRef
7.
Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372:2185–96.PubMedCrossRef
8.
Azoulay E, Lemiale V, Mokart D, Nseir S, Argaud L, Pène F, et al. Effect of high-flow nasal oxygen vs standard oxygen on 28-day mortality in immunocompromised patients with acute respiratory failure: the HIGH randomized clinical trial. JAMA. 2018;320:2099–107.PubMedPubMedCentralCrossRef
9.
Carteaux G, Millán-Guilarte T, De Prost N, Razazi K, Abid S, Thille AW, et al. Failure of noninvasive ventilation for de novo acute hypoxemic respiratory failure: role of tidal volume. Crit Care Med. 2016;44:282–90.PubMedCrossRef
10.
Ferreyro BL, Angriman F, Munshi L, Del Sorbo L, Ferguson ND, Rochwerg B, et al. Association of noninvasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure: a systematic review and meta-analysis. JAMA. 2020;324:57–67.PubMedCrossRef
11.
Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;62:777–84.CrossRef
12.
13.
Keenan SP, Sinuff T, Burns KE, Muscedere J, Kutsogiannis J, Mehta S, et al. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2011;183:E195-214.PubMedPubMedCentralCrossRef
14.
15.
16.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.PubMedCrossRef
17.
White IR, Barrett JK, Jackson D, Higgins JP. Consistency and inconsistency in network meta-analysis: model estimation using multivariate meta-regression. Res Synth Methods. 2012;3:111–25.PubMedPubMedCentralCrossRef
18.
Salanti G, Ades AE, Ioannidis JPA. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011;64:163–71.PubMedCrossRef
19.
20.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.PubMedCrossRef
21.
22.
Dias S, Welton NJ, Caldwell DM, Ades AE. Checking consistency in mixed treatment comparison meta-analysis. Stat Med. 2010;29:932–44.PubMedCrossRef
23.
Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 7—rating the quality of evidence–inconsistency. J Clin Epidemiol. 2011;64:1294–302.PubMedCrossRef
24.
Guyatt GH, Oxman AD, Montori V, Vist G, Kunz R, Brozek J, et al. GRADE guidelines: 5—rating the quality of evidence–publication bias. J Clin Epidemiol. 2011;64:1277–82.PubMedCrossRef
25.
Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, et al. GRADE guidelines: 4—rating the quality of evidence–study limitations (risk of bias). J Clin Epidemiol. 2011;64:407–15.PubMedCrossRef
26.
Puhan MA, Schünemann HJ, Murad MH, Li T, Brignardello-Petersen R, Singh JA, et al. A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ. 2014;349:g5630.PubMedCrossRef
27.
Brignardello-Petersen R, Bonner A, Alexander PE, Siemieniuk RA, Furukawa TA, Rochwerg B, et al. Advances in the GRADE approach to rate the certainty in estimates from a network meta-analysis. J Clin Epidemiol. 2018;93:36–44.PubMedCrossRef
28.
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864–74.
29.
Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, et al. GRADE guidelines 6—rating the quality of evidence–imprecision. J Clin Epidemiol. 2011;64:1283–93.PubMedCrossRef
30.
Brignardello-Petersen R, Guyatt GH, Mustafa RA, Chu DK, Hultcrantz M, Schünemann HJ, et al. GRADE guidelines 33—addressing imprecision in a network meta-analysis. J Clin Epidemiol. 2021;139:49–56.PubMedCrossRef
31.
Wysocki M, Tric L, Wolff MA, Millet H, Herman B. Noninvasive pressure support ventilation in patients with acute respiratory failure—a randomized comparison with conventional therapy. Chest. 1995;107:761–8.PubMedCrossRef
32.
Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Umberto MG. Acute respiratory failure in patients with severe community-acquired pneumonia: a prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med. 1999;160:1585–91.PubMedCrossRef
33.
Antonelli M, Conti G, Bufi M, Costa MG, Lappa A, Rocco M, et al. Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA. 2000;283:235–41.PubMedCrossRef
34.
Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med. 2001;344:481–7.PubMedCrossRef
35.
Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A. Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med. 2003;168:1438–44.PubMedCrossRef
36.
Wermke M, Schiemanck S, Höffken G, Ehninger G, Bornhäuser M, Illmer T. Respiratory failure in patients undergoing allogeneic hematopoietic SCT–a randomized trial on early non-invasive ventilation based on standard care hematology wards. Bone Marrow Transplant. 2012;47:574–80.PubMedCrossRef
37.
Zhan Q, Sun B, Liang L, Yan X, Zhang L, Yang J, et al. Early use of noninvasive positive pressure ventilation for acute lung injury: a multicenter randomized controlled trial. Crit Care Med. 2012;40:455–60.PubMedCrossRef
38.
Lemiale V, Mokart D, Resche-Rigon M, Pène F, Mayaux J, Faucher E, Nyunga M, et al. Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure: a randomized clinical trial. JAMA. 2015;314:1711–9.PubMedCrossRef
39.
He H, Sun B, Liang L, Li Y, Wang H, Wei L, et al. A multicenter RCT of noninvasive ventilation in pneumonia-induced early mild acute respiratory distress syndrome. Crit Care. 2019;23:300.PubMedPubMedCentralCrossRef
40.
Delclaux C, L’Her E, Alberti C, Mancebo J, Abroug F, Conti G, et al. Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial. JAMA. 2000;284:2352–60.PubMedCrossRef
41.
Martin TJ, Hovis JD, Costantino JP, Bierman MI, Donahoe MP, Rogers RM, et al. A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure. Am J Respir Crit Care Med. 2000;161:807–13.PubMedCrossRef
42.
Cosentini R, Brambilla AM, Aliberti S, Bignamini A, Nava S, Maffei A, et al. Helmet continuous positive airway pressure vs oxygen therapy to improve oxygenation in community-acquired pneumonia: a randomized, controlled trial. Chest. 2010;138:114–20.PubMedCrossRef
43.
Squadrone V, Massaia M, Bruno B, Marmont F, Falda M, Bagna C, et al. Early CPAP prevents evolution of acute lung injury in patients with hematologic malignancy. Intensive Care Med. 2010;36:1666–74.PubMedCrossRef
44.
Brambilla AM, Aliberti S, Prina E, Nicoli F, Del Forno M, Nava S, et al. Helmet CPAP vs oxygen therapy in severe hypoxemic respiratory failure due to pneumonia. Intensive Care Med. 2014;40:942–9.PubMedCrossRef
45.
Lemiale V, Mokart D, Mayaux J, Lambert J, Rabbat A, Demoule A, et al. The effects of a 2-h trial of high-flow oxygen by nasal cannula versus Venturi mask in immunocompromised patients with hypoxemic acute respiratory failure: a multicenter randomized trial. Crit Care. 2015;19:380.PubMedPubMedCentralCrossRef
46.
Jones PG, Kamona S, Doran O, Sawtell F, Wilsher M. Randomized controlled trial of humidified high-flow nasal oxygen for acute respiratory distress in the emergency department: the HOT-ER study. Respir Care. 2016;61:291–9.PubMedCrossRef
47.
Andino R, Vega G, Pacheco SK, Arevalillo N, Leal A, Fernández L, et al. High-flow nasal oxygen reduces endotracheal intubation: a randomized clinical trial. Ther Adv Respir Dis. 2020;14:1753466620956459.PubMedPubMedCentralCrossRef
48.
AlptekİnoĞlu Mendİl N, Temel Ş, YÜksel RC, GÜndoĞan K, Eser B, Kaynar L, et al. The use of high-flow nasal oxygen vs standard oxygen therapy in hematological malignancy patients with acute respiratory failure in hematology wards. Turk J Med Sci. 2021. https://​doi.​org/​10.​3906/​sag-2007-228.​
49.
Antonelli M, Conti G, Rocco M, Bufi M, De Blasi RA, Vivino G, et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med. 1998;339:429–35.PubMedCrossRef
50.
Muncharaz AB, Bort MC, Asensio DB, Campos LM, Tegedor BV, Pérez JM, et al. Non-invasive ventilation versus invasive mechanical ventilation in patients with hypoxemic acute respiratory failure in an intensive care unit—a randomized controlled study. Minerva Pneumol. 2017;56:1–10.
51.
Awadallah M, Taha A, Sarhan T. Cardiorespiratory changes and outcome during noninvasive and invasive mechanical ventilation in ARDS: a comparative study. Res Opin Anesthes Intensive Care. 2021;8:6–12.CrossRef
52.
Azevedo JR, Montenegro WS, Leitao AL, Silva MM, Prazeres JS, Maranhao JP. High flow nasal cannula oxygen (hfnc) versus non-invasive positive pressure ventilation (nippv) in acute hypoxemic respiratory failure—a pilot randomized controlled trial [abstract]. Intensive Care Med Exp. 2015;3(Suppl 1):A166.PubMedCentralCrossRef
53.
Grieco DL, Menga LS, Cesarano M, Rosà T, Spadaro S, Bitondo MM, et al. Effect of helmet noninvasive ventilation vs high-flow nasal oxygen on days free of respiratory support in patients with COVID-19 and moderate to severe hypoxemic respiratory failure: the HENIVOT randomized clinical trial. JAMA. 2021;325:1731–43.PubMedCrossRef
54.
Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ. Non-invasive ventilation for the management of acute hypercapnic respiratory failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017;7:Cd004104.PubMed
55.
Liu Q, Gao Y, Chen R, Cheng Z. Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: a systematic review and meta-analysis of controlled studies. Crit Care. 2016;20:265.PubMedPubMedCentralCrossRef
56.
Esquinas Rodriguez AM, Papadakos PJ, Carron M, Cosentini R, Chiumello D. Clinical review: Helmet and non-invasive mechanical ventilation in critically ill patients. Crit Care. 2013;17:223.PubMedPubMedCentralCrossRef
57.
Patel BK, Wolfe KS, Pohlman AS, Hall JB, Kress JP. Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2016;315:2435–41.PubMedPubMedCentralCrossRef
58.
59.
Brochard L, Slutsky A, Pesenti A. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am J Respir Crit Care Med. 2017;195:438–42.PubMedCrossRef
60.
Onelli R, Fantini R, Tabbì L, Castaniere I, Pisani L, Pellegrino MR, et al. Early inspiratory effort assessment by oesophageal manometry predicts noninvasive ventilation outcome in de novo respiratory failure: a pilot study. Am J Respir Crit Care Med. 2020;202:558–67.CrossRef
61.
Scala R, Pisani L. Noninvasive ventilation in acute respiratory failure: which recipe for success? Eur Respir Rev. 2018;27:180029.PubMedCrossRef
62.
Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363:1107–16.PubMedCrossRef
63.
Zayed Y, Barbarawi M, Kheiri B, Haykal T, Chahine A, Rashdan L, et al. Initial noninvasive oxygenation strategies in subjects with de novo acute hypoxemic respiratory failure. Respir Care. 2019;64:433–44.CrossRef
Metadata
Title
Efficacy of non-invasive and invasive respiratory management strategies in adult patients with acute hypoxaemic respiratory failure: a systematic review and network meta-analysis
Authors
Masaaki Sakuraya
Hiromu Okano
Tomoyuki Masuyama
Shunsuke Kimata
Satoshi Hokari
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2021
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-021-03835-8

Other articles of this Issue 1/2021

Critical Care 1/2021 Go to the issue

Review

Monitoring and modifying brain oxygenation in patients at risk of hypoxic ischaemic brain injury after cardiac arrest

Research

A randomized controlled trial to determine whether beta-hydroxy-beta-methylbutyrate and/or eicosapentaenoic acid improves diaphragm and quadriceps strength in critically Ill mechanically ventilated patients

Research

The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

Letter

Hospital networks and patient transport capacity during the COVID-19 pandemic when intensive care resources become scarce

Research

Cerebrospinal fluid cell count variability is a major confounding factor in external ventricular drain-associated infection surveillance diagnostics: a prospective observational study

Research

Development of a new score for early mortality prediction in trauma ICU patients: RETRASCORE