The efficacy of noninvasive ventilation in managing postextubation respiratory failure: a meta-analysis.

INTRODUCTION: To determine the effectiveness of noninvasive ventilation (NIV) in the management of postextubation respiratory failure.

METHODS: Databases including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to find relevant trials. Randomized and quasi-randomized trials studying NIV in adult patients with postextubation respiratory failure were included. Effects on primary outcomes (i.e., reintubation rate, and ICU or/and hospital mortality) were accessed in this meta-analysis.

RESULTS: Ten trials involving 1382 patients were included: two used NIV in patients with established postextubation respiratory failure, and eight used NIV immediately after extubation. The use of NIV following extubation for patients (n = 302) with established respiratory failure did not decrease the reintubation rate (relative risk [RR] 1.02, 95% confidence interval [CI] 0.83-1.25) and ICU mortality (RR 1.14, 95% CI 0.43-3.00), compared to standard medical therapy (SMT). Early application of NIV after extubation (n = 1080) also did not decrease the reintubation rate (RR 0.75, 95% CI 0.45-1.15) significantly. However, in the planned extubation subgroup (n = 849), there were significant reductions in the reintubation rate (RR 0.65, 95% CI 0.46-0.93), ICU mortality rate (RR 0.41, 95% CI 0.21-0.82), and hospital mortality rate (RR 0.59, 95% CI 0.38-0.93) compared to SMT.

CONCLUSION: Current evidence suggests that the use of NIV in patients with established postextubation respiratory failure should be monitored cautiously. Early use of NIV can benefit patients with planned extubation by decreasing the reintubation rate and the ICU and hospital mortality rates.