Can non‐invasive positive pressure ventilation prevent endotracheal intubation in acute lung injury/acute respiratory distress syndrome? A meta‐analysis

Abstract

The role of non-invasive positive pressure ventilation (NIPPV) in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is controversial. The aim of this study was to investigate whether NIPPV could prevent endotracheal intubation and decrease mortality rate in patients with ALI/ARDS. Randomized controlled trials (RCT) which reported endotracheal intubation and mortality rate in patients with ALI/ ARDS treated by NIPPV were identified in Pubmed, Medline, Embase, Central Cochrane Controlled Trials Register, Chinese National Knowledge Infrastructure, reference lists and by manual searches. Fixed-and random-effects models were used to calculate pooled relative risks. This meta-analysis included six RCT involving 227 patients. The results showed that endotracheal intubation rate was lower in NIPPV (95% confidence interval (CI): 0.44-0.80, z = 3.44, P = 0.0006), but no significant difference was found either in intensive care unit (ICU) mortality (95% CI: 0.45-1.07, z = 1.65, P = 0.10) or in hospital mortality (95% CI: 0.17-1.58, z = 1.16, P = 0.25). Only two studies discussed the aetiology of ALI/ARDS as pulmonary or extra-pulmonary, and neither showed statistical heterogeneity (I 2 = 0%, χ 2 = 0.31, P = 0.58), nor a significant difference in endotracheal intubation rate (95% CI: 0.35-9.08, z = 0.69, P = 0.49). In conclusion, the early use of NIPPV can decrease the endotracheal intubation rate in patients with ALI/ARDS, but does not change the mortality of these patients.

Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: a multi-center prospective cohort study

“…Early use of non-invasive ventilation (NIV) can reduce the need for intubation of mild ARDS patients [7][8][9][10][11][12]. In a few observational studies [13][14][15][16], lower rates of intubation were seen among hypoxemic patients receiving high-flow nasal cannula (HFNC) than among those receiving NIV or standard oxygen therapy.…”

A study on the role of noninvasive ventilation in mild-to-moderate acute respiratory distress syndrome

“…However, in the meta-analysis, only three studies ( n = 89) involved patients with ARDS and the analysis also included postsurgical subjects with atelectasis. [ 10 ] In another meta-analysis involving only subjects with ARDS, it was shown that NIV avoids intubation in approximately 50% of the patients, provided the patients are judiciously chosen. [ 9 ] There is sparse data on the role of NIV from the developing world.…”

Successful management of H1N1 related severe acute respiratory distress syndrome with noninvasive positive pressure ventilation

“…Although the guidelines published on behalf of the European Respiratory Society and the European Society of Intensive Care Medicine were clearly indicating the use of mechanical ventilation for severe ARDS caused by H1N1 pneumonia (13), our case report, as well as other reports and studies (14)(15)(16)(17)(18), suggest that NIPPV can be useful in well selected patients. Hence, we postulate that the absence of other organ dysfunction associated with the acute respiratory failure as well as an early improvement of the oxygenation parameters with NIPPV may warrant an attempt of noninvasive ventilation as a first line ventilatory strategy to manage patients with severe influenza A H1N1 related ARDS.…”