Invasive-noninvasive Sequential Ventilation for the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Background: The study aimed to evaluate the efficacy and safety of invasivenoninvasive sequential ventilation versus invasive ventilation in the treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Method: PubMed, Cochrane, Embase, Wanfang, CNKI, VIP database were searched by the index words to identify the qualified RCTs, and relevant literature sources were also searched. The latest research was conducted in June 2017. Relative Risks (RR), and Mean Difference (MD) along with 95% confidence interval (95% CI) were used to analyze the main outcomes. Result: Twenty-nine RCTs were involved in this analysis of 1061 patients in the invasivenoninvasive sequential ventilation group (In-non group) and 1074 patients in the invasive ventilation group (In group). The results indicated that compared with the invasive ventilation, invasive-noninvasive sequential ventilation would significantly decrease the incidence of VAP (RR:0.20, 95%CI: 0.16-0.26), mortality (RR:0.38, 95%CI: 0.26-0.55), reintubation (RR:0.39, 95%CI: 0.27-0.55); and statistically reduced the duration of invasive ventilation (MD:-9.23, 95%CI: -10.65, -7.82), the total duration of mechanical ventilation (MD:-4.91, 95%CI: -5.99, -3.83), and the length of stay in the ICU (MD:-5.10, 95%CI: -5.43, -4.76). Conclusion: The results demonstrated that the application of noninvasive sequential ventilation after invasive ventilation at the pulmonary infection control window has a significant influence on VAP incidence, mortality, and the length of stay in the ICU, but further well-designed, adequately powered RCTs are required to validate the conclusion.

The effect of non-invasive sequential ventilation treatment based on the use of an invasive ventilator on the arterial blood gas and inflammatory stress reaction in patients with severe pneumonia with respiratory failure

“…We found that mechanical ventilation time, invasive ventilation time, ICU stay and hospital stay in the study group were significantly shorter in the intervention group when compared to the conventional treatment group, thus indicating that noninvasive sequential ventilation therapy based on the use of an invasive ventilator can effectively shorten the mechanical ventilation time. This regimen was also shown to be conducive to the recovery of the disease, as confirmed by hospital stay data; these results were consistent with some previous reports [24,25]. Because non-invasive sequential ventilation therapy can ensure the stability of ventilation after invasive mechanical ventilation therapy; this strategy can improve a patient's respiratory failure symptoms, and parameters can be gradually adjusted according to the patient's actual condition to ensure that while reducing airway resistance, pulmonary surfactant consumption can also be reduced; in turn, this reduces ventilator oxygen consumption and shortens the overall duration of ventilation [26].…”

Sequential non-invasive following short-term invasive mechanical ventilation in the treatment of tuberculosis with respiratory failure: a randomized controlled study

“…Although there was no significant difference in ventilation time and the length of ICU stay between the two groups, our study detected sequential MV was able to reduce the incidence of VAP and atelectasis, mainly due to the reduced time of invasive ventilation. A recent meta-analysis performed by Huang et al also assessed the safety of sequential MV versus conventional MV in the treatment of acute exacerbation of COPD (AECOPD) [ 15 ]. Their results showed the application of sequential MV at the pulmonary infection control window significantly reduced VAP incidence (RR: 0.20, 95% CI 0.16–0.26), mortality (RR: 0.38, 95% CI 0.26–0.55), reintubation rate (RR: 0.39, 95% CI 0.27–0.55), invasive ventilation time (MD: − 9.23, 95% CI − 10.65, − 7.82), total ventilation time (MD: − 4.91, 95% CI − 5.99, − 3.83), and the length of ICU stay (MD: − 5.10, 95% CI − 5.43, − 4.76).…”

Sequential Non-Invasive Following Short-Term Invasive Mechanical Ventilation in the Treatment of Tuberculosis with Respiratory Failure: A Randomized Controlled Study

“…Although there was no signi cant difference in ventilation time and the length of ICU stay between the two groups, our study detected SMV was able to reduce the incidence of VAP and atelectasis, mainly due to the reduced time of invasive ventilation. A recent meta-analysis performed by Huang et al also assessed the safety of SMV versus CMV in the treatment of acute exacerbation of COPD (AECOPD) [14].…”