Non-invasive ventilation versus invasive mechanical ventilation in patients with hypoxemic acute respiratory failure in an Intensive Care Unit. A randomized controlled study

Muncharaz, A. Belenguer; Cubedo-Bort, Manuel; Blasco-Asensio, David; Mateu‐Campos, Lidón; Vidal-Tegedor, Bárbara; Madero-Pérez, Javier; Ferrándiz-Sellés, Amparo

doi:10.23736/s0026-4954.16.01770-3

Cited by 5 publications

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“…A few small RCTs have shown benefit with NIV for early or mild ARDS or de novo hypoxic respiratory failure (418, 419). Since the last guideline distribution, only one additional study was added for analysis (420). Due to a small number of patients studied, low quality of evidence, uncertainty regarding whether clinicians can identify hypoxic patients in respiratory failure in whom NIV might be beneficial, and observational data that suggest the potential for harm with NIV in this setting, no clear recommendation can be made.…”

Section: Screening and Early Treatmentmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

Evans

Rhodes

Alhazzani

et al. 2021

Critical Care Medicine

1,492

1,081

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shock (27). The specific components of performance improvement did not appear to be as important as the presence of a program that included sepsis screening and metrics.Sepsis screening tools are designed to promote early identification of sepsis and consist of manual methods or automated use of the electronic health record (EHR). There is wide variation in diagnostic accuracy of these tools with most having poor predictive values, although the use of some was associated with improvements in care processes (28)(29)(30)(31). A variety of clinical variables and tools are used for sepsis screening, such as systemic inflammatory response syndrome (SIRS) criteria, vital signs, signs of infection, quick Sequential Organ Failure Score (qSOFA) or Sequential Organ Failure Assessment (SOFA) criteria, National Early Warning Score (NEWS), or Modified Early Warning Score (MEWS) (26,32). Machine learning may improve performance of screening tools, and in a meta-analysis of 42,623 patients from seven studies for predicting hospital acquired sepsis the pooled area under the receiving operating curve (SAUROC) (0.89; 95% CI, 0.86−0.92); sensitivity (81%; 95% CI, 80−81), and specificity (72%; 95% CI, 72−72) was higher for machine learning than the SAUROC for traditional screening tools such as SIRS (0.70), MEWS (0.50), and SOFA (0.78) (32).Screening tools may target patients in various locations, such as in-patient wards, emergency departments, or ICUs (28)(29)(30)32). A pooled analysis of three RCTs did not demonstrate a mortality benefit of active screening (RR, 0.90; 95% CI, 0.51−1.58) (33-35). However, while there is wide variation in sensitivity and specificity of sepsis screening tools, they are an important component of identifying sepsis early for timely intervention.Standard operating procedures are a set of practices that specify a preferred response to specific clinical circumstances (36). Sepsis standard operating procedures, initially specified as Early Goal Directed Therapy have evolved to "usual care" which includes a standard approach with components of the sepsis bundle, early identification, lactate, cultures, antibiotics, and fluids (37). A large study examined the association between implementation of state-mandated sepsis protocols, compliance, and mortality. A retrospective cohort study of 1,012,410 sepsis admissions to 509 hospitals in the United States in a retrospective cohort examined mortality before (27 months) and after (30 months) implementation of New York state sepsis regulations, with a concurrent control population from four other states (38). In this comparative interrupted time series, mortality was lower in hospitals with higher compliance with achieving the sepsis bundles successfully.Lower resource countries may experience a different effect. A meta-analysis of two RCTs in Sub-Saharan Africa found higher mortality (RR, 1.26; 95% CI, 1.00−1.58) with standard operating procedures compared with usual care, while it was decreased in one observational study (adjusted hazard ratio [HR]; 95% CI, 0.55...

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Section: Screening and Early Treatmentmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

Evans

Rhodes

Alhazzani

et al. 2021

Critical Care Medicine

1,492

1,081

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“…Network meta-analysis was conducted using 19 RCTs (N = 2777) [155][156][157][158][159][160][161][162][163][164][165][166][167][168][169][170][171][172][173]. Short-term mortality (direct comparison 14 RCTs [155,158,160,[162][163][164][165][166][167][168][169][170][171]173]: N = 1494) occurred in 107 fewer/1000 patients (166 fewer-31 fewer patients); tracheal intubation (direct comparison 14 RCTs [155,158,160,[163][164][165][166][167][168][169][170][171]173]: N = 1495) was performed in 135 fewer/1000 patients (188 fewer-69 fewer patients); pneumonia (direct comparison 8 RCTs: N = 804) occurred in 50 fewer/1000 patients (75...…”

Section: Summary Of Evidencementioning

confidence: 99%

“…Network meta-analysis was conducted using 19 RCTs (N = 2777) [155][156][157][158][159][160][161][162][163][164][165][166][167][168][169][170][171][172][173]. Short-term mortality direct comparison 2 RCTs: N = 976) occurred in 117 fewer/1000 patients (215 fewer-44 more patients); intubation (direct comparison 4 RCTs [156,[159][160][161]: N = 1176) was performed in 89 fewer/1000 patients (187 fewer-127 more); pneumonia (direct comparison 1 RCT [160]: N = 200) occurred in 82 fewer/1000 patients (110 fewer-4 more patients).…”

Section: Summary Of Evidencementioning

confidence: 99%

“…Network meta-analysis was conducted using 19 RCTs (N = 2777) [155][156][157][158][159][160][161][162][163][164][165][166][167][168][169][170][171][172][173]. Short-term mortality (direct comparison 2 RCTs [157,171]: N = 129) occurred in 31 fewer/1000 patients (203 fewer-296 more patients); pneumonia (direct comparison 2 RCTs [157,171]: N = 129) occurred in 401 fewer/1000 patients (450 fewer-295 fewer patients). From the above, the desirable effect of NPPV was judged to be "moderate.…”

Section: Summary Of Evidencementioning

confidence: 99%

“…There was 1 RCT [157] that reported on skin disorders, which was an important outcome relating to harm; there were more cases of skin disorders with NPPV (3/32 [9.4%] vs. 0/32 [0%]). From the above, the undesirable effect of NPPV was judged to be "trivial.…”

Section: Summary Of Evidencementioning

confidence: 99%

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ARDS Clinical Practice Guideline 2021

et al. 2022

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Background The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021. Methods The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. We also conducted systematic reviews that used meta-analyses of diagnostic accuracy and network meta-analyses as a new method. Results Recommendations for adult patients with ARDS are described: we suggest against using serum C-reactive protein and procalcitonin levels to identify bacterial pneumonia as the underlying disease (GRADE 2D); we recommend limiting tidal volume to 4–8 mL/kg for mechanical ventilation (GRADE 1D); we recommend against managements targeting an excessively low SpO2 (PaO2) (GRADE 2D); we suggest against using transpulmonary pressure as a routine basis in positive end-expiratory pressure settings (GRADE 2B); we suggest implementing extracorporeal membrane oxygenation for those with severe ARDS (GRADE 2B); we suggest against using high-dose steroids (GRADE 2C); and we recommend using low-dose steroids (GRADE 1B). The recommendations for pediatric patients with ARDS are as follows: we suggest against using non-invasive respiratory support (non-invasive positive pressure ventilation/high-flow nasal cannula oxygen therapy) (GRADE 2D), we suggest placing pediatric patients with moderate ARDS in the prone position (GRADE 2D), we suggest against routinely implementing NO inhalation therapy (GRADE 2C), and we suggest against implementing daily sedation interruption for pediatric patients with respiratory failure (GRADE 2D). Conclusions This article is a translated summary of the full version of the ARDS Clinical Practice Guideline 2021 published in Japanese (URL: https://www.jsicm.org/publication/guideline.html). The original text, which was written for Japanese healthcare professionals, may include different perspectives from healthcare professionals of other countries.

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Respiratory support strategy in adults with acute hypoxemic respiratory failure: a systematic review and network meta-analysis

et al. 2022

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Introduction Network meta-analyses (NMAs) of respiratory management strategies for acute hypoxemic respiratory failure (AHRF) have been reported, but no previous study has compared noninvasive ventilation (NIV), high-flow nasal oxygen (HFNO), standard oxygenation therapy (SOT), and invasive mechanical ventilation (IMV) for de novo AHRF. Therefore, we conducted an NMA to assess the effectiveness of these four respiratory strategies in patients with de novo AHRF. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults aged ≥18 years with AHRF and RCTs that compared two different oxygenation techniques (SOT, NIV, HFNO, or IMV) were selected. A frequentist-based approach with multivariate random-effects meta-analysis was used. The outcomes were mortality and intubation rates. Results Among the 14,263 records initially identified, 25 studies (3302 patients) were included. In the analysis of mortality, compared to SOT, NIV (risk ratio [RR], 0.76; 95% confidence interval [CI], 0.61–0.95) reduced mortality; however, IMV (RR, 1.01; 95% CI, 0.57–1.78) and HFNO (RR, 0.89; 95% CI, 0.66–1.20) did not. For assessments of the intubation incidence, compared to SOT, NIV use (RR, 0.63; 95% CI, 0.51–0.79) was associated with a reduction in intubation, but HFNO (RR, 0.82; 95% CI, 0.61–1.11) was not significant. Conclusions Our NMA demonstrated that only NIV showed clinical benefits compared with SOT as an initial respiratory strategy for de novo AHRF. Further investigation, especially comparison with HFNO, is warranted. Trial registration PROSPERO (registration number: CRD42020213948, 11/11/2020).

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Non-invasive ventilation versus invasive mechanical ventilation in patients with hypoxemic acute respiratory failure in an Intensive Care Unit. A randomized controlled study

Cited by 5 publications

References 0 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

ARDS Clinical Practice Guideline 2021

Respiratory support strategy in adults with acute hypoxemic respiratory failure: a systematic review and network meta-analysis

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