Shirin Shafazand, MD, MS
What is the efficacy of noninvasive ventilation in acute respiratory failure?
Included studies compared noninvasive ventilation (noninvasive positive-pressure ventilation [NPPV] or continuous positive airway pressure [CPAP]) with standard therapy or each other in adults in an acute care setting who had or were at risk for acute or acute-on-chronic respiratory failure, and reported physiologic or clinical outcomes. Outcomes were endotracheal intubation, treatment failure, and hospital mortality.
MEDLINE, EMBASE/Excerpta Medica, CINAHL, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, ACP Journal Club, metaRegister of Controlled Trials, ClinicalTrials.gov, and Journals@Ovid (all to Jun 2009); personal files; and reference lists were searched for fully published, parallel-design, randomized controlled trials (RCTs). 146 RCTs that focused on acute respiratory failure or after intubation or postoperative periods met the selection criteria. Only studies of acute respiratory failure are reported here.
Noninvasive ventilation improves outcomes in patients with some causes of acute respiratory failure (Table).
Insufficient evidence exists to evaluate noninvasive ventilation in patients with severe community-acquired pneumonia or those with acute exacerbations of asthma, or to compare NPPV with conventional mechanical ventilation in patients with severe exacerbation of chronic obstructive pulmonary disease.
In patients with acute respiratory failure and cardiogenic pulmonary edema or severe exacerbation of chronic obstructive pulmonary disease, adding noninvasive ventilation to standard therapy improves clinical outcomes in an acute care setting.
Noninvasive positive-pressure ventilation (NPPV) plus standard therapy (ST) or continuous positive airway pressure (CPAP) by mask plus ST vs ST in patients with acute respiratory failure in an acute care setting*
*COPD = chronic obstructive pulmonary disease; GRADE = Grading of Recommendations Assessment, Development, and Evaluation; NR = not reported; other abbreviations defined in Glossary. RRR, RRI, and CI calculated from data in article based on a random-effects model. Insufficient data were available to calculate NNTs. Only comparisons with strong recommendations (GRADE level 1) for or against treatment are reported here.
†RRRs > 0 favor noninvasive ventilation; RRIs > 0 favor standard therapy.
‡High-quality evidence (GRADE approach).
§Not statistically significant.
||Low-quality evidence (GRADE approach) based on subgroup of patients without cardiac disease.
Shafazand S. Review: Adding noninvasive ventilation to standard therapy improves outcomes in patients with some causes of acute respiratory failure. Ann Intern Med. ;154:JC6–7. doi: 10.7326/0003-4819-154-12-201106210-02007
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Published: Ann Intern Med. 2011;154(12):JC6-7.
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