Abstract
Purpose
To summarize the evidence comparing noninvasive positive pressure ventilation (NPPV) and invasive positive pressure ventilation (IPPV) weaning on mortality, ventilator associated pneumonia and the total duration of mechanical ventilation among invasively ventilated adults with respiratory failure.
Source
Meta-analysis of randomized and quasi-randomized studies comparing early extubation with immediate application of NPPV to IPPV weaning. We selected randomized studies that 1) included adults, with respiratory failure, invasively ventilated for at least 24 hr; 2) compared extubation with immediate application of NPPV to weaning using IPPV; and 3) reported at least one clinically important outcome.
Principal findings
We searched MEDLINE (1966 to 2003), EMBASE (1980 to 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2003) for randomized controlled trials comparing NPPV and IPPV weaning. Additional data sources included personal files, conference proceedings and author contact. Two reviewers independently assessed trial quality and abstracted data. Five studies enrolling 171 patients demonstrated that compared to IPPV, noninvasive weaning decreased mortality (relative risk, 0.41 [95% confidence interval [CI] 0.22-0.76]), ventilator associated pneumonia (relative risk, 0.28 [95% CI 0.09-0.85]) and the total duration of mechanical ventilation (weighted mean difference,-7.33 days [95% CI -11.45 to -3.22 days]).
Conclusions
In the absence of a large randomized controlled trial, this meta-analysis demonstrated a consistent positive effect of noninvasive weaning on mortality. Notwithstanding, the use of NPPV to facilitate weaning, in mechanically ventilated patients, with predominantly chronic obstructive pulmonary disease, is associated with promising, but insufficient, evidence of net clinical benefit at present.
Résumé
Objectif
Résumer les données comparatives sur le sevrage de la ventilation à pression positive non effractive (VPPNE) et de la ventilation à pression positive effractive (VPPE) sur la mortalité, la pneumonie associée à la ventilation et la durée totale de la ventilation mécanique chez des adultes atteints ďinsuffisance respiratoire placés sous ventilation effractive.
Source
Une méta-analyse ďétudes randomisées et quasi-randomisées comparant ľextubation précoce, suivie de ľapplication immédiate de VPPNE, au sevrage de la VPPE. Les études sélectionnées 1) incluaient des adultes atteints ďinsuffisance respiratoire, placés sous ventilation effractive pendant au moins 24 h; 2) comparaient ľextubation, suivie immédiatement de VPPNE, au sevrage de la VPPE et 3) reportaient au moins un résultat clinique important.
Constatations principales
Les études randomisées et contrôlées comparant la VPPNE et le sevrage de la VPPE ont été repérées dans MEDLINE (1966 à 2003), EMBASE (1980 à 2003) et Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2003). Des fichiers personnels, les comptes rendus de conférences et des collègues ont complété nos sources. Deux réviseurs indépendants ont évalué la qualité des études et les données résumées. Cinq études, sur 171 patients, ont démontré que le sevrage de la VPPNE, comparé à celui de la VPPE, a réduit la mortalité (risque relatif (RR), 0,41 [intervalle de confiance de 95 % [IC] 0,22-0,76]), la pneumonie associée à la ventilation (RR, 0,28 [IC de 95 % 0,09-0,85]) et la durée totale de la ventilation mécanique (différence moyenne pondérée, -7,33 jours [IC de 95 %-11,45 à -3,22 jours]).
Conclusion
En ľabsence ďune grande étude randomisée et contrôlée, cette méta-analyse a démontré un effet positif, régulièrement obtenu, du sevrage non effractif sur la mortalité. Néanmoins, ľusage de la VPPNE pour faciliter le sevrage de la ventilation mécanique, chez des patients atteints surtout de maladie pulmonaire obstructive chronique, est associé à des indices prometteurs, mais insuffisants, de bénéfices cliniques évidents.
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E.A.Burns, K., Adhikari, N.K. & Meade, M.O. Neuroanesthesia and Intensive Care A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation. Can J Anesth 53, 305 (2006). https://doi.org/10.1007/BF03022220
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DOI: https://doi.org/10.1007/BF03022220