Karen Burns, MD, FRCPS
Associate Professor
Saint Michael's Hospital
Toronto, Ontario, Canada
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James Stevenson, BSc
Medical Student
Royal College of Surgeons of Ireland, United States
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Matthew Laird, BMSc
Medical Student
Royal College of Surgeons of Ireland, United States
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Neill K.J. Adhikari, MD, MSc
Associate Professor
Sunnybrook Health Sciences Centre, United States
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Yuchong Li, MD
Graduate Student
Keenan Research Centre - St. Miichael's Hospital, United States
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Cong Lu, MD
Graduate Student
Keenan Research Centre - St. Miichael's Hospital, United States
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Xiaolin He, MD PhD
Lab Manager
Keenan Research Centre - St. Miichael's Hospital, United States
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Wentao Wang, MD
Staff Physician
The Second Affiliated Hospital of Zhengzhou University, United States
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Zhenting Liang, MSc
Graduate Student
The First Affiliated Hospital of Guangzhou Medical University, United States
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Lu Chen, MD
Postgraduate Student
Keenan Research Centre, United States
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Haibo Zhang, PhD
Professor
Unity Health Toronto - St. MIchael's Hospital, United States
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Jan O. Friedrich, MD, PhD
Associate Professor
Unity Health Toronto - St. MIchael's Hospital, United States
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Title: Noninvasive Ventilation Versus Invasive Weaning in Critically Ill Adults: A Meta-Analysis
Introduction: Noninvasive weaning significantly reduced mortality, pneumonia, and the duration of ventilation related to weaning. In subgroup analyses, noninvasive weaning significantly reduced mortality, pneumonia, reintubation, and ICU stay in trials enrolling COPD (vs. mixed) populations. Extubation to noninvasive ventilation has been investigated as a strategy to wean critically ill adults from invasive ventilation and reduce ventilator-related complications.
Methods: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, proceedings of four conferences, and bibliographies (to June 2020) for randomized and quasi-randomized trials that compared extubation with immediate application of noninvasive ventilation to continued invasive weaning in intubated adults and reported mortality (primary outcome) or other outcomes. Two reviewers independently screened citations, assessed trial quality, and abstracted data.
Results: We identified 28 trials, of moderate to good quality, involving 2,066 patients, 44.6% with chronic obstructive pulmonary disease (COPD). Noninvasive weaning significantly reduced mortality [risk ratio (RR) 0.57, 95% confidence interval (CI) 0.44 to 0.74; high quality], weaning failures (RR 0.59, 95% CI 0.43 to 0.81; high quality), pneumonia (RR 0.30, 95% CI 0.22 to 0.41; high quality), intensive care unit (ICU) [mean difference (MD) -4.62 days, 95% CI -5.91 to -3.34] and hospital stay (MD -6.29 days, 95% CI -8.90 to -3.68). Noninvasive weaning also significantly reduced the total duration of ventilation, duration of invasive ventilation and duration of ventilation related to weaning (MD -0.57, 95% CI -1.08 to -0.07) and tracheostomy rate. Mortality, pneumonia, reintubation, and ICU stay were significantly lower in trials enrolling COPD (vs. mixed) populations.
Conclusions: Noninvasive weaning significantly reduced mortality, pneumonia, and the duration of ventilation related to weaning. In subgroup analyses, noninvasive weaning significantly reduced mortality, pneumonia, reintubation, and ICU stay in trials enrolling COPD (vs. mixed) populations.