Critical Care: Mechanical Ventilation & Respiratory Failure I |

Early Noninvasive Ventilation Prevents Evolution of Acute Respiratory Failure in Immunosuppressed Patients: A Systemic Review and Meta-analysis of Randomized Controlled Trials FREE TO VIEW

Wei-cheng Chen; Chih-Wei Yao; Hsu-Tang Cheng; Kuo-yang Huang; Chia-Hsiang Li; Shinn-Jye Laing; Chih-Yen Tu; Hung-Jen Chen
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China Medical University Hospital, Taichung City, Taiwan

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):305A. doi:10.1016/j.chest.2016.08.318
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SESSION TITLE: Mechanical Ventilation & Respiratory Failure I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Immunosuppressed patients with acute respiratory failure are related to high mortality. Noninvasive ventilation (NIV) may improve survival in some populations, but its benefit is still controversial for immunosuppressed patients. This meta-analysis aimed to determine whether the early NIV could avoid endotracheal intubation and further decrease the mortality rate versus conventional oxygen therapy.

METHODS: We searched PubMed/MEDLINE, Cochrane, and Web of Science databases published up to March 2016. Two independent authors included all randomized controlled trials (RCTs) and comparing NIV to conventional oxygen therapy in immunosuppressed patients with acute respiratory failure, with documentation of intubation rate and mortality rate. The immunosuppression was defined as at least one of the following: hematologic or solid malignancy, recipients of organ transplantation, high-dose steroid (>1mg/Kg/day) or other immunosuppressant drug therapy, or human immunodeficiency virus infection. We derived summary estimates using a random-effects model and reported them as risk ratio (RR) with confidence intervals.

RESULTS: Five eligible RCTs were identified from 395 studies in the search (Four bilevel positive airway pressure, one continuous positive airway pressure). Meta-analysis showed reduced intubation rate (32% vs 47%, RR=0.52, 95% CI: 0.32-0.85, P=0.009) and decreased mortality rate with borderline statistically significance (37.1% vs 48.8%, RR=0.70, 95% CI: 0.49-1.02, P=0.06) in NIV group than the conventional oxygen therapy. In the subgroup analysis, the reduced intubation rate was more prominent in the patients with hematologic or solid cancer who used NIV (28.5% vs 37.6%, RR=0.45, 95% CI: 0.22-0.89, P=0.02).

CONCLUSIONS: Early noninvasive ventilation can reduce the intubation rate in immunosuppressed patients with acute respiratory failure versus conventional oxygen therapy. There is a trend toward decreased mortality rate. The type and protocol of ventilation were not standardized, and new studies are still needed.

CLINICAL IMPLICATIONS: In the early phase of acute respiratory failure among immunosuppressed patients, noninvasive ventilation can support patient's effort, improve the oxygenation, prevent evolution to intubation, and possibly reduce mortality.

DISCLOSURE: The following authors have nothing to disclose: Wei-cheng Chen, Chih-Wei Yao, Hsu-Tang Cheng, Kuo-yang Huang, Chia-Hsiang Li, Shinn-Jye Laing, Chih-Yen Tu, Hung-Jen Chen

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