Noninvasive ventilation and survival in acute care settings: a comprehensive systematic review and metaanalysis of randomized controlled trials.

摘要: OBJECTIVE Noninvasive ventilation is increasingly applied to prevent or treat acute respiratory failure, but its benefit on survival still controversial for many indications. We performed a metaanalysis of randomized controlled trials focused the effect noninvasive mortality. DATA SOURCES BioMedCentral, PubMed, Embase, and Cochrane Central Register clinical (updated December 31, 2013) were searched. STUDY SELECTION included all published in last 20 years adults, reporting mortality, comparing any other treatment prevention failure as tool allowing an earlier extubation. Studies with unclear methodology, two modalities, palliative settings excluded. EXTRACTION extracted data study design, population, setting, comparator, follow-up duration. SYNTHESIS Seventy-eight studies analyzed. was associated reduction mortality (12.6% group vs 17.8% control arm; risk ratio=0.73 [0.66-0.81]; p<0.001; number needed treat=19 7,365 patients included) at longest available follow-up. Mortality reduced when used (14.2% 20.6%; ratio=0.72; treat=16, improved pulmonary edema, chronic obstructive disease exacerbation, mixed etiologies, postoperative failure) (5.3% 8.3%; ratio=0.64 [0.46-0.90]; treat=34, postextubation ICU patients), not facilitate Overall results confirmed hospital Patients maintained even crossover controls rescue treatment. CONCLUSIONS This comprehensive suggests that improves care settings. The could be lost some subgroups if late Whenever indicated, early adoption should promoted.