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Non-invasive ventilation (NIV) is a supportive therapy that improves mortality in acute respiratory failure (RF). It may also be used in patients recently extubated in intensive care units (ICUs), after operation, and to aid weaning from mechanical ventilation (MV) by reducing the morbidity and mortality associated with further MV. A meta-analysis of the available evidence was performed on the use of NIV in three areas: weaning, reduction in reintubation rates post-extubation on ICU, and reduction in RF after major surgery. Sixteen relevant randomized controlled trials were identified by three reviewers after a detailed search of identified medical databases. A meta-analysis of summary statistics relating to predetermined endpoints (ICU and hospital length of stay, ICU and hospital mortality, reintubation, pneumonia) was performed. NIV reduced the ICU length of stay when used for weaning (5.12 days) and post-surgery (0.44 days). NIV reduced reintubation rates post-surgery [odds ratio (OR) 0.24, 95% confidence interval (CI) 0.12-0.50] and the incidence of pneumonia in weaning (OR 0.12, 95% CI 0.05-0.31) and post-surgery (OR 0.27, 95% CI 0.09-0.77). There was insufficient evidence to suggest that NIV improves ICU survival, but an increased hospital survival in post-surgery (OR 4.54, [corrected] 95% CI 1.35-15.31) and a reduction after weaning (OR 0.55, 95% CI 0.31-0.98) [corrected] was seen. A meta analysis of NIV use in selected subgroups of recently extubated patients suggests that the judicious NIV use may reduce ICU and hospital length of stay, pneumonia, and reintubation rates and hospital survival.

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IntroductionThe purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the provision of acute non-invasive ventilation in adults together with measurable markers of good practice.MethodsDevelopment of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards.Results6 quality statements have been developed, each describing a standard of care for the provision of acute non-invasive ventilation in the UK, together with measurable markers of good practice.ConclusionBTS Quality Standards for acute non-invasive ventilation in adults form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline’s recommendations.

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