Is there a role for noninvasive ventilation in acute respiratory distress syndrome? A meta-analysis

Agarwal, Ritesh; Reddy, C. Ekambar Eshwara; Aggarwal, Ashutosh N.; Gupta, Dheeraj

doi:10.1016/j.rmed.2006.03.018

Cited by 79 publications

(59 citation statements)

References 9 publications

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“…16 A meta-analysis suggested that NIV did not decrease the intubation rate and that there was not enough evidence to support the use of NIV in ALI/ARDS patients. 18 Recent research suggests that NIV benefits a small percentage of patients with ALI/ARDS due to H1N1, but the past high NIV failure rate should be kept in mind, and these patients should be closely monitored and intubated without delay if they clinically deteriorate. 19 The H1N1 pandemic differed from earlier pandemics such as the H2N2 1889 Russian influenza pandemic, the H2N2 1957 Asian influenza pandemic, and the H3N2 1968 Hong Kong influenza pandemic, in which the infection was mostly among children and young adults, and the mortality was greatest in very young children and the elderly.…”

Section: Discussionmentioning

confidence: 99%

Survival From Severe Pandemic H1N1 in Urban and Rural Turkey: A Case Series

et al. 2011

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. RESULTS: During the study period, in our ICU we followed 18 patients (10 female) with H1N1. Their median (and IQR) age was 39 y (24 -52 y), their median (and IQR) Acute Physiology and Chronic Health Evaluation (APACHE II) score was 16 (10 -25), and 7 (39%) of them lived in rural places. All 18 patients had acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The most common risk factors for severe H1N1 infection were obesity (33%), COPD (16%), and pregnancy (11%). Thirteen patients (72%) needed mechanical ventilation at ICU admission. Mortality was 50% (9/18) at day 28. Significantly more survivors were urban dwellers than rural (82% vs 0%, P < .001). There were also statistically significant differences between survivors and nonsurvivors in success of noninvasive ventilation, time to confirmation of the H1N1 virus after ICU admission, creatinine, lactate dehydrogenase, pH, P aCO 2 , and P aO 2 /F IO 2 . CONCLUSIONS: The most common clinical presentation was ALI/ARDS in H1N1 patients who needed intensive care. Living in rural areas might have affected those patients' access to advanced ICU facilities and early ventilatory support. Failure of noninvasive ventilation, late diagnosis, late antiviral therapy, high APACHE II score, and living in a rural area were associated with mortality.

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Section: Discussionmentioning

confidence: 99%

Survival From Severe Pandemic H1N1 in Urban and Rural Turkey: A Case Series

et al. 2011

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“…Independent risk factors for NPPV failure in this group of patients include severe hypoxaemia, shock and metabolic acidosis [64]. A recent meta-analysis reported no reduction in the ETI rate and ICU mortality rate with the addition of NPPV to standard care [66]. Conclusions are difficult to draw owing to the heterogeneity of the studies analysed.…”

Section: Acute Cardiogenic Pulmonary Oedemamentioning

confidence: 96%

Noninvasive positive pressure ventilation in the acute care setting: where are we?

Ambrosino¹,

Vagheggini²

2008

European Respiratory Journal

168

128

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Noninvasive positive pressure ventilation (NPPV) is a technique used to deliver mechanical ventilation that is increasingly utilised in acute and chronic conditions. The present review examines the evidence supporting the use of NPPV in acute respiratory failure (ARF) due to different conditions. Strong evidence supports the use of NPPV for ARF to prevent endotracheal intubation (ETI), as well as to facilitate extubation in patients with acute exacerbations of chronic obstructive pulmonary disease and to avoid ETI in acute cardiogenic pulmonary oedema, and in immunocompromised patients. Weaker evidence supports the use of NPPV for patients with ARF due to asthma exacerbations, with post-operative or post-extubation ARF, pneumonia, acute lung injury, acute respiratory distress syndrome, or during bronchoscopy. NPPV should be applied under close clinical and physiological monitoring for signs of treatment failure and, in such cases, ETI should be promptly available. A trained team, careful patient selection and optimal choice of devices can optimise outcome of NPPV.Noninvasive positive pressure ventilation is increasingly being used in the management of acute respiratory failure but caregivers must respect evidence-supported indications and avoid contraidincations. Additionally, the technique must be applied in the appropriate location by a trained team in order to avoid disappointing results.

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“…20 However, because of substantial patient heterogeneity in the included studies, that result cannot be extrapolated to the subset of patients with ALI and ARDS. Agarwal et al 21 conducted a meta-analysis of randomized controlled trials and included only patients with ALI/ARDS. The results suggested that patients with ALI/ARDS were unlikely to have important outcome benefits from NIV added to standard therapy, but the analysis included only 3 studies (with a total of 111 patients), so there was a chance of type I and type II errors.…”

Section: Physiological Rationalementioning

confidence: 99%