Noninvasive respiratory support following extubation in critically ill adults: a systematic review and network meta-analysis

Fernando, Shannon M.; Tran, Alexandre; Sadeghirad, Behnam; Burns, Karen E. A.; Fan, Eddy; Brodie, Daniel; Munshi, Laveena; Goligher, Ewan C.; Cook, Deborah J.; Fowler, Robert; Herridge, Margaret S.; Cardinal, Pierre; Jaber, Samir; Møller, Morten Hylander; Thille, Arnaud W.; Ferguson, Niall D.; Slutsky, Arthur S.; Brochard, Laurent; Seely, Andrew J. E.; Rochwerg, Bram

doi:10.1007/s00134-021-06581-1

Cited by 42 publications

(36 citation statements)

References 76 publications

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“…Although recent advances in critical care technology have significantly improved the prognosis and survival of patients receiving ventilator support ( 26 ), extubation failure still occurs in approximately 10–15% of patients ( 27 ). Previous studies have shown that extubation failure may be associated with higher rates of tracheotomies, increased mortality, prolonged stay in the intensive care unit, and impaired functional outcome after recovery ( 28 – 30 ).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic efficacy of sonographic measurement of laryngeal air column width difference for predicting the risk of post-extubation stridor: A meta-analysis of observational studies

et al. 2023

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BackgroundThis meta-analysis aimed at assessing the diagnostic accuracy of ultrasound-measured laryngeal air column width difference (ACWD) in predicting post-extubation stridor (PES) in intubated adult patients.MethodsWe searched the Medline, Cochrane Library, EMBASE, and Google scholar databases from inception to October, 2022 to identify studies that examined the diagnostic accuracy of ACWD for PES. The primary outcome was the diagnostic performance by calculating the pooled sensitivity, specificity, and area under the curve (AUC). The secondary outcomes were the differences in ACWD and duration of intubation between patients with and without PES.ResultsFollowing literature search, 11 prospective studies (intensive care setting, n = 10; operating room setting, n = 1) involving 1,322 extubations were included. The incidence of PES among the studies was 4–25%. All studies were mixed-gender (females: 24.1–68.5%) with sample sizes ranging between 41 and 432. The cut-off values of ACWD for prediction of PES varied from 0.45 to 1.6 mm. The pooled sensitivity and specificity of ACWD for PES were 0.8 (95% CI = 0.69–0.88, I2: 37.26%, eight studies) and 0.81 (95% CI = 0.72–0.88, I2: 89.51%, eight studies), respectively. The pooled AUC was 0.87 (95% CI = 0.84–0.90). Patients with PES had a smaller ACWD compared to those without PES (mean difference = −0.54, 95% CI = −0.79 to −0.28, I2: 97%, eight studies). Moreover, patients with PES had a longer duration of tracheal intubation than that in those without (mean difference = 2.75 days, 95% CI = 0.92, 4.57, I2: 90%, seven studies).ConclusionUltrasound-measured laryngeal ACWD showed satisfactory sensitivity and specificity for predicting PES. Because of the limited number of studies available, further investigations are needed to support our findings.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022375772.

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Section: Discussionmentioning

confidence: 99%

Diagnostic efficacy of sonographic measurement of laryngeal air column width difference for predicting the risk of post-extubation stridor: A meta-analysis of observational studies

et al. 2023

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“…A recent systematic review and network meta-analysis including 36 RCTs in adults showed a lower reintubation rate with noninvasive respiratory support compared with usual care, although no mode of noninvasive respiratory support proved superior ( 72 ). In pediatrics, there is very little data supporting or refuting the use of noninvasive ventilation to prevent reintubation ( 73 , 74 ).…”

Section: Use Of Niv After Extubationmentioning

confidence: 99%

Clinical Challenges in Pediatric Ventilation Liberation: A Meta-Narrative Review

Dijk

Blokpoel

Abu‐Sultaneh

et al. 2022

Pediatric Critical Care Medicine

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OBJECTIVES: To map the evidence for ventilation liberation practices in pediatric respiratory failure using the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards. DATA SOURCES: CINAHL, MEDLINE, COCHRANE, and EMBASE. Trial registers included the following: ClinicalTrials.gov, European Union clinical trials register, International Standardized Randomized Controlled Trial Number register. STUDY SELECTION: Abstracts were screened followed by review of full text. Articles published in English language incorporating a heterogeneous population of both infants and older children were assessed. DATA EXTRACTION: None. DATA SYNTHESIS: Weaning can be considered as the process by which positive pressure is decreased and the patient becomes increasingly responsible for generating the energy necessary for effective gas exchange. With the growing use of noninvasive respiratory support, extubation can lie in the middle of the weaning process if some additional positive pressure is used after extubation, while for some extubation may constitute the end of weaning. Testing for extubation readiness is a key component of the weaning process as it allows the critical care practitioner to assess the capability and endurance of the patient’s respiratory system to resume unassisted ventilation. Spontaneous breathing trials (SBTs) are often seen as extubation readiness testing (ERT), but the SBT is used to determine if the patient can maintain adequate spontaneous ventilation with minimal ventilatory support, whereas ERT implies the patient is ready for extubation. CONCLUSIONS: Current literature suggests using a structured approach that includes a daily assessment of patient’s readiness to extubate may reduce total ventilation time. Increasing evidence indicates that such daily assessments needs to include SBTs without added pressure support. Measures of elevated load as well as measures of impaired respiratory muscle capacity are independently associated with extubation failure in children, indicating that these should also be assessed as part of ERT.

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“…The use of high-flow nasal cannula (HFNC) in critical care areas has increased over the past few years, particularly during the COVID-19 pandemic [ 1 ]. HFNC has been shown to effectively reduce intubation rates for patients with acute hypoxemic respiratory failure (AHRF) [ 2 ] and prevent post-extubation respiratory failure [ 3 ]. It may also be non-inferior to noninvasive ventilation to prevent reintubation for patients with chronic obstructive pulmonary disease (COPD) [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

The effects of flow settings during high-flow nasal cannula support for adult subjects: a systematic review

Albuainain

Tan

et al. 2023

Crit Care

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Background During high-flow nasal cannula (HFNC) therapy, flow plays a crucial role in the physiological effects. However, there is no consensus on the initial flow settings and subsequent titration. Thus, we aimed to systematically synthesize the effects of flows during HFNC treatment. Methods In this systematic review, two investigators independently searched PubMed, Embase, Web of Science, Scopus, and Cochrane for in vitro and in vivo studies investigating the effects of flows in HFNC treatment published in English before July 10, 2022. We excluded studies that investigated the pediatric population (< 18 years) or used only one flow. Two investigators independently extracted the data and assessed the risk of bias. The study protocol was prospectively registered with PROSPERO, CRD42022345419. Results In total, 32,543 studies were identified, and 44 were included. In vitro studies evaluated the effects of flow settings on the fraction of inspired oxygen (FIO2), positive end-expiratory pressure, and carbon dioxide (CO2) washout. These effects are flow-dependent and are maximized when the flow exceeds the patient peak inspiratory flow, which varies between patients and disease conditions. In vivo studies report that higher flows result in improved oxygenation and dead space washout and can reduce work of breathing. Higher flows also lead to alveolar overdistention in non-dependent lung regions and patient discomfort. The impact of flows on different patients is largely heterogeneous. Interpretation Individualizing flow settings during HFNC treatment is necessary, and titrating flow based on clinical findings like oxygenation, respiratory rates, ROX index, and patient comfort is a pragmatic way forward.

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Noninvasive respiratory support following extubation in critically ill adults: a systematic review and network meta-analysis

Cited by 42 publications

References 76 publications

Diagnostic efficacy of sonographic measurement of laryngeal air column width difference for predicting the risk of post-extubation stridor: A meta-analysis of observational studies

Diagnostic efficacy of sonographic measurement of laryngeal air column width difference for predicting the risk of post-extubation stridor: A meta-analysis of observational studies

Clinical Challenges in Pediatric Ventilation Liberation: A Meta-Narrative Review

The effects of flow settings during high-flow nasal cannula support for adult subjects: a systematic review

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