Noninvasive versus invasive mechanical ventilation for immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis

Abstract

BackgroundTo determine the effects of noninvasive mechanical ventilation (NIV) compared with invasive mechanical ventilation (IMV) as the initial mechanical ventilation on clinical outcomes when used for treatment of acute respiratory failure (ARF) in immunocompromised patients.MethodsWe searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Biomedical Literature Database (CBM) and other databases. Subgroup analyses by disease severity and causes of immunodeficiency were also conducted.ResultsThirteen observational studies with a total of 2552 patients were included. Compared to IMV, NIV was shown to significantly reduce in-hospital mortality (OR 0.43, 95 % CI 0.23 to 0.80, P value = 0.007) and 30-day mortality (OR 0.34, 95 % CI 0.20 to 0.61, P value < 0.0001) in overall analysis. Subgroup analysis showed NIV had great advantage over IMV for less severe, AIDS, BMT and hematological malignancies patients in reducing mortality and duration of ICU stay.ConclusionsThe overall evidence we obtained shows NIV does more benefits or at least no harm to ARF patients with certain causes of immunodeficiency or who are less severe.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0289-y) contains supplementary material, which is available to authorized users.

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“…Previous studies were associated with sustained improvement of reduction in PICU length of stay in patients applied NIV [2,10,[17][18][19]. Although the meaningful relationship was not established in our study, the mean duration of hospitalization was much longer in NIV failure group than that of success group in PICU.…”

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“…However, these meta-analyses included studies focused on immunocompromised, acute cardiogenic pulmonary edema, or post-operative patients; their findings may therefore be less applicable to COVID-19 patients, in whom acute hypoxemic respiratory failure and ARDS are more common presentations. [43,[81][82][83] In acute hypoxemic respiratory failure with an etiology other than cardiogenic pulmonary edema, NIPPV has a high failure rate. In one RCT, failure was reported in 49% of patients with hypoxic respiratory failure ventilated with NIPPV; these patients therefore required intubation [71].…”

Short‐ and long‐term outcomes of neutropenic cancer patients in intensive care according to requirement for invasive ventilation

“…Patients who were successfully treated with NIV did not have significantly improved survival in our cohort, however these results were limited by the low numbers in this group. Other observational studies with sufficient numbers have found lower ICU mortality among patients successfully treated with NIV as opposed to IMV, as well as worse survival in those patients who fail NIV . This association of mortality with invasive ventilation, while consistently shown in observational studies, cannot be taken to imply causation given possible confounding by indication which would only be fully accounted for with randomised controlled trial design.…”