Effects of prophylactic non-invasive ventilation on weaning: A systematic review with meta-analysis

Abstract

Objective

The aim of this study was to evaluate the effects of prophylactic non-invasive ventilation (NIV) on reintubation, postextubation respiratory failure, length of stay (LOS), and mortality in the intensive care unit (ICU).

Method

A systematic review of the databases followed by meta-analysis was conducted. We included randomised or quasi-randomised clinical trials conducted in adults, with a mechanical ventilation time >48 h, who had good performance in the spontaneous breathing test and compared the use of prophylactic NIV with oxygen supplementation.

Results

Eleven studies were included in this review. There was a difference in favour of prophylactic NIV for the outcome reintubation (odds ratio [OR]: 0.49; 95% confidence interval [CI]: 0.32, 0.74), ICU mortality (OR: 0.39; 95% CI: 0.21, 0.71), hospital mortality (OR: 0.53; 95% CI: 0.33, 0.85), ICU LOS (median [MD]: -2.86; 95% CI: −5.47, −0.24), and postextubation respiratory failure development (OR: 0.28; 95 % CI: 0.12, 0.67). There was no difference noted for hospital LOS (MD: -0 0.42; 95% CI: -3.42, 2.59). In the subgroup analysis, the use of rescue NIV, mainly in the control group, showed no statistically significant difference in the outcomes.

Conclusion

The use of prophylactic NIV reduced reintubation rates, ICU and hospital LOS, and mortality. These findings support the recommendation for its use in daily practice. Rescue NIV may have reduced the reintubation rate in control group who underwent the procedure.

Prospero registration

CRD42022381099.