Noninvasive or invasive mechanical ventilation in oncohematologic patients with acute respiratory failure: a systematic review and meta-analysis

Acute respiratory failure [ARF] in oncohematologic subjects is one of the most common causes of high mortality rates. Noninvasive mechanical ventilation [NIMV] has arisen as an accessory treatment in this clinical scenario. This study aimed to compare mortality rates and severity of illness associated with NIMV or invasive mechanical ventilation [IMV] in oncohematologic patients with ARF. A search was conducted in the PubMed, SCOPUS, Cochrane Library, LILACS, Web of Science, and gray literature databases, published between November 2007 and May 2021. Eight studies with a total of 570 patients were included. Patients with good responses to NIMV showed lower values of the Simplified Acute Physiology Score III [SAPS 3] [range: 42±7 to 53±17] when compared to those intubated following NIMV failure [range: 50±11 to 63.3±17.4] and those who underwent IMV as the primary ventilator support [range: 64.9±17.5 to 66±17]. Similarly, patients whose NIMV treatment failed and those that initially used IMV had higher baseline values of Sequential Organ Failure Assessment Score [SOFA] when compared to the group with a good response to NIMV. ICU mortality ranged from 40% to 68% in NIMV success, 54% to 79% in NIMV failure, and from 54% to 80% in the group treated with IMV. NIMV therapy had a significant protective effect on mortality [RR=0.71, 95% CI: 0.53-0.94, p=0.02]. NIMV use in oncohematologic patients admitted to the ICU with ARF was associated with lower mortality. Patients successfully treated with the NIMV group showed lower values of SOFA and SAPS 3 [Prospero Systematic Review -protocol number: 132770].