Early non-invasive ventilation versus conventional oxygen therapy in immunocompromised patients with respiratory failure: a meta-analysis

Abstract

Background and Objectives: Respiratory failure is common in immunocompromised patients and mechanical ventilation (MV) is the mainstay of therapy. Non-invasive ventilation (NIV) is an alternative to MV in a select group of patients and aims to avoid the complications of MV. Methods: We performed a meta-analysis of randomized controlled trials that used early NIV versus conventional oxygen therapy in immunocompromised patients with respiratory failure. The primary outcome of interest was intubation and MV rate. The secondary outcomes were ICU and all-cause mortality, ICU length of stay and duration of mechanical ventilation. Results: Four studies with a total population of 553 patients were included. Rate of intubation and mechanical ventilation was lower in the patients treated with early NIV versus those given oxygen alone (RR=0.73[0.59-0.89]) but the result was significantly heterogeneous (I2=55%). Upon sensitivity analysis, the benefit of early NIV in reducing intubation and mechanical ventilation rate was preserved (RR=0.49[0.33-0.73]). Early NIV also significantly decreased ICU mortality rate (RR 0.52 [0.28-0.97]) and ICU length of stay (mean decrease of 2.24days [range 3.92-0.56]). However, it did not decrease all-cause mortality (RR=0.77[0.53-1.11]) and the duration of mechanical ventilation (mean decrease of 0.08[range: -0.49-0.33]). Conclusion: In immunocompromised patients with respiratory failure, early NIV is effective in reducing intubation and MV rates. It also decreased ICU mortality rates and ICU length of stay, and showed overall trend towards reduction in all-cause mortality versus standard oxygen therapy.