Eficacia del uso profiláctico de la ventilación mecánica no invasiva en pacientes durante la extubación con prueba de respiración espontánea superada: revisión sistemática y metaanálisis

Abstract

BackgroundThe use of prophylactic non-invasive mechanical ventilation after extubation has been increasing, but the evidence for its use is not yet clear. ObjectiveTo evaluate the efficacy of prophylactic non-invasive mechanical ventilation after extubation compared with standard oxygen therapy in patients with invasive mechanical ventilation and who overcome a spontaneous breathing trial. Data sourcesDatabases including PubMed, Embase, and LILACS (August 2014) were searched for pertinent studies without language restrictions. DesignRandomized trials of prophylactic non-invasive mechanical ventilation after extubation compared with standard oxygen therapy in patients with invasive mechanical were included. Effects on primary outcomes: reduce post-extubation respiratory failure, reintubation rate, ICU and/or hospital mortality, and hospital length of stay were accessed in this meta-analysis. Data extractionThree review authors independently assessed trial quality and abstracted data according to pre-specified criteria. The program RevMan 5.3 was used for analysis. Data synthesisSeven trials with moderate to good quality involving 969 patients were included.The use of NIV following extubation for patients decrease the reintubation rate (odds risk [OR] 0.43, 95% confidence interval [CI] 0.25-0.76, I2 0%); reduces ICU mortality (OR 0.29, 95% CI 0.13-0.67, I2 0%), and reduces hospital mortality (OR 0.54, 95% CI 0.29-1.0, I2 0%) compared to standard oxygen therapy, particularly in patients with risk factors associated with failed extubation. ConclusionsThe results of this review suggested prophylactic non-invasive mechanical ventilation after extubation seems to be effective in reducing reintubation rate, and ICU and/or hospital mortality. This is most important in patients with risk factors associated with failed extubation.