Noninvasive or Invasive Mechanical Ventilation in Oncohematologic Patients with Acute Respiratory Failure: A Systematic Review and Meta-Analysis

Abstract

Background: 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. Objective: This study aimed to compare mortality rates and severity of illness associated with NIMV or invasive mechanical ventilation (IMV) in oncohematologic patients with ARF. Methods: 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. Results: 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). Conclusions: NIMV use in oncohematologic patients admitted to the intensive care units (ICU) with ARF was associated with lower mortality. Patients successfully treated in the NIMV group showed lower values of SOFA and SAPS 3 (Prospero Systematic Review -protocol number: 132770).