Abstract
BackgroundTo determine the effects of noninvasive mechanical ventilation (NIV) compared with invasive mechanical ventilation (IMV) as the initial mechanical ventilation on clinical outcomes when used for treatment of acute respiratory failure (ARF) in immunocompromised patients.MethodsWe searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Biomedical Literature Database (CBM) and other databases. Subgroup analyses by disease severity and causes of immunodeficiency were also conducted.ResultsThirteen observational studies with a total of 2552 patients were included. Compared to IMV, NIV was shown to significantly reduce in-hospital mortality (OR 0.43, 95 % CI 0.23 to 0.80, P value = 0.007) and 30-day mortality (OR 0.34, 95 % CI 0.20 to 0.61, P value < 0.0001) in overall analysis. Subgroup analysis showed NIV had great advantage over IMV for less severe, AIDS, BMT and hematological malignancies patients in reducing mortality and duration of ICU stay.ConclusionsThe overall evidence we obtained shows NIV does more benefits or at least no harm to ARF patients with certain causes of immunodeficiency or who are less severe.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0289-y) contains supplementary material, which is available to authorized users.
Highlights
To determine the effects of noninvasive mechanical ventilation (NIV) compared with invasive mechanical ventilation (IMV) as the initial mechanical ventilation on clinical outcomes when used for treatment of acute respiratory failure (ARF) in immunocompromised patients
Settings in the NIV group were as follows: (1) Ventilation modes: two studies [27, 32] used continuous positive airway pressure (CPAP) ventilation only; three [33, 34, 36] solely used bilevel positive airway pressure (BiPAP); another five [17, 20, 28, 30, 37] solely used pressure support ventilation (PSV); another one [31] used both CPAP and Bilevel positive airway pressure (Bi-PAP); no description was given in the remaining studies
(4) Positive End Expiratory Pressure (PEEP): in most studies, PEEP ranged between 3–10 cmH2O, adjusted with ventilation flow, pressure support and other settings to achieve a proper clinical outcome, including a pulse oximetry oxyhemoglobin saturation ≥ 95 %, an oxygen saturation ≥ 90 %, FiO2 ≤ 0.6, an exhaled tidal volume of 8 to 10 ml/ kg or a respiratory rate ≤ 25 breaths/min
Summary
To determine the effects of noninvasive mechanical ventilation (NIV) compared with invasive mechanical ventilation (IMV) as the initial mechanical ventilation on clinical outcomes when used for treatment of acute respiratory failure (ARF) in immunocompromised patients. In spite of better antimicrobial agents and preventive measures, infections continue to be one of the most frequent complications in immunocompromised patients and have a high mortality rate of 30 to 90 % [2], with the highest when acute respiratory failure (ARF) occurs. Noninvasive mechanical ventilation (NIV) and invasive mechanical ventilation (IMV) are two approaches for providing supplemental oxygen for patients with relatively severe ARF. NIV has gained more and more popularity since its first application in 1980s [3], and is widely accepted as a first-line intervention for certain forms of ARF, including acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and cardiogenic pulmonary edema [4,5,6,7,8,9,10,11,12,13,14]
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