Skip to main content

Abstract

Guidelines recommend noninvasive ventilation (NIV) for severe exacerbations of chronic obstructive pulmonary disease (COPD) and cardiogenic pulmonary edema to prevent intubation and enhance survival [1, 2]. However, clinicians apply NIV to a broader array of clinical conditions to provide partial respiratory support and to limit intubation-related complications, including pneumonia and prolonged mechanical ventilation. Regardless of the indication, the clinician’s goal in using NIV is to reduce patient morbidity and mortality. In this chapter, we summarize current RCTs and meta-analyses pertaining to the application of NIV to wean patients from invasive ventilation, prevent extubation failure in at-risk patients, and to treat post-extubation respiratory failure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

CI:

Confidence interval

COPD:

Chronic obstructive pulmonary disease

CPAP:

Continuous positive airway pressure

FEV1 :

Forced expiratory volume in 1 s

GRADE:

Grading of Recommendations Assessment Development and Evaluation

I2 :

Measure of heterogeneity

ICU:

Intensive care unit

MD:

Mean difference

NIV:

Noninvasive ventilation

PS:

Pressure support

RR:

Relative risk

References

  1. Keenan SP, Sinuff T, Cook DJ, Hill NS. Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive positive-pressure ventilation? A systematic review of the literature. Ann Intern Med. 2003;138(11):861–70.

    Article  PubMed  Google Scholar 

  2. Mariani J, Macchia A, Belziti C, Deabreu M, Gagliardi J, Doval H, Tognoni G, Tajer C. Noninvasive ventilation in acute cardiogenic pulmonary edema: a meta-analysis of randomized controlled trials. J Card Fail. 2011;17(10):850–9.

    Article  PubMed  Google Scholar 

  3. Ferreyra G, Fanelli V, Del Sorbo L, Ranieri VM. Are guidelines for non-invasive ventilation during weaning still valid? Minerva Anestesiol. 2011;77:921–6.

    PubMed  CAS  Google Scholar 

  4. International Consensus Conferences in Intensive Care Medicine. Noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med. 2001;163:283–91.

    Article  Google Scholar 

  5. British Thoracic Society Standards of Care Committee. Noninvasive ventilation in acute respiratory failure. Thorax. 2002;57:192–211.

    Article  Google Scholar 

  6. Boles J-M, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T. Weaning from mechanical ventilation. Eur Respir J. 2007;29:1033–56.

    Article  PubMed  Google Scholar 

  7. Keenan SP, Sinuff T, Burns KE, Muscedere J, Kutsogiannis J, Mehta S, Cook DJ, Ayas N, Adhikari NK, Hand L, Scales DC, Pagnotta R, Lazosky L, Rocker G, Dial S, Laupland K, Sanders K, Dodek P, Canadian Critical Care Trials Group/Canadian Critical Care Society Noninvasive Ventilation Guidelines Group. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2011;183(3):E195–214.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Guyatt GH, Oxman A, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunneman H. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jaeschke R, Guyatt GH, Dellinger P, Schunneman H, Levy MM, Kunz R, Norris S, Bion J. Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ. 2008;337:327–30.

    Article  Google Scholar 

  10. Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Role of noninvasive positive-pressure ventilation in postextubation respiratory failure: a meta-analysis. Respir Care. 2007;52(11):1472–9.

    PubMed  Google Scholar 

  11. Lin C, Yu H, Fan H, Li Z. The efficacy of noninvasive ventilation in managing postextubation respiratory failure: a meta-analysis. Heart Lung. 2014;43:99–104.

    Article  PubMed  Google Scholar 

  12. Olper L, Corbetta D, Cabrini L, Landoni G, Zangrillo A. Effects of non-invasive ventilation on reintubation rate: a systematic review and meta-analysis of randomized studies of patients undergoing cardiothoracic surgery. Crit Care Resusc. 2013;15:220–7.

    PubMed  Google Scholar 

  13. Glossop AJ, Shepherd N, Bryden DC, Mills GH. Non-invasive ventilation for weaning, avoiding reintubation after extubation and in the postoperative period: a meta-analysis. Br J Anaesth. 2012;109:305–14.

    Article  PubMed  CAS  Google Scholar 

  14. Burns KEA, Premji A, Meade MO, Adhikari NKJ. Weaning critically ill adults with noninvasive positive pressure ventilation: a meta-analysis. Review. Cochrane Database Syst Rev. 2013;(12);CD004127.

    Google Scholar 

  15. Ioannidis JA, Cappelleri JC, Lau J. Issues in comparisons between meta-analyses and large trials. JAMA. 1998;279:1089–93.

    Article  PubMed  CAS  Google Scholar 

  16. Cornell JE, Mulrow CD, Localio R, et al. Random-effects meta-analysis of inconsistent effects: a time for change. Ann Intern Med. 2014;160.

    Google Scholar 

  17. Thorlund K, Imperger G, Walsh M, Chu R, Gluud C, Wettersley J, Guyatt G, Devereaux PJ, Thabane L. The number of patients and events required to limit the risk of overestimation of intervention effects in meta-analysis – a simulation study. PLoS One. 2011;6(10), e25491.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  18. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated Sept 2008]. The Cochrane Collaboration. 2011. Available from www.cochrane-handbook.org

  19. Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguia C, Gonzalez M, Epstein SK, Hill NS, Nava S, Soares MA, D’Empaire G, Alia I, Anzueto A. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med. 2014:350(24):2452–60.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Karen E. A. Burns MD, FRCPC, MSc .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Burns, K.E.A., Adhikari, N.K.J. (2016). Noninvasive Ventilation and Weaning Outcome. In: Esquinas, A. (eds) Noninvasive Mechanical Ventilation and Difficult Weaning in Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-04259-6_55

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-04259-6_55

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-04258-9

  • Online ISBN: 978-3-319-04259-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics