Noninvasive ventilation improves the outcome in patients with pneumonia-associated respiratory failure: Systematic review and meta-analysis.

Adult Hospital Mortality Humans Noninvasive Ventilation / methods Pneumonia / complications Randomized Controlled Trials as Topic Respiration, Artificial / methods Respiratory Insufficiency / etiology
Invasive ventilation Meta-analysis Mortality Noninvasive ventilation Pneumonia

Journal

Journal of infection and public health
ISSN: 1876-035X
Titre abrégé: J Infect Public Health
Pays: England
ID NLM: 101487384

Informations de publication

Date de publication:
Mar 2022
Historique:
received: 16 06 2021
revised: 29 11 2021
accepted: 09 02 2022
pubmed: 20 2 2022
medline: 16 3 2022
entrez: 19 2 2022
Statut: ppublish

Résumé

Noninvasive ventilation (NIV) is beneficial in exacerbations of chronic obstructive pulmonary disease (COPD), but its effectiveness in pneumonia-associated respiratory failure is still controversial. In the current meta-analysis, we aimed to investigate whether the use of NIV before intubation in pneumonia improves the mortality and intubation rates of respiratory failure as compared to no use of NIV in adults. We searched three databases from inception to December 2019. We included studies, in which pneumonia patients were randomized initially into either NIV-treated or non-NIV-treated groups. Five full-text publications, including 121 patients, reported eligible data for statistical analysis. With NIV the overall hospital mortality rate seemed lower in patients with pneumonia-associated respiratory failure, but this was not significant [odds ratio (OR) = 0.39; 95% confidence interval (CI): 0.13-1.14; P = 0.085]. In the intensive care unit, the mortality was significantly lower when NIV was applied compared to no NIV treatment (OR = 0.22; 95% CI: 0.07-0.75; P = 0.015). NIV also decreased mortality compared to no NIV in patient groups, which did not exclude patients with COPD (OR = 0.25; 95% CI: 0.08-0.74; P = 0.013). The need for intubation was significantly reduced in NIV-treated patients (OR = 0.22; 95% CI: 0.09-0.53; P = 0.001), which effect was more prominent in pneumonia patient groups not excluding patients with pre-existing COPD (OR = 0.13; 95% CI: 0.03-0.46; P = 0.002). NIV markedly decreases the death rate in the intensive care unit and reduces the need for intubation in patients with pneumonia-associated respiratory failure. The beneficial effects of NIV seem more pronounced in populations that include patients with COPD. Our findings suggest that NIV should be considered in the therapeutic guidelines of pneumonia, given that future clinical trials confirm the results of our meta-analysis. All data and materials generated during the current study are available from the corresponding author on reasonable request.

Sections du résumé

BACKGROUND BACKGROUND
Noninvasive ventilation (NIV) is beneficial in exacerbations of chronic obstructive pulmonary disease (COPD), but its effectiveness in pneumonia-associated respiratory failure is still controversial. In the current meta-analysis, we aimed to investigate whether the use of NIV before intubation in pneumonia improves the mortality and intubation rates of respiratory failure as compared to no use of NIV in adults.
METHODS METHODS
We searched three databases from inception to December 2019. We included studies, in which pneumonia patients were randomized initially into either NIV-treated or non-NIV-treated groups. Five full-text publications, including 121 patients, reported eligible data for statistical analysis.
RESULTS RESULTS
With NIV the overall hospital mortality rate seemed lower in patients with pneumonia-associated respiratory failure, but this was not significant [odds ratio (OR) = 0.39; 95% confidence interval (CI): 0.13-1.14; P = 0.085]. In the intensive care unit, the mortality was significantly lower when NIV was applied compared to no NIV treatment (OR = 0.22; 95% CI: 0.07-0.75; P = 0.015). NIV also decreased mortality compared to no NIV in patient groups, which did not exclude patients with COPD (OR = 0.25; 95% CI: 0.08-0.74; P = 0.013). The need for intubation was significantly reduced in NIV-treated patients (OR = 0.22; 95% CI: 0.09-0.53; P = 0.001), which effect was more prominent in pneumonia patient groups not excluding patients with pre-existing COPD (OR = 0.13; 95% CI: 0.03-0.46; P = 0.002).
CONCLUSION CONCLUSIONS
NIV markedly decreases the death rate in the intensive care unit and reduces the need for intubation in patients with pneumonia-associated respiratory failure. The beneficial effects of NIV seem more pronounced in populations that include patients with COPD. Our findings suggest that NIV should be considered in the therapeutic guidelines of pneumonia, given that future clinical trials confirm the results of our meta-analysis.
AVAILABILITY OF DATA AND MATERIALS UNASSIGNED
All data and materials generated during the current study are available from the corresponding author on reasonable request.

Identifiants

DOI: 10.1016/j.jiph.2022.02.004 PMID: 35182933
pubmed: 35182933
pii: S1876-0341(22)00036-3
doi: 10.1016/j.jiph.2022.02.004
pii:
doi:

Types de publication

Journal Article Meta-Analysis Review Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

349-359

Informations de copyright

Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Auteurs

Istvan Ruzsics (I)

Department of Pulmonology, First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary.

Peter Matrai (P)

Institute of Bioanalysis, Medical School, University of Pecs, Pecs, Hungary.

Peter Hegyi (P)

Institute for Translational Medicine, Szentagothai Research Centre, Medical School, University of Pecs, Pecs, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.

David Nemeth (D)

Institute for Translational Medicine, Szentagothai Research Centre, Medical School, University of Pecs, Pecs, Hungary.

Judit Tenk (J)

Institute for Translational Medicine, Szentagothai Research Centre, Medical School, University of Pecs, Pecs, Hungary.

Alexandra Csenkey (A)

Institute for Translational Medicine, Szentagothai Research Centre, Medical School, University of Pecs, Pecs, Hungary.

Balint Eross (B)

Institute for Translational Medicine, Szentagothai Research Centre, Medical School, University of Pecs, Pecs, Hungary.

Gabor Varga (G)

Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary.

Marta Balasko (M)

Institute for Translational Medicine, Szentagothai Research Centre, Medical School, University of Pecs, Pecs, Hungary.

Erika Petervari (E)

Institute for Translational Medicine, Szentagothai Research Centre, Medical School, University of Pecs, Pecs, Hungary.

Gabor Veres (G)

First Department of Pediatrics, Semmelweis University, Budapest, Hungary.

Robert Sepp (R)

Second Department of Internal Medicine and Cardiology Centre, University Szeged, Szeged, Hungary.

Zoltan Rakonczay (Z)

Department of Pathophysiology, Faculty of Medicine, University of Szeged, Szeged, Hungary.

Aron Vincze (A)

Department of Gastroenterology, First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary.

Andras Garami (A)

Institute for Translational Medicine, Szentagothai Research Centre, Medical School, University of Pecs, Pecs, Hungary. Electronic address: andras.garami@aok.pte.hu.

Zoltan Rumbus (Z)

Institute for Translational Medicine, Szentagothai Research Centre, Medical School, University of Pecs, Pecs, Hungary. Electronic address: zoltan.rumbus@aok.pte.hu.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Noninvasive ventilation improves the outcome...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Mortalité hospitalière › Noninvasive ventilation improves the outcome...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Noninvasive ventilation improves the outcome...
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Ventilation non effractive › Noninvasive ventilation improves the outcome...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Noninvasive ventilation improves the outcome...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › Noninvasive ventilation improves the outcome...
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Noninvasive ventilation improves the outcome...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Troubles respiratoires › Insuffisance respiratoire › Noninvasive ventilation improves the outcome...