Non-invasive ventilation in acute respiratory failure: a meta-analysis

Non-invasive positive-pressure ventilation (NPPV) has assumed an important role in the management of respiratory failure because it provides ventilatory support without the need for an invasive airway. However, its effectiveness remains unclear. We performed this meta-analysis to investigate the utility of NPPV intervention in patients with acute respiratory failure (ARF). A comprehensive literature search identified 12 studies enrolling a total of 963 patients from Medline, PubMed, Cochrane and EMBASE databases that assessed the effectiveness of NPPV versus conventional mechanical ventilation and/or non-ventilation therapy in patients with ARF, irrespective of the underlying aetiology, as well as mortality rate and the length of intensive care unit (ICU) or hospital stay. The usage of NPPV was associated with significantly decreased intubation (pooled OR=0.23, 95% CI 0.12-0.42, p<0.001) and ICU mortality rate (pooled OR=0.34, 95% CI 0.20-0.60, p<0.001), but did not influence the hospital mortality rate (pooled OR=0.77, 95% CI 0.32-1.81, p=0.543) and the length of ICU or hospital stay (ICU stay: difference in means=0.38, 95% CI -3.01 to 3.77, p=0.825; hospital stay: difference in means=2.76, 95% CI -1.74 to 7.27, p=0.229). In conclusion, usage of NPPV in patients with ARF is associated with lower intubation and in-ICU mortality rate.