Systematic Review Of Non-invasive Positive Pressure Ventilation In Treating Adult Patients With Acute Respiratory Failure

Background:Non-invasive positive pressure ventilation(NPPV)has been gaining increasing attention as a potential therapeutic agent against acute respiratory failure(ARF).Previous studies have showed conflicting results regarding the effect of NPPV in acute respiratory failure.The present meta-analysis aims to assess the effects of NPPV in the management of ARF in adults by summarizing randomized controlled studies in this field.Method:A systematic literature search was conducted in Embase,Pubmed and Cochrane Library databases for articles before Feb 2018.Identified studies were then reviewed manually to determine if they meet with the a priori inclusion criteria.Nine randomized controlled studies were identified and included in this meta-analysis.The Random-Effect Model was used to assess the odds ratio(OR)and between-study heterogeneity was assessed using I~2 index and Cochran Q test.Sensitivity analysis was performed to pinpoint the exact sources of the observed heterogeneity.Results:Nine studies with a total of 727 acute respiratory failure(ARF)patients were included in the final meta-analysis.In general,NPPV use can reduce the ratio of tracheal intubation.The OR was 0.26[95%confidence intervals(CI)0.11 to 0,64].The mortality of NPPV group was lower than that of oxygen therapy group.The OR was 0.45[95%confidence intervals(CI)0.22 to 0.93].The application of NPPV reduce the treatment time of ICU.The WMD was-1.81 days[95%confidence intervals(CI)-2.78 to-0.85].There was no difference in the duration of hospital stay.The heterogeneity between studies was high.And Egger(p=0.665)and Begg's(p=0.069)test showed little publication bias.Conclusion:Noninvasive positive pressure ventilation is an effective intervention for adults with acute respiratory failure.