Meta-analysis:the Effect Of Preventive Application Of Noninvasive Mechanical Ventilation After Planned Extubation On Prognosis

Purpose:Using meta-analysis to systematically review the efficacyof preventive application of noninvasive ventilation after extubation onextubation failure,reintubation,ICU and hospital mortality,lengths hospitalstay.So that we provide more evidence for clinical application ofnoninvasive mechanical ventilation.Material and method:We search databases of Pubmed, Embase,OVID, Cochrane central Register of controlled trials,Cochrane databaseof systematic reviews and manual searching, screening prospectiverandomized controlled trials or randomized controlled trials whichcomparing preventive using noninvasive ventilation(intervention group)and standard oxygen therapy(as controlled group) after planned extubation.According to inclusion and exclusion criteria,we assessed quality ofincluded studies and extracted data for integration and analysis by usingReview manager5.2software.we evaluated the intervention effect byusing Risk Ratio,95%credible interval or Mean Difference,95%credible interval.Result:Up to March,2013,6RCTs and935experimenters togetherwere selected for inclusion in the meta-analysis.465members inintervention group and470members in controlled group.Statistic analysisrevealed that comparing intervention group with controlled group:1）decrease extubation failure risk （RR,0.49,[95%CI,0.29to0.82];P=0.007）;2)decrease reintubation risk （RR0.68,[95%CI0.48to10.95];P=0.03）;3)decrease ICU mortality （RR,0.41,[95%CI,0.21to0.80];P=0.009）;4)decrease hospital mortality（RR,0.64,[95%CI,0.41to1.01];P=0.05）;5)no effect on hospital stays（MD,-0.52,[95%CI,-3.58to2.55];P=0.74）;6)reduce90-day mortality(RR,0.62,[95%CI,0.41to0.92];P=0.02).Conclusion:After planned extubation,preventive application of NIVcan reduce risk of extubation failure and reintubation,decrease ICU and90-day mortality,and have no significant effect on hospital mortality or thehospital length.