The Use Of Non-Invasive Ventilation For Acute Respiratory Failure In Children:Systematic Review And Meta-Analysis

Object To assess the effectiveness and safety of non-invasive ventilation (NIV) for acute respiratory failure in children.Methods We searched the PubMed, EMBASE, Cochrane library, Cochrane clinical trials, VIP Chinese periodical Database, CNKI, Wan Fang Chinese periodical Database from the establishment of the database to February 3rd 2015, by using the terms (non-invasive positive pressure ventilation and acute respiratory failure), age limits:children from 1 month to 18 years old; The clinical trials we included Randomized Controlled Trial (RCT), cross-over study and observational study. Two dependent investigators assessed the clinical trials by GRADE system.Results 4 RCT,1 cross-over study,4 prospect and 1 retrospect before-after studies were included. After applying the GRADE system, the studies classified as high, moderate, low, very low separately was 0,6,2, and 2. The non-invasive ventilation can greatly reduce the endotracheal intubation rates[RR=0.33,95%Cl(0.17,0.66), P=0.002], significantly decrease the PaCO2[WMD=-3.66,95%Cl(-5.69,-1.63),P=0.0004].It cannot greatly shorten the length of hospital stay (LOS) [WMD=-0.43,95%Cl(-1.27,0.40),P=0.31]. The effect of NIV for acute respiratory failure patients in improving respiratory distress is not certain, and it may has the tendency of decreasing the work of breathing which need more clinical studies to identify. The meta-analysis showed the significantly reduce of respiratory rate [WMD=-6.47,95%Cl(-9.53,-3.41),P<0.0001] and heart rate [WMD=-7.36,95%Cl(-12.08,-2.63),P<0.002], but considering the limited number and quality of the studies included, we cannot be sure,more multi-cenntere and high quality clinical trails are needed.Conclusion Based on the evidence, the use of NIV for acute respiratory failure in children is effective, which can significantly reduce the intubation rate and PaCO2 and may improve the respiratory distress and work of breath. But out of the limited quality of the included studies, further researches with higher quality methodology are needed to clarify the beneficial role of the non-invasive ventilation.