Mandelzweig K, Leligdowicz A, Murthy S, Lalitha R, Fowler RA, Adhikari NKJ. Non-invasive ventilation in children and adults in low- and low-middle income countries: A systematic review and meta-analysis.
J Crit Care 2018;
47:310-319. [PMID:
29426584 DOI:
10.1016/j.jcrc.2018.01.007]
[Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE
We systematically reviewed the effects of NIV for acute respiratory failure (ARF) in low- and low-middle income countries.
MATERIALS AND METHODS
We searched MEDLINE, CENTRAL, and EMBASE (to January 2016) for observational studies and trials of NIV for ARF or in the peri-extubation period in adults and post-neonatal children. We abstracted outcomes data and assessed quality. Meta-analyses used random-effect models.
RESULTS
Fifty-four studies (ten pediatric/n=1099; 44 adult/n=2904), mostly South Asian, were included. Common diagnoses were pneumonia and chronic obstructive pulmonary disease (COPD). Considering observational studies and the NIV arm of trials, NIV was associated with moderate risks of mortality (pooled risk 9.5%, 95% confidence interval (CI) 4.6-14.5% in children; 16.2% [11.2-21.2%] in adults); NIV failure (10.5% [4.6-16.5%] in children; 28.5% [22.4-34.6%] in adults); and intubation (5.3% [0.8-9.7%] in children; 28.8% [21.9-35.8%] in adults). The risk of mortality was greater (p=0.035) in adults with hypoxemic (25.7% [15.2-36.1%]) vs. hypercapneic (12.8% [7.0-18.6%]) ARF. NIV reduced mortality in COPD (relative risk [RR] 0.47 [0.27-0.79]) and in patients weaning from ventilation (RR 0.48 [0.28-0.80]). The pooled pneumothorax risk was 2.4% (0.8-3.9%) in children and 5.2% (1.0-9.4%) in adults. Meta-analyses had high heterogeneity.
CONCLUSIONS
NIV for ARF in these settings appears to be effective.
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