Noninvasive positive-pressure ventilation may help wean patients off mechanical ventilation

Added March 20, 2020

Citation: Burns KE A, Meade M O, Premji A, Adhikari NKJ. Noninvasive positive-pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database of Systematic Reviews 2013; (12): CD004127

What is this? Some patients with COVID-19 will develop respiratory failure and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive care unit (ICU), but this can cause complications. Non-invasive positive-pressure ventilation (NPPV) (such as via a mask connected to a positive pressure ventilator) is used to try to reduce these complications by helping to wean patients off MV.

In this Cochrane systematic review, the authors searched for randomized and quasi-randomized trials comparing early extubation with immediate application of NPPV versus invasive positive-pressure ventilation (IPPV) weaning in adults with respiratory failure. They did not restrict by language of publication and did their searches in May 2013.  They identified 15 randomized and one quasi-randomized trial (total: 994 participants). Two thirds of the included patients had respiratory failure due to chronic obstructive pulmonary disease (COPD).

What works: NPPV appears to decrease mortality, weaning failure, pneumonia, length of stay in ICU and hospital, total duration of ventilation and tracheostomy and re-intubation rates, compared to invasive positive-pressure ventilation. However, these findings are mainly from trials in patients with COPD.

What doesn’t work: Nothing noted.

What’s uncertain: Nothing noted.


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