Effect of Out-of-Hospital Noninvasive Positive-Pressure Support Ventilation in Adult Patients With Severe Respiratory Distress: A Systematic Review and Meta-analysis - 18/04/14
, Shelley McLeod, MSc a, b, Alla Iansavichene, BSc, MLIS b, Adam Dukelow, MD, FRCPC a, b, Michael Lewell, MD, FRCPC a, bAbstract |
Study objective |
Noninvasive positive-pressure ventilation (NIPPV) is increasingly being used by emergency medical services (EMS) for treatment of patients in respiratory distress. The primary objective of this systematic review is to determine whether out-of-hospital NIPPV for treatment of adults with severe respiratory distress reduces inhospital mortality compared with “standard” therapy. Secondary objectives are to examine the need for invasive ventilation, hospital and ICU length of stay, and complications.
Methods |
Electronic searches of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature were conducted and reference lists of relevant articles hand searched. Randomized controlled trials comparing out-of-hospital NIPPV with standard therapy in adults (aged ≥16 years) with severe respiratory distress published in English were included. Two reviewers independently screened abstracts, assessed quality of the studies, and extracted data. Data were pooled with random-effects models and reported as risk ratios (RRs) with 95% confidence intervals (CIs) and number needed to treat (NNT).
Results |
Seven randomized controlled trials were included, with a combined total of 632 patients; 313 in the standard therapy group and 319 in the NIPPV group. In patients treated with NIPPV, the pooled estimate showed a reduction in both inhospital mortality (RR 0.58; 95% CI 0.35 to 0.95; NNT=18) and need for invasive ventilation (RR 0.37; 95% CI 0.24 to 0.58; NNT=8). There was no difference in ICU or hospital length of stay.
Conclusion |
Out-of-hospital administration of NIPPV appears to be an effective therapy for adult patients with severe respiratory distress.
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| Supervising editor: Steven M. Green, MD |
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| Author contributions: SM, SM, AD, and ML conceived the study idea and designed the study protocol. AI performed the literature search. SM and SM independently screened the titles and abstracts, assessed the quality of the studies, and independently extracted data. SM and SM performed the statistical analysis. SM and SM drafted the study manuscript and all authors contributed substantially to its revision. The primary author SM takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. |
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P. 600 - mai 2014 Retour au numéro
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