Modern orvostudományi diagnosztikus eljárások és terápiák fejlesztése transzlációs
megközelítésbe...(EFOP-3.6.2-16-2017-00006) Funder: EFOP
(UNKP-21-3-II- PTE- 1317)
Subjects:
Meta-analysis
Background
Noninvasive ventilation (NIV) is beneficial in exacerbations of chronic obstructive
pulmonary disease (COPD), but its effectiveness in pneumonia-associated respiratory
failure is still controversial. In the current meta-analysis, we aimed to investigate
whether the use of NIV before intubation in pneumonia improves the mortality and intubation
rates of respiratory failure as compared to no use of NIV in adults.
Methods
We searched three databases from inception to December 2019. We included studies,
in which pneumonia patients were randomized initially into either NIV-treated or non-NIV-treated
groups. Five full-text publications, including 121 patients, reported eligible data
for statistical analysis.
Results
With NIV the overall hospital mortality rate seemed lower in patients with pneumonia-associated
respiratory failure, but this was not significant [odds ratio (OR) = 0.39; 95% confidence
interval (CI): 0.13–1.14; P = 0.085]. In the intensive care unit, the mortality was
significantly lower when NIV was applied compared to no NIV treatment (OR = 0.22;
95% CI: 0.07–0.75; P = 0.015). NIV also decreased mortality compared to no NIV in
patient groups, which did not exclude patients with COPD (OR = 0.25; 95% CI: 0.08–0.74;
P = 0.013). The need for intubation was significantly reduced in NIV-treated patients
(OR = 0.22; 95% CI: 0.09–0.53; P = 0.001), which effect was more prominent in pneumonia
patient groups not excluding patients with pre-existing COPD (OR = 0.13; 95% CI: 0.03–0.46;
P = 0.002).
Conclusion
NIV markedly decreases the death rate in the intensive care unit and reduces the need
for intubation in patients with pneumonia-associated respiratory failure. The beneficial
effects of NIV seem more pronounced in populations that include patients with COPD.
Our findings suggest that NIV should be considered in the therapeutic guidelines of
pneumonia, given that future clinical trials confirm the results of our meta-analysis.
Availability of data and materials
All data and materials generated during the current study are available from the corresponding
author on reasonable request.
