Byline: Bandar. Faqihi, Samuel. Trethewey, Julien. Morlet, Dhruv. Parekh, Alice. Turner
The effectiveness of bi-level positive airway pressure (BiPAP) in patients with acute hypercapnic respiratory failure (AHRF) due to etiologies other than chronic obstructive pulmonary disease (COPD) is unclear. To systematically review the evidence regarding the effectiveness of BiPAP in non-COPD patients with AHRF. The Cochrane Library, MEDLINE, EMBASE, and CINAHL Plus were searched according to prespecified criteria (PROSPERO-CRD42018089875). Randomized controlled trials (RCTs) assessing the effectiveness of BiPAP versus continuous positive airway pressure (CPAP), invasive mechanical ventilation, or O[sub]2 therapy in adults with non-COPD AHRF were included. The primary outcomes of interest were the rate of endotracheal intubation (ETI) and mortality. Risk-of-bias assessment was performed, and data were synthesized and meta-analyzed where appropriate. Two thousand four hundred and eighty-five records were identified after removing duplicates. Eighty-eight articles were identified for full-text assessment, of which 82 articles were excluded. Six studies, of generally low or uncertain risk-of-bias, were included involving 320 participants with acute cardiogenic pulmonary edema (ACPO) and solid tumors. No significant differences were seen between BiPAP ventilation and CPAP with regard to the rate of progression to ETI (risk ratio [RR] = 1.49, 95% confidence interval [CI], 0.63-3.62, P = 0.37) and in-hospital mortality rate (RR = 0.71, 95% CI, 0.25-1.99, P = 0.51) in patients with AHRF due to ACPO. The efficacy of BiPAP appears similar to CPAP in reducing the rates of ETI and mortality in patients with AHRF due to ACPO. Further research on other non-COPD conditions which commonly cause AHRF such as obesity hypoventilation syndrome is needed.
Acute respiratory failure (ARF), which generally results from insufficient gas exchange by the respiratory system, is a significant disorder that can require invasive mechanical ventilation (IMV) through endotracheal intubation (ETI) for its management. In the 1990s, ARF was the most common indication for IMV among eight countries, accounting for more than 65% of ventilated patients. Despite the high use of IMV due to improved survival rates, IMV can cause many complications. ETI is associated with ventilator-associated pneumonia (VAP), increased mortality rate,, IMV weaning difficulties, and increased health-care costs. Therefore, noninvasive ventilation (NIV) has been increasingly used for acutely ill patients. NIV has many advantages, including a reduction in the risk of infection, a greater degree of patient co-operation and an increased ability to communicate, as well as improvement in dyspnea. Compared with IMV, NIV can achieve the same physiological outcomes of improved gas exchange and reduced work in breathing. Moreover, NIV has a reduced incidence of side effects related to ETI and IMV, such as VAP, upper airway injuries, and excessive sedation. Thus, NIV has the potential to provide better clinical outcomes in certain patient groups.
For several decades, NIV has been regarded as an effective method for avoiding the use of ETI and decreasing mortality in patients with acute hypercapnic respiratory failure (AHRF). Evidence supports the suggestion that the inclusion of NIV in a standard care strategy may enhance the outcomes in both patients with chronic obstructive...