by Tommaso
Pettenuzzo, Annalisa Boscolo, Elisa Pistollato, Chiara Pretto, Tommaso Antonio
Giacon, Sara Frasson, Francesco Maria Carbotti, Francesca Medici, Giovanni
Pettenon, Giuliana Carofiglio, Marco Nardelli, Nicolas Cucci, Clara Letizia
Tuccio, Veronica Gagliardi, Chiara Schiavolin, Caterina Simoni…
Critical Care volume 28,
Article number: 152, Published: 08 May 2024
Background
Re-intubation secondary to post-extubation respiratory
failure in post-operative patients is associated with increased patient
morbidity and mortality. Non-invasive respiratory support (NRS) alternative to
conventional oxygen therapy (COT), i.e., high-flow nasal oxygen, continuous
positive airway pressure, and non-invasive ventilation (NIV), has been proposed
to prevent or treat post-extubation respiratory failure. Aim of the present
study is assessing the effects of NRS application, compared to COT, on the
re-intubation rate (primary outcome), and time to re-intubation, incidence of
nosocomial pneumonia, patient discomfort, intensive care unit (ICU) and
hospital length of stay, and mortality (secondary outcomes) in adult patients
extubated after surgery.
Methods
A systematic review and network meta-analysis of randomized
and non-randomized controlled trials. A search from Medline, Embase, Scopus,
Cochrane Central Register of Controlled Trials, and Web of Science from
inception until February 2, 2024 was performed.
Results
Thirty-three studies (11,292 patients) were included. Among
all NRS modalities, only NIV reduced the re-intubation rate, compared to COT
(odds ratio 0.49, 95% confidence interval 0.28; 0.87, p = 0.015, I2 = 60.5%,
low certainty of evidence). In particular, this effect was observed in patients
receiving NIV for treatment, while not for prevention, of post-extubation
respiratory failure, and in patients at high, while not low, risk of
post-extubation respiratory failure. NIV reduced the rate of nosocomial pneumonia,
ICU length of stay, and ICU, hospital, and long-term mortality, while not
worsening patient discomfort.
Conclusions
In post-operative patients receiving NRS after extubation,
NIV reduced the rate of re-intubation, compared to COT, when used for treatment
of post-extubation respiratory failure and in patients at high risk of
post-extubation respiratory failure.
