Non-invasive mechanical ventilation weaning protocols: a systematic review
DOI:
https://doi.org/10.1590/1809-2950/17542224042017Keywords:
Non-invasive Ventilation, Positive-Pressure Respiration, Protocols, Weaning, Ventilator WeaningAbstract
The aim of this study was to perform a systematic review of studies that investigated non-invasive ventilation (NIV) weaning protocols in adult or hospitalized elderly individuals. Through a systematic review based on the Prisma protocol, studies of eight databases published in Portuguese, English or Spanish were considered. The primary outcomes of this review were the success rate of NIV weaning, NIV duration and duration of intensive care unit (ICU) and hospital stay, and secondary endpoint were adverse events associated with protocols for NIV weaning. The methodological quality of clinical trials was assessed using the PEDro scale and for observational studies the Dows and Black scale. Four of the 18,476 initial references met the inclusion criteria and were included in this review. Two of the four articles were randomized clinical trials and two were observational studies. The studies assessed elderly patients with respiratory failure, mainly due to exacerbation of chronic obstructive pulmonary disease (COPD), and acute cardiogenic pulmonary edema. High weaning success rates were observed in three of the four studies, and one study demonstrated the superiority of implementing an immediate protocol for weaning to reduce NIV duration and ICU stay. However, because of the heterogeneity and poor methodological quality of the studies, it is not possible to make recommendations on the implementation of weaning protocols in this population.Downloads
References
Vital FM, Ladeira MT, Atallah AN. Non-invasive positive pressure
ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary
oedema. Cochrane Database Syst Rev. 2013;(3):CD005351. doi:
1002/14651858.CD005351.pub2
Ram FS, Picot J, Lightowler J, Wedzicha JA. Non-invasive
positive pressure ventilation for treatment of respiratory
failure due to exacerbations of chronic obstructive pulmonary
disease. Cochrane Database Syst Rev. 2004;(3):CD004104. doi:
1002/14651858.CD004104.pub3
Lim WJ, Mohammed Akram R, Carson KV, Mysore S, Labiszewszi
NA, Wedzicha JA, et al. Non-invasive positive pressure
ventilation for treatment of respiratory failure due to severe
acute exacerbations of asthma. Cochrane Database Syst Rev.
;(12):CD004360. doi: 10.1002/14651858.CD004360.pub4
Gupta D, Nath A, Agarwal R, Behera D. A prospective
randomized controlled trial on the controlled trial on the efficacy
of noninvasive ventilation in severe acute asthma. Respir Care.
;55(5):536-43.
Agarwal R, Aggarwal AN, Gupta D. Role of noninvasive ventilation
in acute lung injury/acute respiratory distress syndrome: a
proportion meta-analysis. Respir Care. 2010;55(12):1653-60.
Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Meduri
UG. Acute respiratory failure in patients with severe communityacquired pneumonia. A prospective randomized evaluation of
noninvasive ventilation. Am J Respir Crit Care Med. 1999;160(5Pt
:1585-91. doi: 10.1164/ajrccm.160.5.9903015
Chiumello D, Chevallard G, Gregoretti C. Non-invasive ventilation
in postoperative patients: a systematic review. Intensive Care
Med. 2011;37(6):918-29. doi: 10.1007/s00134-011-2210-8
Burns KEA, Meade MO, Premji A, Adhikari NKJ. Noninvasive
ventilation as a weaning strategy for mechanical ventilation in
adults with respiratory failure: a Cochrane systematic review.
CMAJ. 2014;186(3):112-22. doi: 10.1503/cmaj.130974
Ferrer M, Sellares J, Torres A. Noninvasive ventilation in
withdrawal from mechanical ventilation. Semin Respir Crit Care
Med. 2014;35(4):507-18. doi: 10.1055/s-0034-1383865
Biasi A, Ísola AM, Gama AMC, Duarte A, Vianna A, Serpa Neto
A, et al. Diretrizes Brasileiras de Ventilação Mecânica. In: FÓRUM
DE DIRETRIZES EM VENTILAÇÃO MECÂNICA, 1., 2013, São
Paulo. Anais… São Paulo: Associação de Medicina Intensiva
Brasileira;Sociedade Brasileira de Pneumologia e Tisiologia; 2013.
Carvalho CRR, Toufen Junior C, Franca SA. III Consenso Brasileiro
de Ventilação Mecânica. Ventilação mecânica: princípios,
análises gráficas e modalidades ventilatórias. J Bras Pneumol.
;33(Supl 2):54-70.
Roberts M, Young K, Plant P, Restrick L, Winter R, Reinhardt A,
et al. The use of non-invasive ventilation in the management of
patients with chronic obstructive pulmonary disease admitted
to hospital with acute type II respiratory failure. London: RCP/
BTS/Intensive Care Society; 2008. (Concise Guidance to Good
Practice series, 11).
Khilnani G, Jain N. Do we need a protocol for weaning patients
from noninvasive ventilation? Indian J Crit Med. 2014;18(12):775-7.
doi: 10.4103/0972-5229.146298
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche P,
Ioannidis JPA, et al. The PRISMA statement for reporting
systematic reviews and meta-analyses of studies that evaluate
healthcare interventions: explanation and elaboration. BJM.
;339:b2700. doi: 10.1136/bmj.b2700
Downs SH, Black N. The feasibility of creating a checklist for the
assessment of the methodological quality both of randomised
and non-randomised studies of health care interventions. J
Epidemiol Community Health. 1998;52(6):377-84.
Lun CT, Chan VL, Leung WS, Cheung APS, Cheng SL, Tsui
MSN, et al. A pilot randomized study comparing two methods
of non-invasive ventilation withdrawal after acute respiratory
failure in chronic obstructive pulmonary disease. Respirology.
;18(5):814-9. doi: 10.1111/resp.12080
Duan J, Tang X, Huang S, Jia J, Guo S. Protocol-directed versus
physician-directed weaning from noninvasive ventilation: The
impact in chronic obstructive pulmonary disease patients.
J Trauma Acute Care Surg. 2012;72(5):1271-75. doi: 10.1097/
TA.0b013e318249a0d5
Damas C, Andrade C, Araújo JP, Almeida J, Bettencourt P.
Weaning from non-invasive positive pressure ventilation:
experience with progressive periods of withdraw. Rev Port
Pneumol. 2008;14(1):49-53.
Momii H, Tashima Y, Kadokami T, Narita S, Yoshida M, Ando S.
Experience of step-wise protocol using noninvasive positive
pressure ventilation for treating cardiogenic pulmonary
edema. Eur J Emerg Med. 2012;19(4):267-70. doi: 10.1097/
MEJ.0b013e32834ada48
Sellares J, Ferrer M, Bencosome C, Loureiro H, Martinez P, Pajares
V, et al. Withdrawal of non-invasive ventilation (NIV) in acute
hypercapnic respiratory failure (AHRF): randomized controlled
trial. Am J Respir Crit Care Med. 2012;185:A6489.
Downloads
Published
Issue
Section
License
Copyright (c) 2017 Fisioterapia e Pesquisa
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
