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Ventilación No Invasiva Extrahospitalaria en la Insuficiencia Respiratoria Aguda: Revisión Sistemática, Metanálisis en Red y Metanálisis de Datos de Paciente Individual
Author(s) -
Goodacre Steve,
Stevens John W.,
Pandor Abdullah,
Poku Edith,
Ren Shijie,
Cantrell Anna,
Bounes Vincent,
Mas Arantxa,
Payen Didier,
Petrie David,
Roessler Markus Soeren,
Weitz Gunther,
Ducros Laurent,
Plaisance Patrick
Publication year - 2014
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12466
Subject(s) - medicine , meta analysis , acute respiratory failure , intensive care medicine , noninvasive ventilation , respiratory failure , medline , ventilation (architecture) , emergency medicine , mechanical ventilation , mechanical engineering , political science , law , engineering
Objectives This meta‐analysis aimed to determine the effectiveness of prehospital continuous positive airway pressure ( CPAP ) or bilevel inspiratory positive airway pressure (Bi PAP ) in acute respiratory failure. Methods Fourteen electronic databases and research registers were searched from inception to August 2013. Randomized or quasi‐randomized controlled trials that reported mortality or intubation rate for prehospital CPAP or Bi PAP were selected and compared to a relevant comparator in patients with acute respiratory failure. An aggregate data network meta‐analysis was used to jointly estimate intervention effects relative to standard care. A network meta‐analysis using a mixture of individual patient‐level data and aggregate data was carried out to assess potential treatment effect modifiers. Results Eight randomized and two quasi‐randomized controlled trials (six CPAP , four Bi PAP , sample sizes 23 to 207) were identified. The aggregate data network meta‐analysis suggested that CPAP was the most effective treatment in terms of mortality (probability = 0.989) and intubation rate (probability = 0.639) and reduced both mortality (odds ratio [ OR ] = 0.41; 95% credible interval [CrI] = 0.20 to 0.77) and intubation rate ( OR = 0.32; 95% CrI = 0.17 to 0.62), compared to standard care. The effect of Bi PAP on mortality ( OR = 1.94; 95% CrI = 0.65 to 6.14) and intubation rate ( OR = 0.40; 95% CrI = 0.14 to 1.16) was uncertain. The network meta‐analysis using individual patient‐level data and aggregate data suggested that sex was a modifier of the effect of treatment on mortality. Conclusions Prehospital CPAP can reduce mortality and intubation rates compared to standard care, while the effectiveness of prehospital Bi PAP is uncertain.