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Noninvasive Positive-Pressure Ventilation for Acute Respiratory Failure: Comparative Effectiveness

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NPPV Versus Supportive Medical Therapy in Patients With Acute Respiratory Failure (1 of 2)

There was high-strength evidence that use of noninvasive positive-pressure ventilation (NPPV) reduces mortality when compared with supportive care. Thirty-nine studies compared the effects of NPPV plus supportive medical therapy with supportive medical therapy alone on the outcome of mortality; 19 of these studies were rated good in quality and 14 were rated fair in quality. Mortality rates ranged from 0–33 percent for NPPV and 0–80 percent for usual supportive care. Overall, there was a lower risk of mortality when NPPV was employed in addition to usual supportive care; the summary odds ratio (OR) was 0.56 (95-percent confidence interval [95% CI], 0.44–0.72). Effects were consistent across studies; funnel plots and test statistics did not suggest publication bias. The evidence is strongest for patients with chronic obstructive pulmonary disease (COPD) and acute cardiogenic pulmonary edema (ACPE), but limited evidence supports an effect in postoperative and post-transplant settings.

There was high-strength evidence that use of NPPV reduces endotracheal intubation rates when compared with supportive care. Thirty-nine studies compared the effects of NPPV plus supportive medical therapy with supportive medical therapy alone on the outcome of endotracheal intubation rates; 19 of these studies were rated good in quality and 14 were rated fair in quality. Intubation rates ranged from 0–62 percent for NPPV and 3–77 percent for supportive care. Overall, there was a lower risk of intubation for patients when NPPV was added to supportive care (summary OR 0.31; 95% CI, 0.24 to 0.41). Tests for heterogeneity showed moderate variability in treatment effects across studies. This evidence is strongest for patients with COPD but also supports an effect in patients with ACPE and in postoperative and post-transplant settings.