Study | No. of patients | Inclusion criteria | Experimental strategy | Control strategy | |
---|---|---|---|---|---|
Patient characteristics | Weaning eligibility | ||||
Girault et al. 201125 | 138 | Chronic hypercapnic respiratory failure; invasive mechanical ventilation for at least 48 h | 2 h SBT failure | Noninvasive pressure support ± PEEP or bilevel NIV with face mask (initial choice) | Invasive pressure support with once daily SBT with T- piece or pressure support ± PEEP |
Rabie Agmy et al. 201226 | 264 | Acute-on-chronic exacerbation of COPD | 2 h SBT failure | NIV (pressure, ST mode) | Invasive pressure support |
Tawfeek et al. 201227 | 42 | Invasive mechanical ventilation > 48 h | 2 h SBT failure | Noninvasive PAV delivered by face mask | SIMV |
Vaschetto et al. 201228 | 20 | Hypoxemic respiratory failure; invasive mechanical ventilation for at least 48 h | Pressure support with PEEP + inspiratory support, ≤ 25 cm H2O and PEEP 8–13 cm H2O; PaO2:FiO2 200–300 mm Hg with FiO2 ≤ 0.6 | Helmet NIV | Invasive pressure support with SBT when PaO2:FiO2 > 250 mm Hg |
Hill et al. 200029 | 21 | Acute respiratory failure | 30 min SBT failure | NIV using VPAP in ST-A mode | Invasive pressure support |
Rabie Agmy et al. 200430 | 37 | Exacerbation of COPD | 2 h SBT failure | NIV (proportional assist in timed mode) delivered by face or nasal mask | Invasive pressure support |
Chen et al. 200131 | 24 | Exacerbation of COPD; mechanical ventilation for at least 48–60 h; O2 saturation ≥ 88% on FiO2 40% | Day 3+ weaning criteria | Bilevel NIV (pressure mode) | Invasive pressure support |
Wang et al. 200432* | 28 | COPD; bronchopulmonary infection | PIC window | NIV (pressure mode) delivered by mask (unspecified) | SIMV + pressure support |
Zheng et al. 200533* | 33 | COPD; severe pulmonary infection | PIC window | Bilevel NIV (pressure mode) delivered by face or nasal mask | Invasive pressure support |
Zou et al. 200634* | 76 | COPD with severe respiratory failure; pulmonary infection | PIC window | Bilevel NIV (pressure, ST mode) delivered by nasal or oronasal mask | SIMV + pressure support |
Prasad et al. 200935 | 30 | COPD; hypercapnic respiratory failure | 2 h SBT failure | Bilevel NIV (pressure mode) delivered by full face mask | Invasive pressure support |
Nava et al. 199836 | 50 | Exacerbation of COPD; mechanical ventilation for at least 36–48 h | Simple weaning criteria, 1 h SBT failure | Noninvasive pressure support on conventional ventilator delivered with face mask | Invasive pressure support |
Collaborating Research Group for Noninvasive Mechanical Ventilation 200537* | 90 | COPD with severe hypercapnic respiratory failure; pneumonia or purulent bronchitis; age ≤ 85 y; capable of self-care during previous year | PIC window | Bilevel NIV (pressure mode) | SIMV + pressure support |
Girault et al. 199938 | 33 | Acute-on-chronic respiratory failure (COPD, restrictive or mixed populations); mechanical ventilation for at least 48 h | Simple weaning criteria, 2 h SBT failure | Flow or pressure mode with nasal or face mask | Flow or pressure mode (pressure support) |
Ferrer et al. 200339 | 43 | Acute respiratory failure and persistent weaning failure; intubation for at least 72 h | 2 h SBT failure on 3 consecutive days | Bilevel NIV in ST mode delivered with face or nasal mask | Assist control or invasive pressure support |
Trevisan et al. 200840 | 65 | Invasive mechanical ventilation > 48 h | 30 min SBT failure | Bilevel NIV (pressure mode) delivered by facemask | Invasive mechanical ventilation |
Note: COPD = chronic obstructive pulmonary disease, FiO2 = fraction of inspired oxygen, NIV = noninvasive ventilation, PaO2 = partial pressure of oxygen, PAV = proportional assist ventilation, PEEP = positive end-expiratory pressure, PIC = pulmonary infection control, SBT = spontaneous breathing trial, SIMV = synchronized intermittent mandatory ventilation, ST = spontaneous/timed, VPAP = variable positive airway pressure.
↵* Trials evaluating patients with COPD and pulmonary infection, which enrolled patients who achieved PIC window criteria or after infection control was achieved. These criteria included an improved radiograph, temperature and leukocyte count (or percentage of neutrophils), in addition to reduced secretion volume and tenacity. Two trials also specified improved hemodynamics, expectoration and level of consciousness;34,36 1 trial57 specified minimum ventilator settings (SIMV rate 10–12 breaths/min, pressure support 10–12 cm H2O).