|
Characteristics of the included studies |
|||||
| Reference |
Definition of failed noninvasive ventilation |
Participants |
Interventions |
Outcomes |
Factors pertaining to the quality of studies |
|
|
|||||
| [15] |
GCS score ≤13, persistent severe respiratory distress, Po2 <60 mmHg despite oxygen supplementation, an increase in PaCO2 >5 mmHg |
56 patients (recruited between January 1999 and August 2000), mean APACHE II score 19.5, mean age 64 years, mean PaCO2 at presentation 40 mmHg |
Variable CPAP (10–16 cmH2O), variable BiPAP (starting from 15 and 10 cmH2O; maximum not described) |
Proportion of patients with hospital mortality and requiring intubation, the duration of noninvasive ventilation needed and hospital length of stay |
Allocation concealment adequate; study not blinded; 3.6% of patients did not have pulmonary oedema were excluded from analysis; analysis was by intention to treat; Jadad scale score 3 |
| [9] |
Severe respiratory distress, inability to tolerate or synchronize with the mask, further deterioration in vital signs or significant haemodynamic compromise, Po2 <60 mmHg despite oxygen supplementation, an increase in PaCO2 >5 mmHg |
36 patients, mean APACHE II score 18, mean age 77 years, mean PaCO2 at presentation 50 mmHg |
Fixed CPAP (10 cmH2O), fixed BiPAP (15 and 5 cmH2O) |
Proportion of patients with hospital mortality and requiring intubation, new onset acute myocardial infarction, duration of noninvasive ventilation needed and hospital length of stay |
Allocation concealment not clear; double blinding; 22% of enrolled patients did not have pulmonary oedema and were excluded from analysis, and 2.8% were excluded because of delay in starting CPAP; analysis was not by intention to treat; Jadad scale score 5 |
| [14] |
Intubation determined by the attending physician but criteria were not described |
16 patients (recruited between May and October 1997), mean APACHE II score not available, mean age 69 years, mean PaCO2 at presentation 40 mmHg |
Variable CPAP (5–12.5 cmH2O), variable BiPAP (starting from 8 and 3 cmH2O; maximum not described) |
Proportion of patients with hospital mortality and requiring intubation, duration of noninvasive ventilation needed |
Allocation concealment not clear; not blinded; no loss to follow up; analysis by intention to treat; Jadad scale score 2 |
| [16] |
Respiratory arrest, respiratory pauses with loss of consciousness, agitation making nursing care impossible and requiring sedation, haemodynamic instability with systolic blood pressure <70 mmHg, and the clinician could elect to intubate if they felt that the patient's condition was not improving satisfactorily |
71 patients, mean APACHE II score not available, mean age 74 years, mean PaCO2 at presentation not available |
Variable CPAP (5–20 cmH2O), variable BiPAP (starting from 10 and 5 cmH2O; maximum 20 and 5) |
Proportion of patients with hospital mortality and requiring intubation, the duration of noninvasive ventilation needed and hospital length of stay |
Allocation concealment not clear; not blinded; no loss to follow up; analysis by intention to treat; Jadad scale score 2 |
| [18] |
Respiratory arrest, respiratory pauses with loss of consciousness, agitation making nursing care impossible and requiring sedation, haemodynamic instability with systolic blood pressure <70 mmHg |
46 patients (recruited between March 2002 and March 2003), mean APACHE II score 18, mean age 77 years, mean PaCO2 at presentation 54 mmHg |
Fixed CPAP (10 cmH2O), variable BiPAP (starting with 15 and 5 cmH2O; titration of inspiratory pressure to achieve tidal volume >400 ml) |
Proportion of patients with hospital mortality and requiring intubation, new onset acute myocardial infarction, duration of noninvasive ventilation needed |
Allocation concealment adequate; not blinded; no loss to follow up; analysis by intention to treat; Jadad scale score 3 |
| [17] |
Respiratory arrest, respiratory pauses with loss of consciousness, agitation making nursing care impossible and requiring sedation, haemodynamic instability with systolic blood pressure <70 mmHg |
36 patients (recruited between January 2001 and January 2002), mean APACHE II score 18, mean age 77 years, mean PaCO2 at presentation 63 mmHg |
Fixed CPAP (10 cmH2O), variable BiPAP (starting with 15 and 5 cmH2O; titration of inspiratory pressure to achieve tidal volume >400 ml) |
Proportion of patients with hospital mortality and requiring intubation, duration of noninvasive ventilation needed |
Allocation concealment adequate; not blinded; no loss to follow up; analysis by intention to treat; Jadad scale score 3 |
| [19] |
Worsening clinical signs (respiratory rate >40 or <10 breaths/minute, reduced conscious level) associated with a falling arterial pH (less than at arrival and <7.2) |
40 patients, mean APACHE II score not available, mean age 75 years, mean PaCO2 at presentation 62 mmHg |
Fixed CPAP (10 cmH2O), fixed BiPAP (15 and 5 cmH2O) |
Proportion of patients with hospital mortality and requiring intubation, new onset myocardial infarction |
Allocation concealment adequate; not blinded; no loss to follow up; analysis by intention to treat; Jadad scale score 3 |
|
APACHE, Acute Physiology and Chronic Health Evaluation; BiPAP = bi-level positive airway pressure; CPAP = continuous positive airway pressure; GCS, Glasgow Coma Scale; PCO2, partial carbon dioxide tension; Po2, partial oxygen tension. | |||||
Ho and Wong Critical Care 2006 10:R49 doi:10.1186/cc4861 |
|||||