Noninvasive respiratory support following extubation in critically ill adults with obesity: a systematic review and network meta-analysis.
Summary
Across 7 RCTs (n=1,933), NIV alone or combined with HFNC reduced day-7 reintubation versus COT and reduced 28-day mortality versus HFNC in obese, extubated ICU patients. NNT to prevent one death was ~15, supporting NIV as preferred post-extubation support in this population.
Key Findings
- NIV + HFNC reduced day-7 reintubation versus COT (RR 0.36; NNT ~10).
- NIV alone reduced day-7 reintubation versus COT (RR 0.45; NNT ~11).
- Versus HFNC, both NIV and NIV + HFNC reduced 28-day mortality (NNT ~15).
- HFNC alone did not significantly reduce reintubation versus COT.
Clinical Implications
For obese ICU patients after extubation, initiate NIV (with or without HFNC) rather than HFNC or COT to lower reintubation and mortality; implement protocols and monitoring to optimize NIV tolerance and efficacy.
Why It Matters
Synthesizes randomized evidence to resolve a clinically relevant controversy in a high-risk population (obesity), offering actionable guidance for post-extubation respiratory support.
Limitations
- Heterogeneity in NIV protocols and patient severity may influence effect sizes
- Limited to obese population; generalizability to non-obese patients requires caution
Future Directions
Head-to-head trials of NIV versus NIV+HFNC to define incremental benefit, and implementation studies optimizing adherence and comfort in obese patients.
Study Information
- Study Type
- Meta-analysis
- Research Domain
- Treatment
- Evidence Level
- I - Network meta-analysis of randomized controlled trials.
- Study Design
- OTHER