Effects of prophylactic non-invasive ventilation on weaning: A systematic review with meta-analysis.

Summary

In adults ventilated >48 hours who passed a spontaneous breathing trial, prophylactic NIV after extubation significantly reduced reintubation, postextubation respiratory failure, ICU mortality, hospital mortality, and ICU length of stay compared with oxygen alone, without affecting overall hospital length of stay.

Key Findings

• Across 11 trials, prophylactic NIV reduced reintubation (OR 0.49; 95% CI 0.32–0.74).
• ICU mortality and hospital mortality decreased (ICU: OR 0.39; 95% CI 0.21–0.71; hospital: OR 0.53; 95% CI 0.33–0.85).
• ICU length of stay was shorter (MD −2.86 days; 95% CI −5.47 to −0.24), while hospital LOS showed no difference.
• Prophylactic NIV reduced postextubation respiratory failure (OR 0.28; 95% CI 0.12–0.67).
• Subgroup analyses suggested rescue NIV use did not materially alter primary outcomes.

Clinical Implications

Consider routine prophylactic NIV in high-risk extubated adults to reduce reintubation and mortality; implement standardized protocols and monitoring.

Limitations

• Heterogeneity in patient selection, NIV settings, and timing may influence generalizability.
• Potential publication bias and limited data on hospital length of stay and long-term outcomes.

Future Directions

Define optimal patient selection, timing, and NIV settings; evaluate cost-effectiveness and long-term outcomes in pragmatic multicenter trials.