Evidence map›Paper›PMID 34825256›Full record

SynthesisIntensive care medicine2022

Noninvasive respiratory support following extubation in critically ill adults: a systematic review and network meta-analysis.

Shannon M Fernando, Alexandre Tran, Behnam Sadeghirad, Karen E A Burns, Eddy Fan, Daniel Brodie, Laveena Munshi, Ewan C Goligher, Deborah J Cook, Robert A Fowler and 10 more

Registry-linked trialOpen access · greenAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Intensive care medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05523479 (The Maximizing Extubation Outcomes Through Educational and Organizational Research), which is not on this map. Cited by 45 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed, 7 pooled it
9.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05523479 naactive not recruitingnot on this mapstarted 2023, after this paper: background citation

The Maximizing Extubation Outcomes Through Educational and Organizational Research (METEOR) Trial

TypeinterventionalSponsorUniversity of PittsburghRan2023 to 2026Enrolled13,018ConditionsAcute Respiratory Failure, Airway ExtubationArmsTraditional online education, Interprofessional education, Clinical protocol, Risk-stratified preventive post-extubation noninvasive ventilation (NIV) or high-flow nasal cannula oxygen (HFNC), Preventive post-extubation high-flow nasal cannula oxygen (HFNC)
3 · Its place in the literature

Who cites it

45 citing papers in PubMed, 7 syntheses or guidelines pooled it, 87 citations in OpenAlex.

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  4. Noninvasive respiratory support after extubation: a systematic review and network meta-analysis.European respiratory review : an official journal of the European Respiratory Society · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors at 9 institutions in 4 countries.

Shannon M FernandoDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. sfernando@qmed.ca.ORCID http://orcid.org/0000-0003-4549-4289
Alexandre TranDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Behnam SadeghiradDepartment of Anesthesia, McMaster University, Hamilton, ON, Canada.
Karen E A BurnsDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Eddy FanInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Daniel BrodieDivision of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Laveena MunshiInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Ewan C GoligherInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Deborah J CookDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Robert A FowlerInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Margaret S HerridgeInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Pierre CardinalDivision of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Samir JaberHôpital Saint-Eloi, Centre Hospitalier Universitaire (CHU) Montpellier, PhyMedExp, INSERM, CNRS, Montpellier, France.
Morten Hylander MøllerDepartment of Intensive Care, Copenhagen University Righospitalet, Copenhagen, Denmark.
Arnaud W ThilleCentre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France.
Niall D FergusonInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Arthur S SlutskyInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Laurent J BrochardInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Andrew J E Seely *Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Bram Rochwerg *Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
University Health Network · CAUniversity of Ottawa · CAImpact · CASt. Michael's Hospital · CACentre National de la Recherche Scientifique · FRCopenhagen University Hospital · DKInserm · FRNewYork–Presbyterian Hospital · USSunnybrook Health Science Centre · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeSystematic review and network meta-analysis to investigate the efficacy of noninvasive respiratory strategies, including noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC), in reducing extubation failure among critically ill adults.

methodsWe searched databases from inception through October 2021 for randomized controlled trials (RCTs) evaluating noninvasive respiratory support therapies (NIPPV, HFNC, conventional oxygen therapy, or a combination of these) following extubation in critically ill adults. Two reviewers performed screening, full text review, and extraction independently. The primary outcome of interest was reintubation. We used GRADE to rate the certainty of our findings.

resultsWe included 36 RCTs (6806 patients). Compared to conventional oxygen therapy, NIPPV (OR 0.65 [95% CI 0.52-0.82]) and HFNC (OR 0.63 [95% CI 0.45-0.87]) reduced reintubation (both moderate certainty). Sensitivity analyses showed that the magnitude of the effect was highest in patients with increased baseline risk of reintubation. As compared to HFNC, no difference in incidence of reintubation was seen with NIPPV (OR 1.04 [95% CI 0.78-1.38], low certainty). Compared to conventional oxygen therapy, neither NIPPV (OR 0.8 [95% CI 0.61-1.04], moderate certainty) or HFNC (OR 0.9 [95% CI 0.66-1.24], low certainty) reduced short-term mortality. Consistent findings were demonstrated across multiple subgroups, including high- and low-risk patients. These results were replicated when evaluating noninvasive strategies for prevention (prophylaxis), but not in rescue (application only after evidence of deterioration) situations.

conclusionsOur findings suggest that both NIPPV and HFNC reduced reintubation in critically ill adults, compared to conventional oxygen therapy. NIPPV did not reduce incidence of reintubation when compared to HFNC. These findings support the preventative application of noninvasive respiratory support strategies to mitigate extubation failure in critically ill adults, but not in rescue conditions.

Indexed as

Noninvasive VentilationRespiratory InsufficiencyAdultAirway ExtubationCannulaCritical IllnessHumansOxygen Inhalation TherapyCritical care medicineExtubation failureHigh-flow nasal cannulaMechanical ventilation

Identifiers

PMID34825256
OpenAlexW3216933675

What OpenQuestion holds

Textmetadata
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.