ArticleEClinicalMedicine2025
Noninvasive respiratory support following extubation in critically ill adults with obesity: a systematic review and network meta-analysis.
Article in EClinicalMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- High-Flow Nasal Cannula Versus Noninvasive Ventilation for Prevention of Reintubation in High-Risk Critically Ill Patients (HIGH-FLOW OXY): An Informative Systematic Review and Meta-Analysis.Critical care explorations · 2026Pooled it
- Sodium bicarbonate therapy in severe metabolic acidemia: an individual patient data meta-analysis of the BICAR-ICU and BICAR-ICU2 trials.Critical care (London, England) · 2026Pooled it
- Effect of noninvasive ventilation on tracheal reintubation among patients with hypoxemic respiratory failure following abdominal surgery: a bayesian post-hoc analysis of the NIVAS trial.Critical care (London, England) · 2025Trial
- Noninvasive ventilation in postoperative critically ill patients with morbid obesity: secondary analysis of the EXTUBOBESE multicentre randomised clinical trial.British journal of anaesthesia · 2025Trial
- Key principles for rehabilitation of critically ill patients with obesity.Intensive care medicine · 2026Review
- Acute respiratory distress syndrome in patients with obesity.Intensive care medicine · 2026Article
- Liberation from Mechanical Ventilation in Acute Hypoxemic Respiratory Failure or Adult Respiratory Distress Syndrome: A Review.Journal of clinical medicine · 2026Review
- Obesity: biomechanical implications for mechanical ventilation.Critical care (London, England) · 2026Review
- Is postoperative ARDS different from medical ARDS?Critical care (London, England) · 2026Article
- Percutaneous dilatational tracheostomy in critical illness: A practice survey of intensivists in Australia and New Zealand.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- Mechanical ventilation for ICU patient with obesity: current best practices and future directions.Intensive care medicine · 2026Review
- Norepinephrine use at extubation in critically ill patients with obesity: a cohort study with multicenter validation.Intensive care medicine · 2025Observational
- Physiological comparison of noninvasive ventilation and CPAP on inspiratory efforts after extubation in critically ill patients with morbid obesity: a post-hoc analysis.Annals of intensive care · 2025Article
- Does obesity impact on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE study.Annals of intensive care · 2025Article
- Bridging the Gap: The Role of Non-Invasive Respiratory Supports in Weaning from Invasive Mechanical Ventilation.Journal of clinical medicine · 2025Review
- Key principles and recent developments for ventilatory management of the surgical critically ill patient.Intensive care medicine · 2025Article
- Neurally adjusted ventilatory assist in critical care patients with and without obesity: a prospective randomized crossover study.Annals of intensive care · 2025Article
- Factors associated with women authorship over 25 years in high-impact critical care randomized controlled trials: the pipeline is still leaking.Critical care (London, England) · 2025Article
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Patients with obesity are at high-risk of extubation failure. Discrepancies were found in the results of recent randomized controlled trials (RCTs) regarding the roles of noninvasive ventilation (NIV), high flow nasal cannula (HFNC) and conventional oxygen therapy (COT) to prevent extubation failure in critically ill patients with obesity. Methods: In this systematic review and network meta-analysis, we searched MEDLINE, Cochrane Center Register of Controlled Trials and Web of Science from 1 January 1998 to 1 July 2024 for RCTs evaluating noninvasive respiratory support therapies (NIV, HFNC, COT, NIV + HFNC) after extubation in critically ill adults with obesity. Primary outcome was reintubation at day 7. Secondary outcome was 28-day mortality. We generated pooled risk ratios (RR) and numbers needed to treat (NNT). We rated risk of bias using the Cochrane risk-of-bias 2.0 tool. The study was registered with PROSPERO (CRD 42022308995). Findings: In seven RCTs including 1933 patients, NIV + HFNC (RR 0.36 [95% confidence interval (CI) 0.16-0.82], NNT = 10 [95% CI 7-33]) and NIV (RR 0.45 [95% CI 0.23-0.88], NNT = 11 [95% CI 8-50]) but not HFNC (RR 0.79 [95% CI 0.40-1.59]) reduced reintubation at day 7, compared to COT. Compared to HFNC, NIV + HFNC (RR 0.46 [95% CI 0.23-0.90], NNT = 14 [95% CI 10-77]) but not NIV (RR 0.57 [95% CI 0.32-1.02]) reduced reintubation at day 7. Compared to HFNC, both NIV (RR 0.31 [95% CI 0.13-0.74], NNT = 15 [95% CI 12-40]) and NIV + HFNC (RR 0.30 [95% CI 0.10-0.89], NNT = 15 [95% CI 11-90]) reduced 28-day mortality. Interpretation: The results suggest that compared to COT and HFNC, NIV alone or with HFNC reduces reintubation in critically ill patients with obesity after extubation. Compared to HFNC, NIV alone or with HFNC reduces mortality. The number needed to treat with NIV or NIV + HFNC to avoid one death was 15. These findings support the application of NIV to mitigate extubation failure in critically ill adults with obesity. Funding: None.
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