Efficacy and safety of noninvasive ventilation in patients after cardiothoracic surgery: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND: Noninvasive ventilation (NIV) is a promising therapeutic strategy after cardiothoracic surgery. This study aimed to meta-analyze the efficacy and safety of NIV as compared to conventional management after cardiothoracic surgery. METHODS: PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing NIV with conventional management after cardiothoracic surgery. Relative risk (RR), standard mean difference (SMD), and 95% confidence intervals (CIs) were used to measure the efficacy and safety of NIV using random-effects model. Heterogeneity was evaluated using the Q statistic. RESULTS: This study included 14 RCTs (1740 patients) for the evaluation of efficacy and safety of NIV as compared to conventional management after cardiothoracic surgery. Overall, NIV had minimal effect on the risk of mortality (RR: 0.64; 95% CI: 0.36–1.14; P = 0.127), endotracheal intubation (RR: 0.52; 95% CI: 0.24–1.11; P = 0.090), respiratory (RR: 0.70; 95% CI: 0.47–1.30; P = 0.340), cardiovascular (RR: 0.81; 95% CI: 0.54–1.22; P = 0.306), renal (RR: 0.70; 95% CI: 0.26–1.92; P = 0.491), and other complications (RR: 0.72; 95% CI: 0.38–1.36; P = 0.305), respiratory rate (SMD: −0.10; 95% CI: −1.21–1.01; P = 0.862), heart rate (SMD: −0.27; 95% CI: −0.76–0.22; P = 0.288), PaO(2)/FiO(2) ratio (SMD: 0.34; 95% CI: −0.17−0.85; P = 0.194), PaCO(2) (SMD: 0.83; 95% CI: −0.12–1.77; P = 0.087), systolic pressure (SMD: −0.04; 95% CI: −0.25–0.17; P = 0.700), pH (SMD: −0.01; 95% CI: −0.44–0.43; P = 0.974), length of ICU stay (SMD: −0.19; 95% CI: −0.47–0.08; P = 0.171), and hospital stay (SMD: −0.31; 95% CI: −1.00–0.38; P = 0.373). Sensitivity analysis showed that NIV was associated with higher levels of PaO(2)/FiO(2) ratio (SMD: 0.52; 95% CI: 0.00–1.05; P = 0.048) and lower risk of endotracheal intubation (RR: 0.38; 95% CI: 0.22–0.66; P = 0.001). CONCLUSION: As compared to conventional management, the use of NIV after cardiothoracic surgery improved patient's oxygenation and decreased the need for endotracheal intubation, without significant complications.