• Keren Mandelzweig, Aleksandra Leligdowicz, Srinivas Murthy, Rejani Lalitha, Robert A Fowler, and Adhikari Neill K J NKJ Department of Critical Care Medicine, Room D1.08, Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4.
• Division of Critical Care, Department of Medicine, Humber River Regional Hospital, 1235 Wilson Avenue Toronto, ON, M3M 0B2, Canada.
• J Crit Care. 2018 Oct 1; 47: 310-319.

PurposeWe systematically reviewed the effects of NIV for acute respiratory failure (ARF) in low- and low-middle income countries.Materials And MethodsWe searched MEDLINE, CENTRAL, and EMBASE (to January 2016) for observational studies and trials of NIV for ARF or in the peri-extubation period in adults and post-neonatal children. We abstracted outcomes data and assessed quality. Meta-analyses used random-effect models.ResultsFifty-four studies (ten pediatric/n=1099; 44 adult/n=2904), mostly South Asian, were included. Common diagnoses were pneumonia and chronic obstructive pulmonary disease (COPD). Considering observational studies and the NIV arm of trials, NIV was associated with moderate risks of mortality (pooled risk 9.5%, 95% confidence interval (CI) 4.6-14.5% in children; 16.2% [11.2-21.2%] in adults); NIV failure (10.5% [4.6-16.5%] in children; 28.5% [22.4-34.6%] in adults); and intubation (5.3% [0.8-9.7%] in children; 28.8% [21.9-35.8%] in adults). The risk of mortality was greater (p=0.035) in adults with hypoxemic (25.7% [15.2-36.1%]) vs. hypercapneic (12.8% [7.0-18.6%]) ARF. NIV reduced mortality in COPD (relative risk [RR] 0.47 [0.27-0.79]) and in patients weaning from ventilation (RR 0.48 [0.28-0.80]). The pooled pneumothorax risk was 2.4% (0.8-3.9%) in children and 5.2% (1.0-9.4%) in adults. Meta-analyses had high heterogeneity.ConclusionsNIV for ARF in these settings appears to be effective.Copyright © 2018 Elsevier Inc. All rights reserved.

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