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Sará Ochoa, Jorge Eliécer; Hernández Ortiz, Olga Helena; Torres López, Moisés Ulises
Acta Colombiana de Cuidado Intensivo, July-September 2015, 2015-07-00, Volume: 15, Issue: 3Journal Article
EL uso de la ventilación mecánica no invasiva durante la extubación se ha incrementado, pero no es totalmente clara la evidencia que soporta su uso y condición clínica. Evaluar la eficacia de la ventilación mecánica no invasiva profiláctica, comparada con la oxigenoterapia estándar, en pacientes en liberación de la ventilación invasiva y prueba de respiración espontánea superada. Búsqueda sistemática en PubMed, EMBASE y LILACS, sin restricción de idiomas. Ensayos clínicos aleatorios que comparen el uso de ventilación mecánica no invasiva, con oxigenoterapia estándar, para disminuir la falla ventilatoria postextubación, reintubación, estancia en UCI, estancia en hospitalización, mortalidad en UCI, mortalidad en hospitalización o mortalidad a los 90 días. Tres evaluadores independientemente extrajeron los datos y evaluaron la calidad de acuerdo a los criterios previstos; se realizó el análisis estadístico con el programa RevMan 5.3. Se identificaron 7 ensayos clínicos de moderada a buena calidad metodológica, con 969 pacientes en total. Comparada con oxigenoterapia estándar, la ventilación mecánica no invasiva reduce la reintubación (OR: 0,43; IC 95%: 0,25-0,76; I2: 0%); disminuye la mortalidad en UCI (OR: 0,29; IC 95%: 0,13-0,67; I2: 0%); y en hospitalización (OR: 0,54; IC 95%: 0,29-1; I2: 0%), en especial en pacientes con factores de riesgo para falla ventilatoria postextubación. El uso profiláctico de ventilación mecánica no invasiva reduce la reintubación, mortalidad en UCI y en hospitalización, en especial en pacientes con factores de riesgo identificados para falla respiratoria postextubación. The use of prophylactic non-invasive mechanical ventilation after extubation has been increasing, but the evidence for its use is not yet clear. To evaluate the efficacy of prophylactic non-invasive mechanical ventilation after extubation compared with standard oxygen therapy in patients with invasive mechanical ventilation and who overcome a spontaneous breathing trial. Databases including PubMed, Embase, and LILACS (August 2014) were searched for pertinent studies without language restrictions. Randomized trials of prophylactic non-invasive mechanical ventilation after extubation compared with standard oxygen therapy in patients with invasive mechanical were included. Effects on primary outcomes: reduce post-extubation respiratory failure, reintubation rate, ICU and/or hospital mortality, and hospital length of stay were accessed in this meta-analysis. Three review authors independently assessed trial quality and abstracted data according to pre-specified criteria. The program RevMan 5.3 was used for analysis. Seven trials with moderate to good quality involving 969 patients were included. The use of NIV following extubation for patients decrease the reintubation rate (odds risk OR 0.43, 95% confidence interval CI 0.25-0.76, I2 0%); reduces ICU mortality (OR 0.29, 95% CI 0.13-0.67, I2 0%), and reduces hospital mortality (OR 0.54, 95% CI 0.29-1.0, I2 0%) compared to standard oxygen therapy, particularly in patients with risk factors associated with failed extubation. The results of this review suggested prophylactic non-invasive mechanical ventilation after extubation seems to be effective in reducing reintubation rate, and ICU and/or hospital mortality. This is most important in patients with risk factors associated with failed extubation.
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