Invasive-noninvasive Sequential Ventilation for the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease.
BACKGROUND
The study aimed to evaluate the efficacy and safety of invasivenoninvasive sequential ventilation versus invasive ventilation in the treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD).


METHODS
PubMed, Cochrane, Embase, Wanfang, CNKI, VIP database were searched by the index words to identify the qualified RCTs, and relevant literature sources were also searched. The latest research was conducted in June 2017. Relative Risks (RR), and Mean Difference (MD) along with 95% confidence interval (95% CI) were used to analyze the main outcomes.


RESULTS
Twenty-nine RCTs were involved in this analysis of 1061 patients in the invasivenoninvasive sequential ventilation group (In-non group) and 1074 patients in the invasive ventilation group (In group). The results indicated that compared with the invasive ventilation, invasive-noninvasive sequential ventilation would significantly decrease the incidence of VAP (RR:0.20, 95%CI: 0.16-0.26), mortality (RR:0.38, 95%CI: 0.26-0.55), reintubation (RR:0.39, 95%CI: 0.27-0.55); and statistically reduced the duration of invasive ventilation (MD:-9.23, 95%CI: -10.65, -7.82), the total duration of mechanical ventilation (MD:-4.91, 95%CI: -5.99, -3.83), and the length of stay in the ICU (MD:-5.10, 95%CI: -5.43, -4.76).


CONCLUSION
The results demonstrated that the application of noninvasive sequential ventilation after invasive ventilation at the pulmonary infection control window has a significant influence on VAP incidence, mortality, and the length of stay in the ICU, but further well-designed, adequately powered RCTs are required to validate the conclusion.
['Huang|Jian-Da|JD|', 'Gu|Tong-Jie|TJ|', 'Hu|Zhi-Lin|ZL|', 'Zhou|Dan-Fei|DF|', 'Ying|Jun|J|']
D000368:Aged D016208:Databases, Factual D018450:Disease Progression D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011014:Pneumonia D029424:Pulmonary Disease, Chronic Obstructive D012121:Respiration, Artificial D016896:Treatment Outcome D057188:Workflow
Invasive-noninvasive sequential ventilation chronic obstructive pulmonary disease RCT pulmonary infection VAP incidence randomized controlled trail.