Pulmonary infection control window as a switching point for sequential ventilation in the treatment of COPD patients: a meta-analysis

Figures & data

Figure 1 Flow diagram showing the selection process of material from identification to inclusion.

Table 1 Characteristics of included studies

Source	Sample size	Age‡ (years)	Inclusion criteria	Intubation criteria	Experimental strategy
Chen et al^Citation9	37	NA	AECOPD with pulmonary infection, respiratory failure	Yes	Bilevel NPPV delivered by face mask
Chen^Citation10	30	65	AECOPD with respiratory failure, pulmonary infection	Yes	Bilevel NPPV delivered by face mask
Jiang and Jiang^Citation11	46	60	AECOPD with severe respiratory failure, pulmonary infection	Yes	Bilevel NPPV delivered by face mask
Li and Zhou^Citation12	40	NA	AECOPD with bronchopulmonary infection, respiratory failure	Yes	Bilevel NPPV delivered by face mask
Li et al^Citation13	41	69	AECOPD with severe respiratory failure, pulmonary infection	Yes	Bilevel NPPV delivered by face or nasal mask
Lin et al^Citation14	32	61.5	AECOPD with severe respiratory failure, pulmonary infection	Yes	Bilevel NPPV delivered by face or nasal mask
Lun et al^Citation15	36	71	AECOPD with bronchopulmonary infection, respiratory failure	Yes	Bilevel NPPV delivered by face mask
Ning et al^Citation16	28	62.4	AECOPD with respiratory failure, pulmonary infection	Yes	Bilevel NPPV delivered by face mask
Wang et al^Citation17	11	64.8	AECOPD with bronchopulmonary infection, respiratory failure	Yes	Bilevel NPPV delivered by face mask
Wang^Citation3	90	67.6	AECOPD with severe respiratory failure, pulmonary infection	Yes	Bilevel NPPV delivered by face mask
Wu et al^Citation18	28	NA	AECOPD with respiratory failure, pulmonary infection	Yes	Bilevel NPPV delivered by face mask
Zhang et al^Citation19	30	66.9	AECOPD with severe respiratory failure, pulmonary infection	Yes	Bilevel NPPV delivered by face mask
Zhang and Zhao^Citation20	48	73	AECOPD with severe respiratory failure, pulmonary infection	Yes	Bilevel NPPV delivered by face mask
Zhao and Li^Citation21	40	70	AECOPD with severe pulmonary infection, respiratory failure	Yes	Bilevel NPPV delivered by face or nasal mask
Zheng et al^Citation22	33	73	AECOPD with severe pulmonary infection, respiratory failure	Yes	Bilevel NPPV delivered by face or nasal mask
Zou et al^Citation23	76	71.5	AECOPD with severe respiratory failure, pulmonary infection	Yes	Bilevel NPPV delivered by face or nasal mask

Note:

‡ Data are shown as mean.

Abbreviations: NA, not available; AECOPD, acute exacerbation of chronic obstructive pulmonary disease; NPPV, noninvasive positive pressure ventilation.

Figure 2 The effect of PIC window on mortality during hospital admission.

Abbreviations: PIC, pulmonary infection control; RR, risk ratio; CI, confidence interval.

Figure 3 The effect of PIC window on VAP.

Abbreviations: PIC, pulmonary infection control; VAP, ventilator-associated pneumonia; RR, risk ratio; CI, confidence interval.

Figure 4 The effect of PIC window on duration of MV.

Note: Weights are from random effects analysis.
Abbreviations: PIC, pulmonary infection control; MV, mechanical ventilation; WMD, weighted mean difference; CI, confidence interval; IMV, intermittent mandatory ventilation.

Figure 5 The effect of PIC window on length of ICU stay and hospital stay.

Note: Weights are from random effects analysis.
Abbreviations: PIC, pulmonary infection control; ICU, intensive care unit; WMD, weighted mean difference; CI, confidence interval; ICU, intensive care unit.

Figure 6 The effect of PIC window on adverse events associated with weaning.

Abbreviations: PIC, pulmonary infection control; RR, risk ratio; CI, confidence interval.

Figure S1 Risk of bias analysis.

Notes: (A) Risk-of-bias summary: the authors’ judgments about each risk-of-bias item for the each included studies. (B) Risk-of-bias graph: the authors’ judgments about each risk-of-bias item presented as percentages across all included studies.

Figure S2 Sensitivity analysis.

Notes: (A) Time of IMV. (B) Total time of MV. (C) Length of ICU stay. (D) Length of hospital stay.

Abbreviations: IMV, intermittent mandatory ventilation; MV, mandatory ventilation; ICU, intensive care unit; CI, confidence interval.

Figure S3 Publication bias.

Notes: The primary outcomes mortality (A and B) and ventilator-associated pneumonia (C and D) were detected by Begg’s and Egger’s tests.

Abbreviations: SE, standard error; OR, odds ratio.

Table S1 Results of subgroup analyses from a meta-analyses of randomized controlled trials

Trials	Mortality^Citation2–Citation15	VAP^Citation2–Citation16	Time of IMV^Citation2–Citation16	Hospital stay^Citation2–Citation4,Citation6,Citation7,Citation9–Citation11,Citation13,Citation16	Adverse events^Citation2–Citation8,Citation12–Citation16
	RR or WMD (95% CI), P-value
All trials^Citation2–Citation16	RR 0.36 (0.23, 0.57) <0.00001	RR 0.28 (0.19, 0.41) <0.00001	WMD −7.68 (−9.43, −5.93) <0.00001	WMD −8.46 (−10.35, −6.58) <0.0001	RR 0.41 (0.27, 0.63) <0.0001
Subgroup analyses
Risk of bias
Low^Citation2–Citation4,Citation6–Citation8,Citation10,Citation12,Citation14,Citation15	0.36 (0.22, 0.60) <0.0001	0.25 (0.11, 0.54) =0.000	−8.54 (−10.01, 7.07) =0.000	−8.80 (−11.52, −6.07) =0.000	0.39 (0.23, 0.64) =0.000
High^Citation5,Citation9,Citation11,Citation13,Citation16	0.36 (0.23, 0.57) =0.041	0.29 (0.19, 0.45) =0.000	−5.56 (−8.57, −2.55) =0.000	−8.48 (−10.16, −6.80) =0.000	0.48 (0.22, 1.03) =0.50
Sample size (n)
≤40^Citation3,Citation4,Citation6–Citation11,Citation13,Citation15,Citation16	0.42 (0.24, 0.74) =0.003	0.25 (0.15, 0.42) =0.000	−7.54 (−10.18, −4.90) =0.000	−8.33 (−10.07, −6.58) =0.000	0.42 (0.23, 0.76) =0.003
>40^Citation2,Citation5,Citation7,Citation12,Citation14	0.28 (0.13, 0.61) =0.001	0.32 (0.19, 0.56) =0.000	−7.72 (−9.16, −6.29) =0.000	−8.14 (−19.89, 3.62) =0.040	0.40 (0.22, 0.73) =0.004
Disease severity (respiratory failure)
Moderate^Citation7–Citation10,Citation13,Citation15,Citation16	0.39 (0.20, 0.76) =0.006	0.25 (0.13, 0.46) =0.000	−6.91 (−9.46, −4.37) =0.000	−8.13 (−10.15, −6.10) =0.000	0.35 (0.18, 0.65) =0.001
Severe^Citation2–Citation7,Citation11,Citation12,Citation14	0.34 (0.19, 0.63) =0.001	0.30 (0.19, 0.49) =0.000	−8.22 (−9.80, −5.93) =0.000	−8.68 (−13.20, −4.16) =0.000	0.48 (0.27, 0.85) =0.011
Experimental strategy
Face mask^Citation5–Citation10,Citation13–Citation16	0.33 (0.19, 0.58) =0.000	0.24 (0.15, 0.40) =0.000	−7.40 (−9.58, −5.55) =0.000	−7.57 (−9.56, −5.58) =0.000	0.43 (0.27, 0.70) =0.001
Face/nasal mask^Citation2–Citation4,Citation11,Citation12	0.44 (0.20, 0.96) =0.040	0.35 (0.20, 0.63) =0.000	−8.54 (−12.09, −4.99) =0.000	−10.58 (−14.75, 6.42) =0.000	0.36 (0.15, 0.64) =0.019
Control strategy
SIMV + PS^Citation3–Citation7,Citation9,Citation13–Citation15	0.34 (0.20, 0.61) =0.000	0.29 (0.15, 0.56) =0.000	−7.60 (−9.00, −6.21) =0.000	−8.82 (−11.09, −6.55) =0.000	0.42 (0.24, 0.72) =0.002
AC/SIMV + PS^Citation2,Citation8,Citation10–Citation12,Citation16	0.40 (0.18, 0.85) =0.018	0.27 (0.17, 0.44) =0.000	−8.90 (−11.51, −6.29) =0.000	−8.15 (−11.17, −5.14) =0.000	0.40 (0.21, 0.79) =0.008

Abbreviations: RR, relative risk; WMD, weighted mean difference; CI, confidential interval; VAP, ventilator-associated pneumonia; IMV, intermittent mandatory ventilation; AC, assisted/controlled ventilation; SIMV, synchronized intermittent mandatory ventilation; PS, pressure support.

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 Google Scholar

ChenHHuangFLiangYXApplied research of invasive-noninvasive mechanical ventilation for chronic obstructive pulmonary disease complicating acute respiratory failureLing Nan J Emerg Med201015275277

 Google Scholar

ZhangXYZhaoYClinical research of sequential invasive-noninvasive mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease with respiratory failureJ ClinPulm Med201217420423

 Google Scholar

WuQWangHXZhengSYEffect of sequential non-invasive following short-term invasive mechanical ventilation (MV) on patients with AECOPDAppl J Gen Pract20075945949

 Google Scholar

WangCCollaborating Research Group for Noninvasive Mechanical Ventilation of Chinese Respiratory SocietyPulmonary infection control window in treatment of severe respiratory failure of chronic obstructive pulmonary diseases: a prospective, randomized controlled, multi-centred studyChin Med J20051181589159416232342

 PubMed Web of Science ®Google Scholar

NingKDongYCWangYTValue of the right time to the shift of invasive and noninvasive ventilation-clinical characteristics to the treatment of AECOPD with respiratory failureChinese J Gen Pract20108711712

 Google Scholar

LinWXYangJMLinQSequential mechanical ventilation in patients with chronic obstructive pulmonary disease caused by severe respiratory failureShan Dong Med J200848102103

 Google Scholar

LiJHZhouZXSequential non-invasive following short-term invasive mechanical ventilation in COPD patients with severe respiratory failurePractGeriatr200822368372

 Google Scholar

WangCShangMHuangKSequential non-invasive mechanical ventilation following short-term invasive mechanical ventilation in COPD induced hypercapnic respiratory failureChin Med J (Engl)2003116394312667385

 PubMed Web of Science ®Google Scholar

LiJLChangSXLuCLStudy on clinical application of bi-level positive airway pressure after removal of endotracheai intubation for Chronic Obstructive Pulmonary Disease complicated with type II respiratory failureClin Med China201228712714

 Google Scholar

LunYHYanJWLinRPApplication of sequential non-invasive following short-term invasive mechanical ventilation in patients with AECOPDChinese J N Clin Med20092144148

 Google Scholar

JiangYPJiangLDResearch on bi-level noninvasive positive pressure ventilation in the treatment of invasive-noninvasive sequential ventilationMod Prev Med20083513711375

 Google Scholar

ZhangJXGaoXLLiuSHAnalysis of sequential mechanical ventilation in chronic obstructive pulmonary disease patients with severe respiratory failureInt J Respir200727246251

 Google Scholar

ZhaoJMLiGXSequential non-invasive following short-term invasive mechanical ventilation initiated at the point of PIC windowMed J West China201224271275

 Google Scholar