Respiratory failure & ventilation
Assessment of Tidal Volume in Patients Undergoing Noninvasive Ventilation: Systematic Review and Meta-Analysis
Pooled result · Vt/PBWResult — go to the resultMD 1.02 mL/kg 95% CI 0.60–1.45Authors' conclusion
In adults with ARF treated with NIV, higher Vt/PBW was associated with NIV failure and worse outcomes. These findings reflect prognostic associations rather than causality, and interventional studies with systematic Vt monitoring are needed. Importantly, elevated Vt/PBW, higher RR, lower Paco2, and increased mortality, without differences in PS, collectively implicate elevated respiratory drive as a driver of increased mortality (PROSPERO [CRD42024584977]).Findings: Higher Vt/PBW was associated with NIV failure, particularly in hypoxemic respiratory failure; post hoc analyses showed associations with increased mortality, higher respiratory rate, and lower Paco2.
Study context
- Population
- Adults with acute respiratory failure (ARF) treated with noninvasive ventilation (NIV)patients in eleven studies
- Participants
- 1,136 adults
- Comparison
- Vt/PBW and Vt in NIV failure vs. success
- Outcome
- Vt/PBW
Methodological detailsrandom-effects meta-analysis, observational studies, Risk of Bias In Nonrandomized Studies of Interventions, Grading of Recommendations Assessment, Development, and Evaluation
- Random-effects meta-analysis
- Observational studies
- Risk of Bias In Nonrandomized Studies of Interventions
- Grading of Recommendations Assessment, Development, and Evaluation
Pooled result
As reported in the abstract
MD
1.02 mL/kg
95% CI 0.60–1.45
Further pooled results
| Outcome | MD (CI) | |
|---|---|---|
| Absolute Vt | 1.30 (−33.31 to 35.91) | |
| −40−2002040Difference (linear scale) |
| Outcome | MD (mL/kg) (95% CI) | |
|---|---|---|
| Vt/PBW in hypoxemic ARF | 0.89 (0.04–1.73) | |
| −1012Difference, mL/kg (linear scale) |
Mortality (post hoc)
| Odds ratio (95% CI) | ||
|---|---|---|
| Higher Vt/PBWIncreased mortality · post hoc analysis | 9.11 (3.88–21.37) | |
| 0.050.21520Odds ratio (log scale) |
Respiratory rate (post hoc)
| MD (breaths/min) (95% CI) | ||
|---|---|---|
| Higher Vt/PBWHigher respiratory rate · post hoc analysis | 3.14 (1.36–4.92) | |
| −20246Difference, breaths/min (linear scale) |
Paco2 (post hoc)
| MD (mm Hg) (95% CI) | ||
|---|---|---|
| Higher Vt/PBWLower Paco2 · post hoc analysis | −2.38 (−4.16 to −0.5938) | |
| −6−4−202Difference, mm Hg (linear scale) |
Pressure support (PS) level (post hoc)
| MD (95% CI) | ||
|---|---|---|
| Higher Vt/PBWNo association · post hoc analysis | 0.24 (−0.81 to 1.29) | |
| −1012Difference (linear scale) |
Vt/PBW in hypoxemic ARF
- No data were available for hypercapnic ARF
Certainty of evidence
- Certainty of evidence ranged from very low to moderate
Original publication
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