Background:Noninvasive ventilation (NIV) is a promising therapeutic strategy after cardiothoracic surgery. This study aimed to meta-analyze the efficacy and safety of NIV as compared to conventional management after cardiothoracic surgery.Methods:PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing NIV with conventional management after cardiothoracic surgery. Relative risk (RR), standard mean difference (SMD), and 95% confidence intervals (CIs) were used to measure the efficacy and safety of NIV using random-effects model. Heterogeneity was evaluated using the Q statistic.Results:This study included 14 RCTs (1740 patients) for the evaluation of efficacy and safety of NIV as compared to conventional management after cardiothoracic surgery. Overall, NIV had minimal effect on the risk of mortality (RR: 0.64; 95% CI: 0.36-1.14; P = 0.127), endotracheal intubation (RR: 0.52; 95% CI: 0.24-1.11; P = 0.090), respiratory (RR: 0.70; 95% CI: 0.47-1.30; P = 0.340), cardiovascular (RR: 0.81; 95% CI: 0.54-1.22; P = 0.306), renal (RR: 0.70; 95% CI: 0.26-1.92; P = 0.491), and other complications (RR: 0.72; 95% CI: 0.38-1.36; P = 0.305), respiratory rate (SMD: -0.10; 95% CI: -1.21-1.01; P = 0.862), heart rate (SMD: -0.27; 95% CI: -0.76-0.22; P = 0.288), PaO2/FiO(2) ratio (SMD: 0.34; 95% CI: -0.17-0.85; P = 0.194), PaCO2 (SMD: 0.83; 95% CI: -0.12-1.77; P = 0.087), systolic pressure (SMD: -0.04; 95% CI: -0.25-0.17; P = 0.700), pH (SMD: -0.01; 95% CI: -0.44-0.43; P = 0.974), length of ICU stay (SMD: -0.19; 95% CI: -0.47-0.08; P = 0.171), and hospital stay (SMD: -0.31; 95% CI: -1.00-0.38; P = 0.373). Sensitivity analysis showed that NIV was associated with higher levels of PaO2/FiO(2) ratio (SMD: 0.52; 95% CI: 0.00-1.05; P = 0.048) and lower risk of endotracheal intubation (RR: 0.38; 95% CI: 0.22-0.66; P = 0.001).Conclusion:As compared to conventional management, the use of NIV after cardiothoracic surgery improved patient's oxygenation and decreased the need for endotracheal intubation, without significant complications.
基金：
Capital Health Development Research and Special Projects of Beijing (Risk factors and prediction score of acute respiratory distress syndrome after cardiac surgery) [SF-2016-2-1052]
第一作者机构：[1]Capital Med Univ, Beijing Inst Heart Lung & Blood Vessel Dis, Beijing Anzhen Hosp, Dept Resp & Crit Care Med, Beijing 100029, Peoples R China
通讯作者：
通讯机构：[1]Capital Med Univ, Beijing Inst Heart Lung & Blood Vessel Dis, Beijing Anzhen Hosp, Dept Resp & Crit Care Med, Beijing 100029, Peoples R China
推荐引用方式(GB/T 7714)：
Zhu Guangfa,Huang Yan,Wei Dong,et al.Efficacy and safety of noninvasive ventilation in patients after cardiothoracic surgery: A PRISMA-compliant systematic review and meta-analysis[J].MEDICINE.2016,95(38):-.doi:10.1097/MD.0000000000004734.
APA：
Zhu, Guangfa,Huang, Yan,Wei, Dong&Shi, Yingxin.(2016).Efficacy and safety of noninvasive ventilation in patients after cardiothoracic surgery: A PRISMA-compliant systematic review and meta-analysis.MEDICINE,95,(38)
MLA：
Zhu, Guangfa,et al."Efficacy and safety of noninvasive ventilation in patients after cardiothoracic surgery: A PRISMA-compliant systematic review and meta-analysis".MEDICINE 95..38(2016):-
