Invasive versus non-invasive ventilation for acute respiratory failure in neuromuscular disease and chest wall disorders

What is the aim of this review?

The aim of this Cochrane review was to look at how the effects of non-invasive ventilation (NIV) compared to invasive ventilation in the treatment of respiratory failure in people with diseases affecting the nerves, muscles or the chest wall. The review set out to compare the two methods in terms of the effects on short-term survival, side effects, and the length of hospital stay.

What was studied in the review?

When someone has severe difficulty in breathing, they may need assistance from a machine (ventilator) which is able to move air in and out of the lungs. Invasive and non-invasive ventilation differ in how the air is delivered to the person. In invasive ventilation, air is delivered via a tube that is inserted into the windpipe through the mouth or sometimes the nose. In NIV, air is delivered through a sealed mask that can be placed over the mouth, nose or the whole face.

Invasive ventilation is the standard treatment used for people with neuromuscular diseases or chest wall disorders who are suffering from acute respiratory failure. However, NIV may offer some advantages such as being able to talk and swallow, and may have fewer risks.

Key Messages

The review authors collected and assessed all the relevant studies to answer this question but did not identify any trials that met the standards needed to be included in the review.

So far, there is no evidence from randomised studies either for or against the routine use of NIV instead of invasive ventilation in people with acute respiratory failure caused by either neuromuscular disease or a chest wall disorder.

However, some evidence from observational studies suggests that NIV should be trialled in all patients except for those with bulbar dysfunction.

How up to date is this review?

The evidence is up to date to 11 September 2017.

Authors' conclusions: 

Acute respiratory failure is a life-threatening complication of acute onset neuromuscular disease and of chronic neuromuscular disease and chest wall disorders. We found no randomised trials on which to elaborate evidence-based practice for the use of non-invasive versus invasive mechanical ventilation. For researchers, there is a need to design and conduct new randomised trials to compare NIV with invasive ventilation in acute neuromuscular respiratory failure. These trials should anticipate variations in treatment responses according to disease condition (acute onset versus acute exacerbation on chronic neuromuscular diseases) and according to the presence or absence of bulbar dysfunction.

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Background: 

Acute respiratory failure is a common life-threatening complication of acute onset neuromuscular diseases, and may exacerbate chronic hypoventilation in patients with neuromuscular disease or chest wall disorders. Standard management includes oxygen supplementation, physiotherapy, cough assistance, and, whenever needed, antibiotics and intermittent positive pressure ventilation. Non-invasive mechanical ventilation (NIV) via nasal, buccal or full-face devices has become routine practice in many centres.

Objectives: 

The primary objective of this review was to compare the efficacy of non-invasive ventilation with invasive ventilation in improving short-term survival in acute respiratory failure in people with neuromuscular disease and chest wall disorders. The secondary objectives were to compare the effects of NIV with those of invasive mechanical ventilation on improvement in arterial blood gas after 24 hours and lung function measurements after one month, incidence of barotrauma and ventilator-associated pneumonia, duration of mechanical ventilation, length of stay in the intensive care unit and length of hospital stay.

Search strategy: 

We searched the following databases on 11 September 2017: the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE and Embase. We also searched conference proceedings and clinical trials registries.

Selection criteria: 

We planned to include randomised or quasi-randomised trials with or without blinding. We planned to include trials performed in children or adults with acute onset neuromuscular diseases or chronic neuromuscular disease or chest wall disorders presenting with acute respiratory failure that compared the benefits and risks of invasive ventilation versus NIV.

Data collection and analysis: 

Two review authors reviewed searches and independently selected studies for assessment. We planned to follow standard Cochrane methodology for data collection and analysis.

Main results: 

We did not identify any trials eligible for inclusion in the review.

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