1) The objective of this quantitative systematic review is to evaluate and synthesize the recent literature on clinical and cost effectiveness of non-invasive positive pressure ventilation in acute respiratory failure from different causes versus invasive ventilation/standard care.
2) A review of existing systematic reviews of RCTs on the effectiveness of non-invasive positive pressure ventilation in acute respiratory failure from different causes.
3) If appropriate, the ‘review of reviews’ will be supplemented by a systematic review of RCTs or previously excluded/more recent RCTs; a judgement will be made to assess whether all relevant RCT evidence has been captured by the reviews and any overlap with the inclusion and exclusion criteria specified in this protocol will be assessed.
Inclusion criteria: this review will consider studies that include participants who are suffering from acute respiratory failure from different causes. Exclusion criteria: severely depressed level of consciousness/confusion/non-cooperative; respiratory rate <12/min; severe hypoxia, such as requiring more than 15L O2/min; large amounts of sputum; vomiting and high risk for aspiration; inability to accept NIV; recent abdominal, facial or upper airway surgery; malignancy or life expectancy <6 months because of disease other than COPD; known obstructive sleep apnea syndrome (OSA); metabolic acidotic component - StHCO3- < 20 mM
Non-invasive positive pressure ventilation (NIPPV) - ventilation is a paradigm shift from the physiology of breathing spontaneously. Non-invasive positive pressure ventilation is a type of mechanical ventilation. It consists of a positive-pressure ventilator connected by tubing to a mask that applies positive air pressure to the nose, mouth, or both. It assists ventilation by delivering pressurized gas to the airways, increasing transpulmonary pressure, and inflating the lungs. Exhalation then occurs by means of elastic recoil of the lungs and any active force exerted by the expiratory muscles. The major difference between invasive and non-invasive ventilation is that with the, gas is delivered to the airway via a mask and not via invasive system.
Interventions will be compared to invasive ventilation/standard care. By invasive ventilation we understand endotracheal intubation and by standard care we understand oxygen through high flow nasal cannula, inhaled bronchodilators, combination of antibiotics, diuretics, respiratory stimulants, intravenous or oral corticosteroids.
Primary outcome measures - mortality, quality of life, average length of stay. We are interested in evaluating how many lives can be saved by timely NIPPV intervention in patients who are suffering from acute respiratory failure from different causes, including ICER and QALY estimates. Results may be presented for these outcomes and risk ratios between NIPPV and control. Secondary outcome measures- lung function (e.g. FEV1), blood gases (e.g. PaCO2), dyspnoea, adverse events, improvements in systolic & diastolic BP, heart rate-beats/min, other patient related outcomes (quality of sleep and patient acceptability). Cost effectiveness analysis including budget impact analysis will be conducted for this systematic review.