Background Extubation to non-invasive ventilation (NIV) has been investigated as a strategy to wean critically ill adults from invasive ventilation and reduce ventilator-related complications. Methods We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, proceedings of four conferences and bibliographies (to June 2020) for randomised and quasi-randomised trials that compared extubation with immediate application of NIV to continued invasive weaning in intubated adults and reported mortality (primary outcome) or other outcomes. Two reviewers independently screened citations, assessed trial quality and abstracted data. Results We identified 28 trials, of moderate-to-good quality, involving 2066 patients, 44.6% with chronic obstructive pulmonary disease (COPD). Non-invasive weaning significantly reduced mortality (risk ratio (RR) 0.57, 95% CI 0.44 to 0.74; high quality), weaning failures (RR 0.59, 95% CI 0.43 to 0.81; high quality), pneumonia (RR 0.30, 95% CI 0.22 to 0.41; high quality), intensive care unit (ICU) (mean difference (MD) −4.62 days, 95% CI −5.91 to −3.34) and hospital stay (MD −6.29 days, 95% CI −8.90 to −3.68). Non-invasive weaning also significantly reduced the total duration of ventilation, duration of invasive ventilation and duration of ventilation related to weaning (MD −0.57, 95% CI −1.08 to −0.07) and tracheostomy rate. Mortality, pneumonia, reintubation and ICU stay were significantly lower in trials enrolling COPD (vs mixed) populations. Conclusion Non-invasive weaning significantly reduced mortality, pneumonia and the duration of ventilation related to weaning, particularly in patients with COPD. Beneficial effects are less clear (or more careful patient selection is required) in non-COPD patients. PROSPERO registration number CRD42020201402. Data are available from KEAB. Data are available from Dr. Burns (0000-0002-9967-5424) .

中文翻译：

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重症成人无创通气与有创脱机：系统评价和荟萃分析

背景 无创通气 (NIV) 的拔管已被研究作为使危重成人摆脱有创通气和减少呼吸机相关并发症的一种策略。方法 我们检索了 MEDLINE、EMBASE、Cochrane 对照试验中心注册库、四个会议论文集和参考书目（截至 2020 年 6 月），以查找比较拔管与立即应用 NIV 与插管成人持续侵入性脱机的随机和半随机试验，并报告死亡率（主要结果）或其他结果。两名评审员独立筛选引文、评估试验质量和提取数据。结果 我们确定了 28 项中等质量至良好质量的试验，涉及 2066 名患者，其中 44.6% 患有慢性阻塞性肺病 (COPD)。无创脱机显着降低死亡率（风险比 (RR) 0.57，95% CI 0.44 至 0.74；高质量）、脱机失败（RR 0.59、95% CI 0.43 至 0.81；高质量）、肺炎（RR 0.30、95% CI 0.22 至 0.41；高质量），重症监护病房 (ICU)（平均差 (MD) -4.62 天，95% CI -5.91 至 -3.34）和住院时间（MD -6.29 天，95% CI -8.90 至 - 3.68）。无创脱机还显着降低了总通气时间、有创通气时间和与脱机相关的通气时间（MD -0.57, 95% CI -1.08 至 -0.07）和气管切开率。在纳入 COPD（与混合）人群的试验中，死亡率、肺炎、再插管和 ICU 住院时间显着降低。结论 无创脱机显着降低死亡率、肺炎和与脱机相关的通气时间，特别是在 COPD 患者中。在非 COPD 患者中，有益效果不太清楚（或需要更仔细的患者选择）。PROSPERO 注册号 CRD42020201402。数据可从 KEAB 获得。数据可从伯恩斯博士 (0000-0002-9967-5424) 处获得。