Noninvasive neurally adjusted assisted ventilation as weaning mode in
extremely preterm infants: a meta-analysis and systematic review
Abstract
Background: The long duration of IMV for premature infants
connected to adverse clinical complications. It has been proven that
noninvasive ventilation (NIV) improved the weaning process. Noninvasive
neurally adjusted ventilatory assist (NIV-NAVA) is a new type of NIV,
and its effects on weaning are a subject of debate in clinical practice.
To compare NIV-NAVA and conventional NIV as weaning modes in preterm
neonates, this article was preformed. Methods: Cochrane
Library, Embase, PubMed, Scopus, and Web of Science were comprehensively
searched. Published reports were screened and assessed based on
predetermined inclusion and exclusion criteria. The Cochrane Risk of
Bias tool and the Newcastle-Ottawa Scale were used to evaluate the
quality of reports and bias. Review Manager 5.3 was used in the
meta-analysis. Trial sequential analysis (TSA) was used to avoid
false-positive or false-negative conclusions caused by constantly
updated data. Results: Six studies ( n = 265) were
included. Preterm infants who underwent NIV-NAVA had a lower weaning
failure comparing with conventional NIV (risk ratio 0.37, 95%
confidence interval 0.21–0.67, p = 0.001). In TSA the cumulative
Z‑curve crossed monitoring boundary for the benefit of NIV-NAVA
indicated that NIV-NAVA might improve extubation failure. With respect
to the rates of related adverse clinical events, there was no
statistically significant difference between the NIV-NAVA group and the
conventional NIV group in forest plots. Conclusion: The current
meta-analysis suggests that NIV-NAVA may reduce the rate of extubation
failure compared to conventional NIV.