Noninvasive respiratory support preventing reintubation after pediatric cardiac surgery—A systematic review

Abstract Objective To analyze the optimal postextubation respiratory support in pediatric cardiac surgery patients. Design Systematic review of randomized controlled trials. Setting Pediatric or neonatal intensive care units. Participants All aged children (<16 years) having cardiac surgery and postoperative invasive ventilation. Intervention Noninvasive respiratory support, including high flow nasal cannula (HFNC), conventional oxygen therapy (COT), noninvasive positive pressure ventilation (NIPPV), continuous positive pressure (CPAP), and noninvasive high‐frequency oscillatory ventilation (NHFOV). Measurement and Main Results Studies were not pooled for statistical synthesis due to the limited number and quality of the included studies. Risk ratios with 95% confidence intervals were calculated for individual studies. A total of 167 studies were screened and six were included. The risk of bias was low in one, high in one, and had some concerns in four of the studies. Extubation failure (defined as reintubation) was the main outcome of interest. Risk ratio for reintubation was 0.10 (CI 0.02–0.40) and 1.07 (CI 0.16–7.26) in HFNC versus COT, 0.49 (CI 0.05–5.28) in HFNC versus NIPPV, 0.40 (CI 0.08–1.94) in HFNOV versus CPAP, 0.75 (CI 0.26–2.18) in HFNOV versus NIPPV, and 1.37 (CI 0.33–5.73) in CPAP versus NIPPV. Treatment durations did not differ between the groups. Conclusion We did not find clear evidence of a difference in reintubation rates and other clinical outcomes between different noninvasive ventilation strategies. Evidence certainty was assessed to be very low due to the risk of bias, the small number of included studies, and high imprecision. Future quality studies are needed to determine the optimal postextubation support in pediatric cardiac surgery patients.