Prophylactic non-invasive ventilation vs. oxygen support after planned extubation in critically ill obese patients: A systematic review and meta-analysis
Abstract
Background The benefits of prophylactic non-invasive ventilation (NIV) following the extubation of obese patients in intensive care units (ICUs) remain uncertain. We evaluated its impact on reintubation rates in obese patients extubated after at least 24 h of mechanical ventilation. Methods In this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to July 2026 for randomized controlled trials (RCTs) comparing prophylactic NIV with oxygen support (conventional or high-flow oxygen therapy [HFOT]) after planned extubation of obese patients in ICUs. Studies evaluating NIV as rescue therapy for post-extubation respiratory failure or to hasten extubation were excluded. Effect estimates were pooled with random-effects models as odds ratios (ORs) with 95% confidence intervals (CIs). The primary and secondary outcomes were reintubation within day 7 and ICU mortality. Subgroup analysis of reintubation was performed according to the planned daily NIV duration (≥12 h/day vs. <12 h/day). Results Three RCTs (975 of 977 enrolled patients with available outcomes) were included. Prophylactic NIV did not significantly reduce day-7 reintubation (OR=0.72, 95% CI: 0.43–1.18, P =0.191; I 2 =52.5%), whereas a study-level subgroup analysis suggested a lower risk of reintubation in trials planning NIV for at least 12 h/day (OR=0.46, 95% CI: 0.23–0.92, P =0.027; I 2 =29.2%). ICU mortality was unchanged (OR=0.95, 95% CI: 0.43–2.09, P =0.896; I 2 =38.6%). Certainty of evidence was low for both outcomes according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Conclusions Prophylactic NIV did not significantly reduce reintubation after planned extubation in obese ICU patients. A possible benefit with prolonged NIV was suggested in an exploratory subgroup analysis and requires confirmation. Trial Registration PROSPERO CRD420251078725
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BibTeX
@article{pape2026prophylactic,
title = {{Prophylactic non-invasive ventilation vs. oxygen support after planned extubation in critically ill obese patients: A systematic review and meta-analysis}},
author = {Sylvain Le Pape and Audrey de Jong and Rémi Coudroy and Jean-Pierre Frat and Gonzalo Hernández and Helena Huguet and Samir Jaber and Arnaud Thille},
journal = {Journal of Intensive Medicine},
year = {2026},
month = sep,
doi = {10.1016/j.jointm.2026.09.001},
url = {https://hal.science/hal-05756457v1},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Prophylactic non-invasive ventilation vs. oxygen support after planned extubation in critically ill obese patients: A systematic review and meta-analysis
AU - Sylvain Le Pape
AU - Audrey de Jong
AU - Rémi Coudroy
AU - Jean-Pierre Frat
AU - Gonzalo Hernández
AU - Helena Huguet
AU - Samir Jaber
AU - Arnaud Thille
PY - 2026
DA - 2026/09/21
JO - Journal of Intensive Medicine
DO - 10.1016/j.jointm.2026.09.001
UR - https://hal.science/hal-05756457v1
AB - Background The benefits of prophylactic non-invasive ventilation (NIV) following the extubation of obese patients in intensive care units (ICUs) remain uncertain. We evaluated its impact on reintubation rates in obese patients extubated after at least 24 h of mechanical ventilation. Methods In this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to July 2026 for randomized controlled trials (RCTs) comparing prophylactic NIV with oxygen support (conventional or high-flow oxygen therapy [HFOT]) after planned extubation of obese patients in ICUs. Studies evaluating NIV as rescue therapy for post-extubation respiratory failure or to hasten extubation were excluded. Effect estimates were pooled with random-effects models as odds ratios (ORs) with 95% confidence intervals (CIs). The primary and secondary outcomes were reintubation within day 7 and ICU mortality. Subgroup analysis of reintubation was performed according to the planned daily NIV duration (≥12 h/day vs. <12 h/day). Results Three RCTs (975 of 977 enrolled patients with available outcomes) were included. Prophylactic NIV did not significantly reduce day-7 reintubation (OR=0.72, 95% CI: 0.43–1.18, P =0.191; I 2 =52.5%), whereas a study-level subgroup analysis suggested a lower risk of reintubation in trials planning NIV for at least 12 h/day (OR=0.46, 95% CI: 0.23–0.92, P =0.027; I 2 =29.2%). ICU mortality was unchanged (OR=0.95, 95% CI: 0.43–2.09, P =0.896; I 2 =38.6%). Certainty of evidence was low for both outcomes according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Conclusions Prophylactic NIV did not significantly reduce reintubation after planned extubation in obese ICU patients. A possible benefit with prolonged NIV was suggested in an exploratory subgroup analysis and requires confirmation. Trial Registration PROSPERO CRD420251078725
SN - 2667-100X
ER -