Rapid Responses to:

RESEARCH:
Karen E A Burns, Neill K J Adhikari, Sean P Keenan, and Maureen Meade
Use of non-invasive ventilation to wean critically ill adults off invasive ventilation: meta-analysis and systematic review
BMJ 2009; 338: b1574 [Abstract] [Full text]
*Rapid Responses: Submit a response to this article

Rapid Responses published:

[Read Rapid Response] Which way to wean?
David Pryor   (12 June 2009)

Which way to wean? 12 June 2009
Top
David Pryor,
Intensive care registrar
Royal Melbourne Hospital, VIC 3050, Australia

Send response to journal:
Re: Which way to wean?

I was pleased to see that Burns et al, via the BMJ, were bringing critical care medicine to a more general medical audience, prompting Prof Ferguson’s excellent editorial.

The take home message seemed clear, non-invasive ventilatory weaning had a relative risk reduction for mortality of 0.55 when compared with its invasive counterpart. On reading further I was disappointed by the original papers included in the meta-analysis. The reliance on Prasad’s unpublished data which were weighted for 40% of the headlined chronic obstructive pulmonary disease (COPD) subgroup did seem striking. Wang et al’s original paper did not detail the use of any prophylactic strategies against ventilator associated pneumonia in the control group. The weaning strategy, level of positive end expiratory pressure (PEEP) and sedation protocol were also omitted from Wang's publication.

This all made for a much smaller degree of “impact” as “impact factors” go. However, bringing critical care medicine debate to the BMJ can only be a good thing for the wider readership.

References

1. Burns et al. Use of non-invasive ventilation to wean critically ill adults off invasive ventilation: meta-analysis and systematic review. BMJ 2009; 338: b1574.

2. Wang et al. Pulmonary infection control window in treatment of severe respiratory failure of chronic obstructive pulmonary diseases: a prospective, randomized controlled, multi-centred study. Chin Med J 2005; 118 (19): 1589-1594.

Competing interests: None declared