{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T18:39:42Z","timestamp":1792521582176,"version":"4.5.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Objectives:<\/jats:title>\n \n Noninvasive ventilation (NIV) is widely used in acute respiratory failure (ARF), yet the association between high tidal volume (V\n t<\/jats:sc>\n ) and clinical outcomes remains incompletely defined. We evaluated the association between V\n t<\/jats:sc>\n and NIV failure overall and by ARF type, and its relationship with respiratory and clinical outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Data Sources:<\/jats:title>\n MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, and Latin American and Caribbean Health Science Literature (1976 to September 2025).<\/jats:p>\n <\/jats:sec>\n \n Study Selection:<\/jats:title>\n \n Observational studies of adults with ARF treated with NIV reporting V\n t<\/jats:sc>\n or V\n t<\/jats:sc>\n normalized to predicted body weight (V\n t<\/jats:sc>\n \/PBW) in NIV success and failure groups.\n <\/jats:p>\n <\/jats:sec>\n \n Data Extraction:<\/jats:title>\n Three pairs of reviewers identified studies and extracted data independently. Random-effects meta-analysis was performed. Risk of bias and certainty of evidence were assessed using Risk of Bias In Nonrandomized Studies of Interventions and Grading of Recommendations Assessment, Development, and Evaluation.<\/jats:p>\n <\/jats:sec>\n \n Data Synthesis:<\/jats:title>\n \n Eleven studies (1136 patients) were included. V\n t<\/jats:sc>\n \/PBW was higher in NIV failure vs. success (mean difference [MD], 1.02\u2009mL\/kg [95% CI, 0.60\u20131.45\u2009mL\/kg]), whereas absolute V\n t<\/jats:sc>\n did not differ (MD, 1.30 [\u201333.31 to 35.91]). In hypoxemic ARF, V\n t<\/jats:sc>\n \/PBW remained higher in NIV failure (MD, 0.89\u2009mL\/kg [95% CI, 0.04\u20131.73\u2009mL\/kg]); no data were available for hypercapnic ARF. Post hoc analyses showed that higher V\n t<\/jats:sc>\n \/PBW was associated with increased mortality (odds ratio, 9.11; 95% CI, 3.88\u201321.37), higher respiratory rate (RR; MD, 3.14 breaths\/min [95% CI, 1.36\u20134.92 breaths\/min]), and lower Pa\n co<\/jats:sc>\n 2<\/jats:sub>\n (MD, \u20132.38\u2009mm Hg [95% CI, \u20134.16 to \u20130.5938\u2009mm Hg]), but no with pressure support (PS) level (MD, 0.24 [95% CI, \u20130.81 to 1.29]). Certainty of evidence ranged from very low to moderate.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n \n In adults with ARF treated with NIV, higher V\n t<\/jats:sc>\n \/PBW was associated with NIV failure and worse outcomes. These findings reflect prognostic associations rather than causality, and interventional studies with systematic V\n t<\/jats:sc>\n monitoring are needed. Importantly, elevated V\n t<\/jats:sc>\n \/PBW, higher RR, lower Pa\n co<\/jats:sc>\n 2<\/jats:sub>\n , and increased mortality, without differences in PS, collectively implicate elevated respiratory drive as a driver of increased mortality (PROSPERO [CRD42024584977]).\n <\/jats:p>\n \n Findings:<\/jats:bold>\n Higher V\n t<\/jats:sc>\n \/PBW was associated with NIV failure, particularly in hypoxemic respiratory failure; post hoc analyses showed associations with increased mortality, higher respiratory rate, and lower Pa\n co<\/jats:sc>\n 2<\/jats:sub>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/ccm.0000000000007387","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T18:00:25Z","timestamp":1792519225000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of Tidal Volume in Patients Undergoing Noninvasive Ventilation: Systematic Review and Meta-Analysis"],"prefix":"10.1097","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2550-3678","authenticated-orcid":false,"given":"Roberto","family":"Santa Cruz","sequence":"first","affiliation":[{"name":"Hospital General Ramos Mej\u00eda, Ciudad Aut\u00f3noma de Buenos Aires, Argentina."},{"name":"Universidad de Magallanes, Escuela de Medicina, Punta Arenas, Chile."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Matesa","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Santa Catalina, Ciudad Aut\u00f3noma de Buenos Aires, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Jara","sequence":"additional","affiliation":[{"name":"Hospital General Ramos Mej\u00eda, Ciudad Aut\u00f3noma de Buenos Aires, Argentina."},{"name":"Hospital Zonal General de Agudos Dr. Alberto Balestrini, Buenos Aires, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Nadur","sequence":"additional","affiliation":[{"name":"Hospital General Ramos Mej\u00eda, Ciudad Aut\u00f3noma de Buenos Aires, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Loudet","sequence":"additional","affiliation":[{"name":"C\u00e1tedra Terapia Intensiva y C\u00e1tedra Farmacolog\u00eda Aplicada, Universidad, Nacional de La Plata, La Plata, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Ricci-Cabello","sequence":"additional","affiliation":[{"name":"Health Research Institute of the Balearic Islands (IdISBa), Balearic Islands, Spain."},{"name":"Balearic Islands Cochrane Affiliated Centre, Palma, Spain."},{"name":"CIBER de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Institute of Health Carlos III, Madrid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Esquinas","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Hospital Meseguer, NIV-ICU Group, Murcia, Spain."},{"name":"Biomedical Research Institute Pascual Parrilla-IMIB, Murcia, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"R1-20261020","first-page":"e83624","article-title":"Schematic assessment of non-invasive ventilation in acute respiratory failure by exploration of paradigm shift in emergency medicine.","volume":"17","author":"Suleman","year":"2025","journal-title":"Cureus"},{"key":"R2-20261020","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jcrc.2018.10.012","article-title":"Noninvasive ventilation in acute hypoxemic respiratory failure: A systematic review and meta-analysis.","volume":"49","author":"David-Joao","year":"2019","journal-title":"J Crit 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