From measures to decisions? Clinical applicability, effectiveness and clinimetric properties of advanced bedside monitoring for patients with acute respiratory failure during non-invasive respiratory support: A systematic review and meta-analysis

Background: Patients with acute respiratory failure requiring non-invasive respiratory support (NRS) are at high risk of deterioration. Different advanced monitoring instruments are available that can provide objective measurements of respiratory muscle workload. However, there is currently no evidence synthesis on these instruments, so their clinical applicability and integration into decision-making remain unclear. Aim: This project aims to identify the measurements used, their effectiveness and clinimetric properties. Methods: A systematic search of MEDLINE (via Pubmed), EMBASE, Web of Science, Cochrane Library and CINAHL (PROSPERO registration: CRD42024597047). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Outcome Measurement Instruments. Results: 77 studies including 3679 patients fulfilled the selection criteria. The monitoring instruments were 5: oesophageal manometry, electrical impedance tomography, electromyography, and ultrasonography. Patients who did not respond to NRS had significantly higher DPes [MD 12.60 (95% CI 4.03;21.16), p=0.004], LUS score [MD 3.93 (95% CI 1.29,6.570), p=0.003] and parasternal intercostal thickening fraction (PIC-TF%) [MD 12.58 (95% CI 8.02,17.13), p