Bilevel positive airway pressure ventilation for non-COPD acute hypercapnic respiratory failure patients: A systematic review and meta-analysis

Abstract

The effectiveness of bi-level positive airway pressure (BiPAP) in patients with acute hypercapnic respiratory failure (AHRF) due to etiologies other than chronic obstructive pulmonary disease (COPD) is unclear. To systematically review the evidence regarding the effectiveness of BiPAP in non-COPD patients with AHRF. The Cochrane Library, MEDLINE, EMBASE, and CINAHL Plus were searched according to prespecified criteria (PROSPERO-CRD42018089875). Randomized controlled trials (RCTs) assessing the effectiveness of BiPAP versus continuous positive airway pressure (CPAP), invasive mechanical ventilation, or O 2 therapy in adults with non-COPD AHRF were included. The primary outcomes of interest were the rate of endotracheal intubation (ETI) and mortality. Risk-of-bias assessment was performed, and data were synthesized and meta-analyzed where appropriate. Two thousand four hundred and eighty-five records were identified after removing duplicates. Eighty-eight articles were identified for full-text assessment, of which 82 articles were excluded. Six studies, of generally low or uncertain risk-of-bias, were included involving 320 participants with acute cardiogenic pulmonary edema (ACPO) and solid tumors. No significant differences were seen between BiPAP ventilation and CPAP with regard to the rate of progression to ETI (risk ratio [RR] = 1.49, 95% confidence interval [CI], 0.63–3.62, P = 0.37) and in-hospital mortality rate (RR = 0.71, 95% CI, 0.25–1.99, P = 0.51) in patients with AHRF due to ACPO. The efficacy of BiPAP appears similar to CPAP in reducing the rates of ETI and mortality in patients with AHRF due to ACPO. Further research on other non-COPD conditions which commonly cause AHRF such as obesity hypoventilation syndrome is needed.

High flow nasal cannula versus noninvasive ventilation in the treatment of acute hypercapnic respiratory failure: A systematic review and meta‐analysis

“…Hypercapnia secondary to COPD is well represented within the included literature, featuring in all ( n = 7) of the included studies. Faqihi et al 43 note the scarcity of literature regarding NIV intervention in AHRF outside of COPD and cardiogenic pulmonary oedema, particularly in relation to common conditions such as obesity hypoventilation syndrome. Golmohamad et al 44 also make recommendations against the use of HFNC in the management of patients with obesity hypoventilation syndrome/sleep disordered breathing, owing to the lack of research in the area and the incidence of treatment failure in this patient subgroup within their observational study.…”

Participation of ASK-1 in the cardiomyocyte-protective role of mechanical ventilation in a rat model of myocardial infarction

“…3,5 Corresponding clinical results indicated that the hypoxemia of patients with pulmonary edema and acute MI was evidently alleviated through BiPAP treatment; further, the success rate of rescuing left HF was significantly improved. 6…”

“…3,5 Corresponding clinical results indicated that the hypoxemia of patients with pulmonary edema and acute MI was evidently alleviated through BiPAP treatment; further, the success rate of rescuing left HF was significantly improved. 6 Cardiac hypertrophy and fibrosis can serve as adaptive, compensatory, or maladaptive precursors of cardiac failure. Accumulating evidence has confirmed that ROS signaling is associated with the initiation of cardiac hypertrophy.…”

Dexmedetomidine: A Means to an End or Just Delaying the Inevitable?

“…4,5 In patients with hypercapnia without COPD, NIV reduces the need for intubation compared to standard oxygen therapy, with similar efficacy between BPAP and CPAP. 6 The evidence supporting the use of NIV…”