Effect of Home Non-Invasive Ventilation in Moderate-To-Severe COPD with Hypercapnia: A Meta-Analysis of Randomized Controlled Trials

Banifadel, Momen; Zayed, Yazan; Awad, Mohammed; Yelangi, Anitha; Ghanim, Marcel; Srour, Khaled

doi:10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a2448

Cited by 1 publication

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, we included 1482 patients in 19 RCTs, while other studies included between six and nine RCTs. 19 , 21 , 22 Second, we found that LTHNIPPV could reduce mortality, while previous meta-analysis found that NIPPV reduced PaCO2 but did not significantly reduce mortality in patients with stable hypercapnic COPD. The most recent meta-analysis study, which combined RCTs and observational studies, found that LTHNIPPV reduced all-cause mortality compared to control treatment for patients with stable hypercapnic COPD, but when evidence was limited to data from RCTs, the results were not statistically significant.…”

Section: Discussionmentioning

confidence: 63%

“…Previous meta-analysis studies combined these RCTs and showed that LTHNIPPV reduced PaCO2 but did not decrease all-cause mortality or improve PaO2 compared to control treatment for patients with stable hypercapnic COPD. 19–22 The most recent meta-analysis study combined RCTs and observational studies and found that LTHNIPPV reduced all-cause mortality compared to control treatment for patients with stable hypercapnic COPD. 23 However, it remains unclear whether baseline level and reduction in PaCO2 are associated with the treatment effect of NIPPV on reducing mortality.…”

Section: Introductionmentioning

confidence: 99%

“…The analysis had no language restrictions and included more RCTs than previous meta-analysis studies. 19–23 The main outcome was all-cause mortality, and the secondary outcomes included frequency of hospital admissions, gas exchange, FEV1% pred, 6-min walk distance (6MWD), dyspnea, and health-related quality of life (HRQL). Subgroup analysis based on the baseline level of PaCO2 and the degree of dPaCO2 was performed to establish whether the baseline level of PaCO2 and reduction in PaCO2 were associated with treatment effect of LTHNIPPV in patients with stable hypercapnic COPD.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Baseline Level and Reduction in PaCO2 are Associated with the Treatment Effect of Long-Term Home Noninvasive Positive Pressure Ventilation in Stable Hypercapnic Patients with COPD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Wu¹,

Luo²,

Luo³

et al. 2022

COPD

View full text Add to dashboard Cite

Purpose The evidence of long-term home noninvasive positive pressure ventilation (LTHNIPPV) in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD) is controversial. In this meta-analysis study, we sought to establish whether a baseline level and reduction in partial pressure of arterial carbon dioxide (PaCO2) were associated with the treatment effect of LTHNIPPV in these patients. Patients and Methods Six electronic databases were comprehensively searched from January 1980 until June 2020. Randomized clinical trials (RCTs) comparing LTHNIPPV with control treatment were included. Two authors independently extracted data, assessed the study quality, and used the GRADE approach to evaluate evidence quality. The main outcome was mortality. Results Nineteen studies involving 1482 patients (LTHNIPPV, n = 730; control, n = 752) were included. LTHNIPPV significantly reduced mortality (relative risk [RR] = 0.76; 95% confidence interval [CI]: 0.61–0.95; p = 0.02; I 2 = 14%), the frequency of hospital admissions, PaCO2, and improved partial pressure of oxygen (PaO2) compared to control treatment. LTHNIPPV also relieved dyspnea and improved exercise capacity and health-related quality of life (HRQL) but showed no significant benefit for improving the forced expiratory volume in one second in predicted (FEV1% pred). Subgroup analysis revealed that the baseline level and reduction in PaCO2 were associated with decreased mortality (baseline PaCO2 ≥ 55 mmHg RR = 0.69, P = 0.02; vs baseline PaCO2 < 55 mmHg RR = 0.87, P = 0.32; and higher dPaCO2 RR = 0.42, P < 0.0001; vs lower dPaCO2 RR = 0.91, P = 0.38). Conclusion LTHNIPPV significantly reduced mortality. The baseline level and reduction in PaCO2 were associated with the treatment effect of LTHNIPPV in patients with stable hypercapnic COPD. Large-scale, multicenter RCTs are needed to confirm our results.

show abstract

Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation