Home noninvasive positive pressure ventilation with built-in software in stable hypercapnic COPD: a short-term prospective, multicenter, randomized, controlled trial

Zhou, Luqian; Li, Xiaoying; Guan, Lili; Chen, Jianhua; Guo, Bingpeng; Wu, Weiliang; Huo, Yating; Zhou, Ziqing; Liang, Zhenyu; Zhou, Yuqi; Tan, Jie; Chen, Xin; Song, Yuanlin; Chen, Rongchang

doi:10.2147/copd.s127540

Cited by 31 publications

(35 citation statements)

References 27 publications

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“…Furthermore, there may be substantial additional cost to patients to upgrade to a machine equipped with these newer ventilatory modes if a patient is already using an older ventilator; however, for patients starting with new devices the costs may be similar. All but one RCT [61] excluded subjects with comorbidities such as malignancy, severe heart failure, obstructive sleep apnoea syndrome (OSAS), obesity and unstable angina [31,36,38,44,48,60,62,63]. As a result, the studied population was very homogenous, comprising patients purely with COPD: so-called "respiratory COPD" [84].…”

Section: Justificationmentioning

confidence: 99%

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

et al. 2019

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BackgroundWhile the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.Materials and methodsThe European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients.ResultsThe task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.ConclusionsManaging hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.

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Section: Justificationmentioning

confidence: 99%

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

et al. 2019

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“…In this pilot study, we investigated 34 patients recruited in a prior, prospective, multicentre, randomized, controlled trial 24 , using high-pressure (IPAP ≥ 20 cm H 2 O 9 ) or low-pressure ventilation (IPAP ≤ 16 cm H 2 O 11 ) for 3 months. Patients were clinically stable with chronic hypercapnic COPD with severe to very severe airflow limitation.…”

Section: Methodsmentioning

confidence: 99%

High-pressure versus low-pressure home non-invasive positive pressure ventilation with built-in software in patients with stable hypercapnic COPD: a pilot study

Zhou

Guan

et al. 2017

Sci Rep

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High-pressure non-invasive positive pressure ventilation (NPPV) is a new strategy targeted at maximally reducing arterial carbon dioxide. However, high inspiratory positive airway pressure (IPAP) might cause respiratory adverse events likely to diminish the benefit of NPPV. In the setting of ventilatory support, monitoring NPPV efficacy and resolving problems promptly are critical. This study assessed the treatment effect of high and low-pressure NPPV in chronic hypercapnic COPD using home ventilator with built-in software. In this pilot study, we investigated 34 patients using NPPV for 3 months. 13 patients used high-pressure ventilation and 21 patients used low-pressure ventilation. The primary outcome was daytime partial pressure of arterial blood carbon dioxide (PaCO2). There were no between-group differences in daytime PaCO2 and FEV1, but a trend favouring high-pressure NPPV was observed. Significant between-group differences were found in the transition dyspnoea index (TDI) (high-pressure, 1.69 ± 1.75, versus low-pressure, −0.04 ± 2.71, p = 0.044). No differences were found in usage time, leakage, health-related quality of life, spirometry, or 6-minute walk test. High-pressure NPPV with built-in software monitoring in patients with chronic hypercapnic COPD is associated with improvement in TDI scores and a positive trend in favour of high-pressure NPPV for improving PaCO2 is observed.

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“…A multicentre randomised controlled trial from China comparing patients receiving LTOT with domiciliary NIV + LTOT. Although there was a significant reduction in daytime PaCO 2 and increase in 6MWD with domiciliary NIV + LTOT, there was no mortality benefit, improvement in lung function or QoL (35).…”

Section: Niv In Chronic Hypercapnic Respiratory Failurementioning

confidence: 81%

Update: non-invasive ventilation in chronic obstructive pulmonary disease

Shah¹,

D’Cruz²,

Murphy³

2018

J. Thorac. Dis.

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Chronic obstructive pulmonary disease (COPD) remains a common cause of morbidity and mortality worldwide. Patients with COPD and respiratory failure, whether acute or chronic have a poorer prognosis than patients without respiratory failure. Non-invasive ventilation (NIV) has been shown to be a useful tool in both the acute hospital and chronic home care setting. NIV has been well established as the gold standard therapy for acute decompensated respiratory failure complicating an acute exacerbation of COPD with reduced mortality and intubation rates compared to standard therapy. However, NIV has been increasingly used in other clinical situations such as for weaning from invasive ventilation and to palliate symptoms in patients not suitable for invasive ventilation. The equivocal evidence for the use of NIV in chronic hypercapnic respiratory failure complicating COPD has recently been challenged with data now supporting a role for therapy in selected subgroups of patients. Finally the review will discuss the emerging role of high flow humidified therapy to support or replace NIV in certain clinical situation.

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Home noninvasive positive pressure ventilation with built-in software in stable hypercapnic COPD: a short-term prospective, multicenter, randomized, controlled trial

Cited by 31 publications

References 27 publications

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD

High-pressure versus low-pressure home non-invasive positive pressure ventilation with built-in software in patients with stable hypercapnic COPD: a pilot study

Update: non-invasive ventilation in chronic obstructive pulmonary disease

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