Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease

Abstract

Background Non-invasive positive pressure ventilation (NIPPV) is effective in treating acute exacerbations of chronic obstructive pulmonary disease (COPD). Nocturnal non-invasive positive pressure ventilation (nocturnal-NIPPV) has been proposed as an intervention for stable hypercapnic patients with COPD. Objectives To assess the effects of nocturnal-NIPPV at home via nasal mask or face mask in people with COPD by using a meta-analysis based on individual patient data (IPD). Search methods We searched the Cochrane Airways Group Specialised Register. We performed the latest search in August 2012. Selection criteria Randomised controlled trials in people with stable COPD that compared nocturnal-NIPPV at home for at least five hours per night, for at least three consecutive weeks plus standard therapy with standard therapy alone. Data collection and analysis IPD were collected and two review authors assessed risk of bias independently. Main results This update of the systematic review on nocturnal-NIPPV in COPD (Wijkstra 2002), has led to the inclusion of three new studies, leading to seven included studies on 245 people. We obtained IPD for all participants in all included studies. The 95% confidence interval (CI) of all outcomes included zero. These included partial pressure of CO 2 and O 2 in arterial blood, six-minute walking distance (6MWD), health-related quality of life (HRQoL), forced expiratory volume in one second (FEV 1), forced vital capacity (FVC), maximal inspiratory pressure (PImax) and sleep efficiency. The mean effect on 6MWD was small at 27.7 m and not statistically significant. Given the width of the 95% CI (-28.1 to 66.3 m), the real effect of NIPPV on 6MWD is uncertain and we cannot exclude an effect that is clinically significant (considering that the minimal clinically difference on 6MWD is around 26 m). 1 Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease (Review)

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

“…A recent Cochrane review 110,124 has incorporated IPD analyses but based on a smaller group of studies and without considering hospitalisations or survival. The Cochrane analysis was not aimed at identifying potential effect modifiers.…”

“…110,[114][115][116][117][118][119][120] 114 The recent guidelines 120 are also not considered further, as their findings are based on systematic reviews discussed here. However, all the reviews had reasonably similar aims to the current review with, in most cases, a focus more on the physiological outcomes and less on those outcomes that might more readily populate an economic model to determine cost-effectiveness from a health-service provision perspective.…”

“…The Cochrane review 110,124 was fairly robustly conducted and it had narrow inclusion criteria relative to the current review in that NIV use was required to be used for a minimum of 5 hours per night (for at least 3 weeks). Seven RCTs were included; of note is that a further seven RCTs were included in the current report and, although these may not have met the narrower inclusion criteria of the Cochrane review, they were not listed in the 'excluded studies' section of the Cochrane review.…”

Nocturnal Ventilator Support in COPD

“…This metaanalysis showed that 3 months of NIPPV in patients with stable COPD did not improve lung function, gas exchange, sleep efficiency, or 6-minute walking distance. [11,12] Casanova and colleagues studied the effects of longterm NIPPV (a duration of 12 months) to either NIPPV plus standard care or to standard care alone. The number of hospital admissions was lower after 3 months (5% vs 15%).…”

Approach of pulmonologists in Turkey to noninvasive mechanical ventilation use at home for chronic respiratory failure

“…Restrictive thoracic disorders (RTD) (including thoracic cage deformities and neuromuscular disorders (NMD)), obesity hypoventilation syndrome (OHS) and stable chronic obstructive pulmonary disease (COPD) with severe hypercapnia and nocturnal desaturation can be listed as the appropriate indications for domiciliary NIV use. NIV has been shown to decrease somnolence, fatigue and dyspnea with improved quality of life and survival in selected patients with these disorders (especially for amyotrophic lateral sclerosis (ALS), RTD, OHS) 6; whereas its role in stable COPD still remains controversial (6)(7)(8).…”