Intervention Review

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

  1. Fransien M Struik1,
  2. Yves Lacasse2,
  3. Roger Goldstein3,
  4. Huib M Kerstjens1,
  5. Peter J Wijkstra1,*

Editorial Group: Cochrane Airways Group

Published Online: 13 JUN 2013

Assessed as up-to-date: 1 AUG 2012

DOI: 10.1002/14651858.CD002878.pub2

How to Cite

Struik FM, Lacasse Y, Goldstein R, Kerstjens HM, Wijkstra PJ. Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD002878. DOI: 10.1002/14651858.CD002878.pub2.

Author Information

  1. 1

    University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, Netherlands

  2. 2

    Institut Universitaire de Cardiologie et de Pneumologie de Québec, Hôpital Laval, Québec, Quebec, Canada

  3. 3

    West Park Healthcare Centre, University of Toronto, Division of Respiratory Medicine, Toronto, Ontario, Canada

*Peter J Wijkstra, Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, AA11, PO Box 30.001, 9700 RB, Groningen, Netherlands. p.j.wijkstra@umcg.nl.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 13 JUN 2013

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé
  5. Résumé simplifié
  6. 摘要

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 CO2 and O2 in arterial blood, six-minute walking distance (6MWD), health-related quality of life (HRQoL), forced expiratory volume in one second (FEV1), 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).

Authors' conclusions

Nocturnal-NIPPV at home for at least three months in hypercapnic patients with stable COPD had no consistent clinically or statistically significant effect on gas exchange, exercise tolerance, HRQoL, lung function, respiratory muscle strength or sleep efficiency. Meta-analysis of the two new long-term studies did not show significant improvements in blood gases, HRQoL or lung function after 12 months of NIPPV. However, the small sample sizes of these studies preclude a definite conclusion regarding the effects of NIPPV in COPD.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé
  5. Résumé simplifié
  6. 摘要

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

Background: Non-invasive positive pressure ventilation (NIPPV) is a method to assist or replace spontaneous breathing (or normal breathing) with the aid of a machine called a ventilator. A mask is fitted over the nose or mouth, or both and air is pushed into the lungs. It can be used as a short-term measure, during critical instances in the hospital, but also at home for longer periods in people who have raised levels of carbon dioxide in their blood. We wanted to discover whether using NIPPV at home during the night alongside standard therapy was better or worse than standard therapy alone in people with chronic obstructive pulmonary disease (COPD). COPD is a progressive disease that makes it hard to breathe. In 2002, we published our original Cochrane review looking at this. It is important to check if new studies have been published that could be added to the existing studies in the review. In this review, we performed a new search and found new studies and, therefore, this is an update of the review published in 2002.

What is individual patient data? In this review we used individual patient data. This means we collected original research data for each participant from the original researchers who performed the studies. We used this information to perform our calculations.

Review question: What is the effect of NIPPV in people with COPD on blood gases, six-minute walking distance, health-related quality of life, lung function, respiratory muscle function and sleep efficiency.

Study characteristics: The evidence is current to August 2012. We found seven studies that reported the effects of NIPPV at home. Five of these studies looked at the effects after using NIPPV compared to regular treatment (without NIPPV) for at least three months. Two studies looked for a longer period of time, for at least 12 months. The mean age of all participants included in our meta-analysis was 67 years. All studies included men and women, but 77% of participants were men. We used data from 245 people for our meta-analysis.

Results: NIPPV during the night for 3 and 12 months in people with COPD who had raised levels of carbon dioxide had no clinically or statistically significant effect on gas exchange, six-minute walking distance, health-related quality of life, lung function, respiratory muscle strength and sleep efficiency. This means we found little or no difference in the outcomes.

Quality of the results: Because some trials had very small numbers of participants, our confidence in the quality of evidence is moderate when looking at the effects on gas exchange. All seven trials measured this outcome. Other outcomes were not always measured or available leading to a lower quality of evidence for the other outcomes such as six-minute walking distance, health-related quality of life, lung function, respiratory muscle function and sleep efficiency.

 

Résumé

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé
  5. Résumé simplifié
  6. 摘要

Ventilation en pression positive nocturne non invasive pour le traitement de la bronchopneumopathie chronique obstructive stable

Contexte

La ventilation en pression positive non invasive (VPPNI) nocturne peut apporter des bénéfices aux patients hypercapniques stables atteints de bronchopneumopathie chronique obstructive (BPCO). Les preuves sont cependant équivoques car les résultats publiés sont contradictoires.

Objectifs

Déterminer les effets de la ventilation en pression positive non invasive nocturne administrée par masque nasal ou facial chez les patients atteints de BPCO.

Stratégie de recherche documentaire

Nous avons effectué une recherche initiale dans le registre des essais sur la BPCO du groupe Cochrane sur les voies respiratoires en utilisant les termes de recherche suivants : (ventilat* nasale OU pression positive OU VPPNI). Nous avons également effectué une recherche manuelle dans les actes de conférence de l'American Thoracic Society, la British Thoracic Society et la European Respiratory Society.

Critères de sélection

Les essais contrôlés randomisés portant sur des patients stables atteints de BPCO et comparant une ventilation en pression positive non invasive nocturne + traitement standard au traitement standard seul.

Recueil et analyse des données

Deux évaluateurs ont extrait les données de manière indépendante.

Résultats Principaux

Le seul critère de jugement pour lequel l'intervalle de confiance à 95 % excluait la valeur zéro était la pression inspiratoire maximale (PiMax). L'intervalle de confiance (IC) à 95 % pour les autres critères de jugement incluait la valeur zéro. Ces critères incluaient le volume expiratoire maximal en une seconde (VEMS), la capacité vitale forcée (CVF), la pression partielle artérielle en CO2 (PaCO2), l'efficacité du sommeil et le test de marche pendant 6 minutes (6MWT). L'effet moyen sur le 6MWD était modeste (27,5 m), mais les IC à 95 % étaient larges (-28,1 à 81,8 m), ce qui suggérait une amélioration importante chez certains patients. Ces patients ne pouvaient pas être identifiés a priori.

Conclusions des auteurs

La VPPNI nocturne pendant au moins trois mois chez les patients hypercapniques présentant une BPCO stable n'avait pas d'effet cliniquement ou statistiquement significatif constant sur la fonction pulmonaire, l'échange gazeux, la force musculaire respiratoire, l'efficacité du sommeil ou la tolérance à l'exercice. Néanmoins, les effectifs réduits de ces études ne permettaient pas de tirer de conclusions définitives concernant les effets de la VPPNI dans la BPCO.

 

Résumé simplifié

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé
  5. Résumé simplifié
  6. 摘要

Ventilation en pression positive nocturne non invasive pour le traitement de la bronchopneumopathie chronique obstructive stable

Ventilation en pression positive nocturne non invasive pour le traitement de la bronchopneumopathie chronique obstructive stable

Cette revue évaluait les bénéfices de la VPPNI (ventilation en pression positive non invasive) nocturne chez les patients atteints de BPCO en termes de fonction pulmonaire, gaz du sang, test de marche pendant 6 minutes (6MWD), dyspnée (pendant les activités quotidiennes), état de santé (mesures de la qualité de vie liée à la santé), efficacité du sommeil et fonction musculaire respiratoire.

La VPPNI nocturne pendant au moins trois mois chez des patients atteints de BPCO présentant des niveaux de gaz carbonique élevés n'avait pas d'effet cliniquement ou statistiquement significatif sur la fonction pulmonaire, l'échange gazeux, la force musculaire respiratoire ou l'efficacité du sommeil. La limite supérieure de l'intervalle de confiance pour le 6MWD suggérait que certains patients pouvaient améliorer leur distance de marche. Néanmoins, l'effectif globalement réduit ne permettait pas de tirer de conclusions définitives concernant les effets de la VPPNI dans la BPCO.

Notes de traduction

Traduit par: French Cochrane Centre 1st October, 2012
Traduction financée par: Ministère du Travail, de l'Emploi et de la Santé Français

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé
  5. Résumé simplifié
  6. 摘要

背景

穩定型慢性阻塞性肺病患者使用夜間非侵入性正壓通氣

夜間非侵入性正壓通氣(NIPPV) 可能對穩定的慢性阻塞性肺病併高碳酸血症(hypercapnic)患者有益。然而,目前發表的結果仍所爭議,因此相關證據還未確立。

目標

確定對慢性阻塞性肺病患者經由鼻罩或面罩給予夜間非侵入性正壓通氣的效果。

搜尋策略

由Cochrane Airways Group COPD trials register開始搜尋,使用的搜尋字彙是:nasal ventilat* OR positive pressure OR NIPPV。同時以人工搜尋美國、英國胸腔學會和歐洲呼吸學會的會議摘要。

選擇標準

針對穩定的慢性阻塞性肺病患者,比較標準治療外有、無併用夜間非侵入性正壓通氣的隨機對照試驗。

資料收集與分析

兩位審查員各自進行數據擷取。

主要結論

唯一一個其95%信賴區間(CI)不包括0的結果為最大吸氣壓(PI max)。其他結果的95%信賴區間都包含0。如,第1秒用力吐氣量(FEV1)、用力肺活量(FVC)、動脈血中二氧化碳分壓(PaCO2)、睡眠效益、和6分鐘行走距離(6MWD)等。6分鐘行走距離的平均作用粗略估計為27.5公尺,但其95%信賴區間範圍很大(28.1到81.8公尺),表示有些病患有明顯的進步,但無法分辨是哪些病患。

作者結論

對穩定慢性阻塞性肺病併高碳酸血症的患者,使用夜間非侵入性正壓通氣至少三個月,在肺功能、氣體交換、呼吸肌強度、睡眠效率或運動耐力等各方面的效果,無論在臨床上或統計學上都沒有一致的意義。然而,因為這些研究的樣本數太小,無法針對NIPPV對慢性阻塞性肺病的作用做出確定性的結論。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

經由鼻罩或全面罩夜間通氣,並沒有證據顯示可以改善慢性阻塞性肺病患者的結果,但還需要有更多的研究。本回顧評估夜間非侵入性正壓通氣對慢性阻塞性肺病患者的效益,包括肺功能、血液氣體、6分鐘行走距離、呼吸困難(日間活動時)、健康狀況(健康相關的生活品質測量值)、睡眠效益和呼吸肌功能等。對慢性阻塞性肺病併高碳酸血症的患者,使用夜間非侵入性正壓通氣至少三個月,在肺功能、氣體交換、呼吸肌強度或睡眠效率各方面,都沒有臨床上或統計學上有意義的影響。6分鐘行走距離的信賴區間上限值高,表示某些病人可以改善其行走距離。然而,整體樣本數規模太小,因此無法針對NIPPV對慢性阻塞性肺病的作用做出明確的結論。