Chest
Volume 124, Issue 1, July 2003, Pages 337-343
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A Meta-analysis of Nocturnal Noninvasive Positive Pressure Ventilation in Patients With Stable COPD

https://doi.org/10.1378/chest.124.1.337Get rights and content

Study objectives

The potential benefits of noninvasive positive pressure ventilation (NIPPV) for patients with COPD remains inconclusive, as most studies have included only a small number of patients. We therefore undertook a meta-analysis of randomized controlled trials (RCTs) that compared nocturnal NIPPV with conventional management in patients with COPD and stable respiratory failure.

Design

RCTs were identified from several sources, such as MEDLINE, EMBASE, and CINAHL. In addition, records were identified through hand searching of abstracts from meetings of the American Thoracic Society, the American College of Chest Physicians, and the European Respiratory Society.

Patients

Patients with COPD according to the definition of the American Thoracic Society.

Interventions

NIPPV applied via a nasal or facemask for at least 5 h/d for at least 3 weeks. Patients in the actively treated group continued to receive the usual management for COPD. The control group received the same management as the study group but did not receive NIPPV.

Measurements and results

Paco2, Pao2, 6-min walking distance (6MWD), respiratory muscle function, FEV1, vital capacity, and sleep efficiency (time asleep as a percentage of total time in bed) were used as outcome measures. The publications were reduced to 10 potentially eligible articles from 164 publications retrieved from computer searches and 8 further abstracts. Four trials were finally included in the meta-analysis. The only outcome for which the confidence intervals excluded zero was maximal inspiratory pressure (Pimax). The confidence intervals for the other outcomes included zero. The mean treatment effects for FEV1 and Pimax were small, whereas it was moderate for the 6MWD. Small negative effects were found for the outcomes of vital capacity, Paco2, and sleep efficiency.

Conclusions

This meta-analysis of 3 months of NIPPV in patients with stable COPD showed that ventilatory support did not improve lung function, gas exchange, or sleep efficiency. The high upper limit of the confidence interval for the 6MWD suggested that some people do improve their walking distance. The small overall sample size precluded a clear clinical direction regarding the effects of NIPPV in patients with COPD.

Section snippets

Search Strategy

RCTs were identified from several sources. Through the Cochrane Airways group registry, we searched for RCTs in MEDLINE, EMBASE, and CINAHL in all languages. The following terms were used to identify trials related to NIPPV: nasal ventilation or positive pressure or NIPPV. The bibliographies of all relevant articles were hand searched for additional articles that may contain RCTs. In addition, records were identified through hand searching of abstracts from meetings of the American Thoracic

Results

The publications were reduced to 10 potentially eligible articles from 164 publications retrieved from computer searches and 8 further abstracts identified. Four trials were excluded for the following reasons: the study was not randomized23 and the duration of bilevel pressure ventilation was too short (< 5 h per night),2425 and the training period of bilevel pressure ventilation was too short (< 3 weeks).26 Two publications (abstracts) pertained to long-term European multicenter studies of

Discussion

This meta-analysis showed that nocturnal NIPPV for 3 months in hypercapnic patients with COPD did not have clinically or statistically significant effects on lung function, gas exchange, or sleep efficiency. The small sample size precludes a definitive statement regarding the clinical implications of NIPPV, other than stating that at present there is insufficient evidence from short-term trials to support its widespread use. The small positive treatment effects for Pimax and Pemax are unlikely

ACKNOWLEDGMENT

We thank Carol C. Carlisle (Rhode Island Hospital, Providence, RI) for helping us with the data from their study,14 which was included in this meta-analysis.

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