Moran F, Bradley J
School of Rehabilitation Sciences, University of Ulster, Shore Road, Newtownabbey, Northern Ireland, UK, BT37 0QB.
Cochrane Database Syst Rev. 2003(2):CD002769. doi: 10.1002/14651858.CD002769.
The use of non-invasive ventilation (NIV) has been proposed as a means to temporarily reverse or slow the progression of worsening respiratory failure in cystic fibrosis (CF).
To compare the effect of NIV versus no NIV in people with CF.
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group trials register which comprises references identified from comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. The reference lists of each trial were searched for additional publications that may contain other trials. Date of most recent search: January 2002.
Relevant randomised controlled trials in which a form of pressure preset or volume preset NIV versus no NIV was used in people with acute or chronic respiratory failure in CF.
Two reviewers independently assessed trials for inclusion criteria, methodological quality and data extraction.
Six trials were identified and four trials met the inclusion criteria with a total of 55 participants. All of these trials only evaluated single treatment sessions. Two trials (36 participants) evaluated the use of NIV for airway clearance compared with an alternative physiotherapy method. These trials showed that airway clearance may be easier and people with CF may prefer to use NIV for airway clearance. There was no evidence that NIV increases sputum expectoration or improves lung function. Two trials (19 participants) evaluated the use of NIV for overnight ventilatory support. Of the primary outcomes examined in this review, only lung function was evaluated within the two trials. Due to the small numbers of participants and the differing statistical techniques used within the review and the primary trials, there were discrepancies in the results obtained by the RevMan analysis and the original trial analysis. No clear differences were found between NIV compared with either oxygen or room air.
REVIEWER'S CONCLUSIONS: Non-invasive ventilation may be a useful adjunct to other airway clearance techniques, particularly in people with CF who have difficulty expectorating sputum. Non-invasive ventilation when used in addition to oxygen may improve gas exchange during sleep to a greater extent than oxygen therapy alone in moderate to severe disease. These benefits of NIV have only been demonstrated in single treatment sessions and its efficacy, safety and acceptability in the longer term are unknown. There is a need for long-term randomised controlled trials to determine the clinical effects of non-invasive ventilation in CF.
无创通气（NIV）已被提议作为一种手段，用于暂时逆转或减缓囊性纤维化（CF）患者呼吸衰竭的恶化进程。
比较NIV与不使用NIV对CF患者的影响。
我们检索了Cochrane囊性纤维化和遗传疾病小组试验注册库，该注册库包含通过全面电子数据库检索、手工检索相关期刊以及会议论文摘要书籍所识别的参考文献。对每项试验的参考文献列表进行检索，以查找可能包含其他试验的额外出版物。最近一次检索日期：2002年1月。
相关随机对照试验，其中在CF急性或慢性呼吸衰竭患者中使用了某种形式的压力预设或容量预设NIV与不使用NIV进行对比。
两名评价员独立评估试验的纳入标准、方法学质量和数据提取情况。
共识别出6项试验，4项试验符合纳入标准，共有55名参与者。所有这些试验仅评估了单次治疗疗程。两项试验（36名参与者）评估了NIV用于气道清理与另一种物理治疗方法相比的效果。这些试验表明，气道清理可能更容易，CF患者可能更喜欢使用NIV进行气道清理。没有证据表明NIV能增加痰液咳出或改善肺功能。两项试验（19名参与者）评估了NIV用于夜间通气支持的效果。在本综述中所检查的主要结局中，两项试验仅评估了肺功能。由于参与者数量较少，且综述和原始试验中使用的统计技术不同，RevMan分析和原始试验分析所得结果存在差异。与吸氧或室内空气相比，未发现NIV有明显差异。
无创通气可能是其他气道清理技术的有用辅助手段，特别是对于咳痰困难的CF患者。在中度至重度疾病中，除吸氧外使用无创通气可能比单纯吸氧在睡眠期间能更大程度地改善气体交换。NIV的这些益处仅在单次治疗疗程中得到证实，其长期疗效、安全性和可接受性尚不清楚。需要进行长期随机对照试验来确定无创通气在CF中的临床效果。
