Moran F, Bradley J M, Jones A P, Piper A J
University of Ulster, Room 14J07, School of Health Sciences, Shore Road, Newtownabbey, Northern Ireland, UK, BT37 0QB.
Cochrane Database Syst Rev. 2007 Oct 17(4):CD002769. doi: 10.1002/14651858.CD002769.pub2.
Non-invasive ventilation (NIV) may be a means to temporarily reverse or slow the progression of 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 comprising references identified from comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. We searched the reference lists of each trial for additional publications possibly containing other trials. Most recent search: October 2006.
Randomised controlled trials comparing a form of pressure preset or volume preset NIV to no NIV in people with acute or chronic respiratory failure in CF.
Three reviewers independently assessed trials for inclusion criteria and methodological quality, and extracted data.
Fifteen trials were identified; seven trials met the inclusion criteria with a total of 106 participants. Six trials evaluated single treatment sessions only and one evaluated a six-week intervention. Four trials (79 participants) evaluated NIV for airway clearance compared with an alternative chest physiotherapy method and showed that airway clearance may be easier with NIV and people with CF may prefer it. We were unable to find any evidence that NIV increases sputum expectoration, but it did improve some lung function parameters.Three trials (27 participants) evaluated NIV for overnight ventilatory support. Lung function and nocturnal transcutaneous carbon dioxide were evaluated within two trials. Due to the small numbers of participants and statistical issues, there were discrepancies in the results between the RevMan and the original trial analyses. No clear differences were found between NIV compared with oxygen or room air except for exercise performance, which significantly improved with NIV compared to room air over six weeks.
AUTHORS' 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 largely been demonstrated in single treatment sessions with small numbers of participants. The impact of this therapy on pulmonary exacerbations and disease progression remain unclear. There is a need for long-term randomised controlled trials which are adequately powered to determine the clinical effects of non-invasive ventilation in CF airway clearance and exercise.
无创通气（NIV）可能是暂时逆转或减缓囊性纤维化（CF）患者呼吸衰竭进展的一种手段。
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，其中包括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集确定的参考文献。我们还检索了每项试验的参考文献列表，以查找可能包含其他试验的额外出版物。最近一次检索时间为2006年10月。
比较压力预设或容量预设形式的NIV与不使用NIV对CF急性或慢性呼吸衰竭患者影响的随机对照试验。
三位评审员独立评估试验是否符合纳入标准和方法学质量，并提取数据。
共识别出15项试验；7项试验符合纳入标准，共有106名参与者。6项试验仅评估单次治疗，1项试验评估为期六周的干预。4项试验（79名参与者）比较了NIV与另一种胸部物理治疗方法用于气道清理的效果，结果表明使用NIV进行气道清理可能更容易，CF患者可能更喜欢。我们未找到任何证据表明NIV能增加痰液咳出，但它确实改善了一些肺功能参数。3项试验（27名参与者）评估了NIV用于夜间通气支持的效果。两项试验中评估了肺功能和夜间经皮二氧化碳水平。由于参与者数量少以及统计问题，RevMan分析与原始试验分析结果存在差异。与氧气或室内空气相比，NIV除了运动表现外未发现明显差异，与室内空气相比，NIV在六周内显著改善了运动表现。
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，无创通气与氧气联合使用时，在睡眠期间改善气体交换的程度可能比单纯氧气治疗更大。NIV的这些益处大多在参与者数量少的单次治疗中得到证实。这种疗法对肺部加重和疾病进展的影响仍不清楚。需要进行长期随机对照试验，并有足够的样本量来确定无创通气在CF气道清理和运动方面的临床效果。
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