Moran Fidelma, Bradley Judy M, Piper Amanda J
Health and Rehabilitation Sciences Research Institute and School of Health Sciences, University of Ulster, Newtownabbey, UK.
Cochrane Database Syst Rev. 2013 Apr 30(4):CD002769. doi: 10.1002/14651858.CD002769.pub4.
Non-invasive ventilation may be a means to temporarily reverse or slow the progression of respiratory failure in cystic fibrosis.
To compare the effect of non-invasive ventilation versus no non-invasive ventilation in people with cystic fibrosis.
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: 22 February 2013.
Randomised controlled trials comparing a form of pressure preset or volume preset non-invasive ventilation to no non-invasive ventilation in people with acute or chronic respiratory failure in cystic fibrosis.
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 and one evaluated a six-week intervention.Four trials (79 participants) evaluated non-invasive ventilation for airway clearance compared with an alternative chest physiotherapy method and showed that airway clearance may be easier with non-invasive ventilation and people with cystic fibrosis 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 non-invasive ventilation for overnight ventilatory support, measuring lung function, validated quality of life scores and nocturnal transcutaneous carbon dioxide. 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 non-invasive ventilation compared with oxygen or room air except for exercise performance, which significantly improved with non-invasive ventilation 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 cystic fibrosis who have difficulty expectorating sputum. Non-invasive ventilation, 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 non-invasive ventilation 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 cystic fibrosis airway clearance and exercise.
无创通气可能是暂时逆转或减缓囊性纤维化患者呼吸衰竭进展的一种手段。
比较无创通气与未进行无创通气对囊性纤维化患者的影响。
我们检索了Cochrane囊性纤维化和遗传疾病研究组试验注册库，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2013年2月22日。
比较压力预设或容量预设形式的无创通气与未进行无创通气对囊性纤维化急性或慢性呼吸衰竭患者影响的随机对照试验。
三位评价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项试验评估了单次治疗疗程，1项试验评估了为期六周的干预措施。4项试验（79名参与者）比较了无创通气与另一种胸部物理治疗方法用于气道廓清的效果，结果显示无创通气可能使气道廓清更容易，囊性纤维化患者可能更倾向于选择无创通气。我们未找到任何证据表明无创通气能增加痰液咳出，但它确实改善了一些肺功能参数。3项试验（27名参与者）评估了无创通气用于夜间通气支持的效果，测量了肺功能、验证的生活质量评分以及夜间经皮二氧化碳水平。由于参与者数量较少以及统计问题，RevMan分析与原始试验分析的结果存在差异。与氧气或室内空气相比未发现明显差异，但在为期六周的时间里，与室内空气相比，无创通气显著改善了运动能力。
无创通气可能是其他气道廓清技术的有用辅助手段，尤其对于咳痰困难 的囊性纤维化患者。在中重度疾病中，除氧气治疗外使用无创通气可能比单纯氧气治疗在睡眠期间能更大程度地改善气体交换。无创通气的这些益处主要在参与者数量较少的单次治疗疗程中得到了证实。这种治疗方法对肺部加重和疾病进展的影响仍不明确。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囊性纤维化气道廓清和运动方面的临床效果。
