Struik Fransien M, Lacasse Yves, Goldstein Roger, Kerstjens Huib M, Wijkstra Peter J
Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen,Netherlands.
Cochrane Database Syst Rev. 2013 Jun 13;2013(6):CD002878. doi: 10.1002/14651858.CD002878.pub2.
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.
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).
We searched the Cochrane Airways Group Specialised Register. We performed the latest search in August 2012.
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.
IPD were collected and two review authors assessed risk of bias independently.
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.
无创正压通气（NIPPV）在治疗慢性阻塞性肺疾病（COPD）急性加重期有效。夜间无创正压通气（夜间NIPPV）已被提议作为稳定期高碳酸血症COPD患者的一种干预措施。
通过基于个体患者数据（IPD）的荟萃分析，评估在家中使用鼻罩或面罩进行夜间NIPPV对COPD患者的影响。
我们检索了Cochrane Airways Group专业注册库。我们于2012年8月进行了最新检索。
针对稳定期COPD患者的随机对照试验，比较每晚在家中进行至少5小时、连续至少3周的夜间NIPPV加标准治疗与单纯标准治疗。
收集IPD，两位综述作者独立评估偏倚风险。
本次对COPD患者夜间NIPPV系统评价的更新（Wijkstra 2002）纳入了三项新研究，共七项纳入研究涉及245人。我们获取了所有纳入研究中所有参与者的IPD。所有结局的95%置信区间（CI）均包含零。这些结局包括动脉血二氧化碳分压和氧分压、6分钟步行距离（6MWD）、健康相关生活质量（HRQoL）、一秒用力呼气容积（FEV1）、用力肺活量（FVC）、最大吸气压力（PImax）和睡眠效率。对6MWD的平均影响较小，为27.7米，且无统计学意义。鉴于95%CI较宽（-28.1至66.3米），NIPPV对6MWD的实际影响尚不确定，我们不能排除具有临床意义的影响（考虑到6MWD的最小临床差异约为26米）。
稳定期高碳酸血症COPD患者在家中进行至少三个月的夜间NIPPV，对气体交换、运动耐力、HRQoL、肺功能、呼吸肌力量或睡眠效率没有一致的临床或统计学显著影响。对两项新的长期研究的荟萃分析未显示NIPPV治疗12个月后血气、HRQoL或肺功能有显著改善。然而，这些研究样本量较小，无法就NIPPV对COPD的影响得出明确结论。
