Nursing School, Fudan University, Shanghai, 200032, China.
Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Heart Lung. 2020 May-Jun;49(3):287-295. doi: 10.1016/j.hrtlng.2020.01.007. Epub 2020 Feb 5.
Patients receiving long-term home noninvasive ventilation (NIV) may slow down the progression to acute exacerbation of chronic obstructive pulmonary disease (AECOPD), however, the problem with respiratory instability during sleep diminished was persisted, which may reduce the effectiveness of NIV and the patient's quality of life. A novel NIV mode with volume-assured pressure support (VAPS) has been gradually applied to improve sleep quality in COPD patients with chronic respiratory failure. This meta-analysis aimed to evaluate the efficacy of VAPS in stable COPD patients with chronic respiratory failure.
We performed an electronic literature search for RCTs from January 2008 to October 2018. Studies investigating the effects of VAPS in stable COPD patients with chronic respiratory failure were conducted, and the following primary outcomes were reviewed: effectiveness of ventilation, sleep quality, and quality of life.
Five studies with 150 subjects were identified. While questionnaire scores showed significant improvements in the VAPS mode, no significant difference was found in the effectiveness of ventilation (pH, MD = 0.01 [95% CI -0.01 to 0.02, P = 0.27]; PaCO, MD = 1.25 [95% CI -1.45 to 3.95, P = 0.37]; PaO, MD = 3.14 [95% CI -0.76 to 7.05, P = 0.11]; mSaO, MD = 0.23 [95% CI -1.22 to 1.67, P = 0.76]; mPtcCO, MD = 3.03 [95% CI -6.06 to- 0.60, P = 0.10]). The VAPS mode did not seem to ameliorate sleep quality and quality of life.
The VAPS mode had similar efficacy as the pressure-support (PS) mode. However, VAPS could significantly improve the patients' subjective feelings.
接受长期家庭无创通气（NIV）的患者可能会减缓慢性阻塞性肺疾病（COPD）急性加重的进展，但睡眠期间呼吸不稳定的问题仍然存在，这可能会降低 NIV 的效果和患者的生活质量。一种新型的具有容量保证压力支持（VAPS）的 NIV 模式已逐渐应用于改善 COPD 合并慢性呼吸衰竭患者的睡眠质量。本荟萃分析旨在评估 VAPS 在稳定的 COPD 合并慢性呼吸衰竭患者中的疗效。
我们从 2008 年 1 月至 2018 年 10 月进行了电子文献检索，对使用 VAPS 治疗稳定的 COPD 合并慢性呼吸衰竭患者的 RCT 进行了研究，评估了以下主要结局：通气效果、睡眠质量和生活质量。
确定了 5 项包含 150 例患者的研究。尽管问卷调查评分显示 VAPS 模式下有显著改善，但通气效果（pH 值，MD=0.01 [95% CI -0.01 至 0.02，P=0.27]；PaCO，MD=1.25 [95% CI -1.45 至 3.95，P=0.37]；PaO，MD=3.14 [95% CI -0.76 至 7.05，P=0.11]；mSaO，MD=0.23 [95% CI -1.22 至 1.67，P=0.76]；mPtcCO，MD=3.03 [95% CI -6.06 至-0.60，P=0.10]）无显著差异。VAPS 模式似乎并未改善睡眠质量和生活质量。
VAPS 模式与压力支持（PS）模式疗效相当，但 VAPS 可显著改善患者的主观感受。
