Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2022 Apr 6;17:719-733. doi: 10.2147/COPD.S344962. eCollection 2022.
The evidence of long-term home noninvasive positive pressure ventilation (LTHNIPPV) in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD) is controversial. In this meta-analysis study, we sought to establish whether a baseline level and reduction in partial pressure of arterial carbon dioxide (PaCO2) were associated with the treatment effect of LTHNIPPV in these patients.
Six electronic databases were comprehensively searched from January 1980 until June 2020. Randomized clinical trials (RCTs) comparing LTHNIPPV with control treatment were included. Two authors independently extracted data, assessed the study quality, and used the GRADE approach to evaluate evidence quality. The main outcome was mortality.
Nineteen studies involving 1482 patients (LTHNIPPV, n = 730; control, n = 752) were included. LTHNIPPV significantly reduced mortality (relative risk [RR] = 0.76; 95% confidence interval [CI]: 0.61-0.95; p = 0.02; I = 14%), the frequency of hospital admissions, PaCO2, and improved partial pressure of oxygen (PaO2) compared to control treatment. LTHNIPPV also relieved dyspnea and improved exercise capacity and health-related quality of life (HRQL) but showed no significant benefit for improving the forced expiratory volume in one second in predicted (FEV1% pred). Subgroup analysis revealed that the baseline level and reduction in PaCO2 were associated with decreased mortality (baseline PaCO2 ≥ 55 mmHg RR = 0.69, P = 0.02; vs baseline PaCO2 < 55 mmHg RR = 0.87, P = 0.32; and higher dPaCO2 RR = 0.42, P < 0.0001; vs lower dPaCO2 RR = 0.91, P = 0.38).
LTHNIPPV significantly reduced mortality. The baseline level and reduction in PaCO2 were associated with the treatment effect of LTHNIPPV in patients with stable hypercapnic COPD. Large-scale, multicenter RCTs are needed to confirm our results.
长期家庭无创正压通气（LTHNIPPV）治疗稳定期高碳酸血症慢性阻塞性肺疾病（COPD）患者的疗效尚存争议。本meta 分析旨在确定基线及动脉血二氧化碳分压（PaCO2）下降水平与 LTHNIPPV 治疗效果的相关性。
全面检索 1980 年 1 月至 2020 年 6 月期间的 6 个电子数据库，纳入比较 LTHNIPPV 与对照组治疗的随机临床试验（RCT）。由 2 位作者独立提取数据、评估研究质量，并采用 GRADE 方法评估证据质量。主要结局为死亡率。
共纳入 19 项研究，涉及 1482 例患者（LTHNIPPV 组 730 例，对照组 752 例）。与对照组相比，LTHNIPPV 可显著降低死亡率（相对风险 [RR] = 0.76；95%置信区间 [CI]：0.61~0.95；P = 0.02；I² = 14%）、减少住院次数、降低 PaCO2 水平，改善氧分压（PaO2）。LTHNIPPV 还可缓解呼吸困难，改善运动能力和健康相关生活质量（HRQL），但对改善一秒率预计值（FEV1% pred）无显著获益。亚组分析显示，基线 PaCO2 水平及 PaCO2 下降与死亡率降低相关（基线 PaCO2 ≥ 55mmHg：RR = 0.69，P = 0.02；vs 基线 PaCO2 < 55mmHg：RR = 0.87，P = 0.32；更高的 dPaCO2：RR = 0.42，P < 0.0001；vs 更低的 dPaCO2：RR = 0.91，P = 0.38）。
LTHNIPPV 可显著降低死亡率，且基线 PaCO2 水平及 PaCO2 下降与 LTHNIPPV 治疗稳定期高碳酸血症 COPD 患者的疗效相关。需要开展更大规模、多中心 RCT 以验证本研究结果。
