Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, China.
Breast Center, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, 610041, China.
BMC Med. 2024 Sep 12;22(1):389. doi: 10.1186/s12916-024-03605-7.
Exercise training is fundamental in pulmonary rehabilitation (PR), but patients with chronic obstructive pulmonary disease (COPD) often struggle with exercise intolerance. Respiratory support during exercise in COPD patients may be a beneficial adjunct therapy. In this study, the effect of different respiratory support therapy during pulmonary rehabilitation exercise training in COPD patients was assessed through a network meta-analysis.
Five databases were searched to obtain randomized controlled trials involving different respiratory support therapies during PR exercise training in COPD patients. The Cochrane Handbook tool was employed to assess the risk bias of included studies. Network meta-analysis was performed using the STATA software. The study protocol was registered at PROSPERO (CRD42023491139).
A total of 35 studies involving 1321 patients and 6 different interventions were included. Network meta-analysis showed that noninvasive positive pressure ventilation (NPPV) is superior in improving exercise capacity (6-Minute Walk Test distance, peak work rate, endurance time), dyspnea, and physiological change (peak VO, tidal volume, minute ventilation and lactate level) in stable COPD patients who were at GOLD stage III or IV during PR exercise training. The final surface under the cumulative ranking curve value indicated that NPPV therapy achieved the best assistive rehabilitation effect.
The obtained results indicate that NPPV is most powerful in assisting exercise in severe COPD patients under stable condition. Researchers should focus more on the safety, feasibility, and personalization of interventions. Furthermore, there is a need for additional high-quality trials to assess the consistency of evidence across various respiratory support approaches.
The study was registered at PROSPERO (CRD42023491139).
运动训练是肺康复（PR）的基础，但慢性阻塞性肺疾病（COPD）患者常常难以耐受运动。在 COPD 患者中，运动时的呼吸支持可能是一种有益的辅助治疗方法。在这项研究中，通过网络荟萃分析评估了 COPD 患者 PR 运动训练期间不同呼吸支持治疗的效果。
在五个数据库中搜索涉及 COPD 患者 PR 运动训练期间不同呼吸支持疗法的随机对照试验。使用 Cochrane 手册工具评估纳入研究的风险偏倚。使用 STATA 软件进行网络荟萃分析。该研究方案已在 PROSPERO（CRD42023491139）中注册。
共有 35 项研究涉及 1321 名患者和 6 种不同的干预措施。网络荟萃分析表明，在 PR 运动训练期间，对于处于 GOLD 阶段 III 或 IV 的稳定期 COPD 患者，无创正压通气（NPPV）在改善运动能力（6 分钟步行测试距离、峰值工作率、耐力时间）、呼吸困难和生理变化（峰值 VO、潮气量、分钟通气量和乳酸水平）方面效果优于其他疗法。累积排序曲线下面积的最终值表明，NPPV 治疗的辅助康复效果最佳。
研究结果表明，在稳定状态下，NPPV 对严重 COPD 患者的运动辅助效果最强。研究人员应更加关注干预措施的安全性、可行性和个性化。此外，需要更多高质量的试验来评估各种呼吸支持方法的证据一致性。
该研究在 PROSPERO（CRD42023491139）中注册。
