A meta-analysis on treatment effect of sequential noninvasive following invasive mechanical ventilation in chronic obstructive pulmonary disease patients with respiratory failure_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YANG Lin ^1,2 , YAO Li ^1,2 ,  ZHANG Zhigang ^1,2 , DING Nannan ^1,2 , ZHANG Caiyun ² , YANG Liping ² , YUE Weigang ² , LI Na ^1,2 , TIAN Jinhui ³

1. School of Nursing, Lanzhou University, Lanzhou, Gansu 730000, P. R. China;
2. The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P. R. China;
3. Evidence-based Medicine Center, Lanzhou University, Lanzhou, Gansu 730000, P. R. China;

Corresponding author：

ZHANG Zhigang, Email: zzg3444@163.com

Keywords：

Mechanical ventilation; Sequential ventilation; Chronic obstructive pulmonary disease; Respiratory failure; Meta-analysis

DOI：

10.7507/1671-6205.201903008

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Objective To analyze the treatment effect of sequential noninvasive following invasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with respiratory failure.Methods A review of randomized controlled trials with meta-analysis performed by searching databases of PubMed, the Cochrane Library, Embase, Chinese BioMedical Literature Database, China National Knowledge Infrastructure, and WanFang data. Randomized controlled trials by using sequential noninvasive following invasive mechanical ventilation in COPD patients with respiratory failure were eligible for inclusion.Results Eleven trials were included, involving 553 COPD patients with respiratory failure. Meta-analysis showed that sequential noninvasive following invasive mechanical ventilation reduced the mortality rate [RR=0.37, 95%CI(0.22 to 0.61), P=0.000 1], the incidence of ventilator-associated pneumonia (VAP) [RR=0.20, 95%CI(0.13 to 0.32), P<0.000 01], reintubation rate [RR=0.40, 95%CI(0.23 to 0.68), P=0.0008]; it also decreased the duration of invasive mechanical ventilation [MD=–10.47, 95%CI(–13.80 to –7.14), P<0.000 01] and duration of mechanical ventilation [MD=–4.54, 95%CI(–7.01 to –2.06), P=0.000 3], which also shortened the lengths of stay in an intensive care unit (ICU) [MD=–8.75, 95%CI(–13.49 to –4.01), P=0.000 3], as well as length of hospital stay [MD=–9.11, 95%CI(–11.68 to –6.55), P<0.000 01］.Conclusion Sequential noninvasive following invasive mechanical ventilation can significantly reduce the incidence of VAP, the duration of invasive mechanical ventilation, the length of hospital stay in COPD patients with respiratory failure, and reduce the mortality, reintubation rate, the duration of mechanical ventilation and the length of ICU stay as well.

Citation： YANG Lin, YAO Li, ZHANG Zhigang, DING Nannan, ZHANG Caiyun, YANG Liping, YUE Weigang, LI Na, TIAN Jinhui. A meta-analysis on treatment effect of sequential noninvasive following invasive mechanical ventilation in chronic obstructive pulmonary disease patients with respiratory failure. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(4): 351-358. doi: 10.7507/1671-6205.201903008 Copy

1.	Lv Y, Lv Q, Lv Q, et al. Pulmonary infection control window as a switching point for sequential ventilation in the treatment of COPD patients: a meta-analysis. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1255-1267.
2.	蔡柏蔷. 慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(草案). 中华哮喘杂志(电子版), 2013, 7(1): 1-13.
3.	邹石海, 周锐, 陈平, 等. 以肺部感染控制窗为切换点进行有创-无创序贯治疗在 COPD 呼吸衰竭中的应用. 中南大学学报(医学版), 2006, 31(1): 120-124.
4.	赵志国. 有创–无创序贯通气疗法治疗慢性阻塞性肺疾病引发的严重呼吸衰竭的临床研究. 信息医学, 2018, 31(11): 110-112.
5.	袁顺蓉, 刘南伶, 杨三春, 等. 有创无创序贯机械通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床研究. 西部医学, 2014, 26(9): 1176-1178.
6.	郑瑞强, 刘玲, 杨毅, 等. 有创无创序贯机械通气治疗慢性阻塞性肺病所致急性呼吸衰竭的研究. 中华急诊医学杂志, 2005, 14(1): 21-25.
7.	贺文成, 郑志刚. 经鼻高流量氧疗应用于 COPD 致呼吸衰竭的序贯机械通气. 江西医药, 2018, 53(5): 460-463.
8.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. London: The Cochrane Collaboration, 2011.
9.	Wang C. Pulmonary infection control window in treatment of severe respiratory failure of chronic obstructive pulmonary diseases: a prospective, randomized controlled, multi-centred study. Chin Med J (Engl), 2005, 118(19): 1589-1594.
10.	Nava S, Ambrosino N, Clini E, et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease: a randomized, controlled trial. Ann Intern Med, 1998, 128(9): 721-728.
11.	Wang C, Shang M, Huang K, et al. Sequential non-invasive mechanical ventilation following short-term invasive mechanical ventilation in COPD induced hypercapnic respiratory failure. Chin Med J (Engl), 2003, 116(1): 39-43.
12.	Prasad SBN, Chaudhry D, Khanna R. Role of noninvasive ventilation in weaning from mechanical ventilation in patients of chronic obstructive pulmonary disease: an Indian experience. Indian J Crit Care Med, 2009, 13(4): 207-221.
13.	陈杰, 邱东华, 陶德莹, 等. 慢性阻塞性肺疾病急性呼吸衰竭患者从有创过渡到无创机械通气的时机探讨. 中华结核和呼吸杂志, 2001, 24(2): 99-100.
14.	崔恩海, 邱东华, 陈杰, 等. 短期有创序贯无创面罩机械通气在慢性阻塞性肺疾病危重呼吸衰竭治疗中的应用. 中国急救医学, 2001, 21(11): 640-642.
15.	瞿云中, 唐湘林, 陈平. 无创–有创–无创序贯机械通气在慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭中的应用及护理监测. 中国全科医学, 2009, 12(5B): 830-833.
16.	王银娥, 徐云侠, 陈莲芳. 序贯机械通气治疗慢性阻塞性肺疾病并发呼吸衰竭病人的护理. 护理研究, 2008, 22(3): 688-690.
17.	龙胜泽, 秦志强, 胡克, 等. 以呼吸泵衰竭改善为切换点序贯通气治疗慢性阻塞性肺疾病呼吸衰竭的研究. 中国呼吸与危重监护杂志, 2007, 6(6): 428-432.
18.	曹林发. 慢性阻塞性肺疾病并发呼吸衰竭相关危险因素分析. 江西医药, 2010, 45(2): 129-131.
19.	曾凡鹏, 陈锦河, 陈冬莲, 等. 序贯性机械通气治疗 COPD 并呼吸衰竭切换时点的随机对照研究. 中国医学创新, 2014, 11(12): 51-54.
20.	曾海文. 有创后序贯无创机械通气治疗慢性阻塞性肺疾病合并严重呼吸衰竭的临床分析. 中外医学研究, 2016, 14(28): 37-38.
21.	刘科. 有创–无创机械通气序贯治疗慢性阻塞性肺疾病合并呼吸衰竭疗效观察. 基层医学论坛, 2018, 22(7): 904-905.
22.	顾小雷. 有创–无创机械通气序贯治疗慢性阻塞性肺疾病并呼吸衰竭临床观察. 中外医学研究, 2019, 17(3): 30-31.
23.	沈艳, 沈雁波. 肺部感染控制窗和自主呼吸试验在指导慢性阻塞性肺疾病急性发作机械通气患者脱机时机的应用. 江苏医药, 2015, 41(18): 2154-2156.
24.	符继荣, 张志强, 刘大东. 不同切换点在慢性阻塞性肺疾病合并呼吸衰竭患者序贯通气中的应用研究. 中华临床医师杂志(电子版), 2016, 10(11): 1648-1651.
25.	Li PJ, Wang T, Xiao J. Efficacy of two noninvasive weaning strategies in intubated patients with chronic obstructive pulmonary disease: a meta-analysis and indirect treatment comparison. Heart Lung, 2016, 45(2): 132-139.
26.	张静, 杨阳, 邹俊. 肺部感染控制窗和自主呼吸试验在无创正压通气序贯治疗时机选择中的运用. 护士进修杂志, 2015, 30(5): 446-448.

1. Lv Y, Lv Q, Lv Q, et al. Pulmonary infection control window as a switching point for sequential ventilation in the treatment of COPD patients: a meta-analysis. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1255-1267.
2. 蔡柏蔷. 慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(草案). 中华哮喘杂志(电子版), 2013, 7(1): 1-13.
3. 邹石海, 周锐, 陈平, 等. 以肺部感染控制窗为切换点进行有创-无创序贯治疗在 COPD 呼吸衰竭中的应用. 中南大学学报(医学版), 2006, 31(1): 120-124.
4. 赵志国. 有创–无创序贯通气疗法治疗慢性阻塞性肺疾病引发的严重呼吸衰竭的临床研究. 信息医学, 2018, 31(11): 110-112.
5. 袁顺蓉, 刘南伶, 杨三春, 等. 有创无创序贯机械通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床研究. 西部医学, 2014, 26(9): 1176-1178.
6. 郑瑞强, 刘玲, 杨毅, 等. 有创无创序贯机械通气治疗慢性阻塞性肺病所致急性呼吸衰竭的研究. 中华急诊医学杂志, 2005, 14(1): 21-25.
7. 贺文成, 郑志刚. 经鼻高流量氧疗应用于 COPD 致呼吸衰竭的序贯机械通气. 江西医药, 2018, 53(5): 460-463.
8. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. London: The Cochrane Collaboration, 2011.
9. Wang C. Pulmonary infection control window in treatment of severe respiratory failure of chronic obstructive pulmonary diseases: a prospective, randomized controlled, multi-centred study. Chin Med J (Engl), 2005, 118(19): 1589-1594.
10. Nava S, Ambrosino N, Clini E, et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease: a randomized, controlled trial. Ann Intern Med, 1998, 128(9): 721-728.
11. Wang C, Shang M, Huang K, et al. Sequential non-invasive mechanical ventilation following short-term invasive mechanical ventilation in COPD induced hypercapnic respiratory failure. Chin Med J (Engl), 2003, 116(1): 39-43.
12. Prasad SBN, Chaudhry D, Khanna R. Role of noninvasive ventilation in weaning from mechanical ventilation in patients of chronic obstructive pulmonary disease: an Indian experience. Indian J Crit Care Med, 2009, 13(4): 207-221.
13. 陈杰, 邱东华, 陶德莹, 等. 慢性阻塞性肺疾病急性呼吸衰竭患者从有创过渡到无创机械通气的时机探讨. 中华结核和呼吸杂志, 2001, 24(2): 99-100.
14. 崔恩海, 邱东华, 陈杰, 等. 短期有创序贯无创面罩机械通气在慢性阻塞性肺疾病危重呼吸衰竭治疗中的应用. 中国急救医学, 2001, 21(11): 640-642.
15. 瞿云中, 唐湘林, 陈平. 无创–有创–无创序贯机械通气在慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭中的应用及护理监测. 中国全科医学, 2009, 12(5B): 830-833.
16. 王银娥, 徐云侠, 陈莲芳. 序贯机械通气治疗慢性阻塞性肺疾病并发呼吸衰竭病人的护理. 护理研究, 2008, 22(3): 688-690.
17. 龙胜泽, 秦志强, 胡克, 等. 以呼吸泵衰竭改善为切换点序贯通气治疗慢性阻塞性肺疾病呼吸衰竭的研究. 中国呼吸与危重监护杂志, 2007, 6(6): 428-432.
18. 曹林发. 慢性阻塞性肺疾病并发呼吸衰竭相关危险因素分析. 江西医药, 2010, 45(2): 129-131.
19. 曾凡鹏, 陈锦河, 陈冬莲, 等. 序贯性机械通气治疗 COPD 并呼吸衰竭切换时点的随机对照研究. 中国医学创新, 2014, 11(12): 51-54.
20. 曾海文. 有创后序贯无创机械通气治疗慢性阻塞性肺疾病合并严重呼吸衰竭的临床分析. 中外医学研究, 2016, 14(28): 37-38.
21. 刘科. 有创–无创机械通气序贯治疗慢性阻塞性肺疾病合并呼吸衰竭疗效观察. 基层医学论坛, 2018, 22(7): 904-905.
22. 顾小雷. 有创–无创机械通气序贯治疗慢性阻塞性肺疾病并呼吸衰竭临床观察. 中外医学研究, 2019, 17(3): 30-31.
23. 沈艳, 沈雁波. 肺部感染控制窗和自主呼吸试验在指导慢性阻塞性肺疾病急性发作机械通气患者脱机时机的应用. 江苏医药, 2015, 41(18): 2154-2156.
24. 符继荣, 张志强, 刘大东. 不同切换点在慢性阻塞性肺疾病合并呼吸衰竭患者序贯通气中的应用研究. 中华临床医师杂志(电子版), 2016, 10(11): 1648-1651.
25. Li PJ, Wang T, Xiao J. Efficacy of two noninvasive weaning strategies in intubated patients with chronic obstructive pulmonary disease: a meta-analysis and indirect treatment comparison. Heart Lung, 2016, 45(2): 132-139.
26. 张静, 杨阳, 邹俊. 肺部感染控制窗和自主呼吸试验在无创正压通气序贯治疗时机选择中的运用. 护士进修杂志, 2015, 30(5): 446-448.

Chinese Journal of Respiratory and Critical Care Medicine

A meta-analysis on treatment effect of sequential noninvasive following invasive mechanical ventilation in chronic obstructive pulmonary disease patients with respiratory failure

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