Noninvasive Positive Pressure Ventilation in Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

SUN Jiehao , HAN Ning , WU Xiuying

Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, China;

Corresponding author：

Keywords：

Chronic obstructive pulmonary disease; Noninvasive positive pressure ventilation; Systematic review

DOI：

10.7507/1672-2531.20080241

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Objective 　To determine the efficacy and prognosis of noninvasive positive pressure ventilation (NPPV) in exacerbations of chronic obstructive pulmonary disease (COPD).
Methods 　Trials were located through electronic searches of MEDLINE, EMBASE, Springer, and Foreign Journals Integration System (from the start date to March 2008). We also checked the bibliographies of retrieved articles. Statistical analysis was performed with The Cochrane Collaboration’s software RevMan 4.2.10.
Results 　A total of 19 trials involving 1 236 patients were included. Results showed that: (1) NPPV vs. conventional therapy: NPPV was superior to conventional therapy in terms of intubation rate (RR 0.36, 95%CI 0.27 to 0.49), failure rate (RR 0.62, 95%CI 0.43 to 0.90), and mortality (RR 0.49, 95%CI 0.34 to 0.69). The length of hospital stay was shorter in the NPPV group compared with the conventional group (WMD – 3.83, 95%CI – 5.78 to – 1.89), but the length of ICU stay was similar. The changes of PaO2, PaCO2, and pH were much more obvious in the NPPV group compared with the conventional group. The change of respiratory rate was more significant in the NPPV group compared with the conventional group (WMD – 3.75, 95%CI – 5.48 to – 2.03). At discharge and follow-up, there were no significant differences in FEV1, pH, PaCO2, PaO2, and vital capacity between the two groups. (2) NPPV vs. invasive ventilation: the mortality was similar between the two groups. The incidence of complications was lower in the NPPV group compared with the invasive group (RR 0.38, 95%CI 0.20 to 0.73). The length of ICU stay, duration of mechanical ventilation, and weaning time were shorter in the NPPV group than those of the invasive group. At discharge and follow-up, clinical conditions were similar between the two groups.
Conclusion 　 The limited current evidence showed that NPPV was superior to conventional therapy in improving intubation rate, mortality, short term of blood-gas change, the change of respiratory rate; and superior to invasive ventilation in the length of hospital stay and the incidence of complication. There were no difference among them in discharge and follow-up.

Citation： SUN Jiehao,HAN Ning,WU Xiuying. Noninvasive Positive Pressure Ventilation in Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(12): 1112-1121. doi: 10.7507/1672-2531.20080241 Copy

1.	杭燕南. 危重病人的呼吸支持和机械通气治疗. 见: 庄心良,曾因明, 陈伯銮. 主编. 现代麻醉学. 第3版. 北京: 人民卫生出版社, 2006, 2414-2416.
2.	Avdeev S, Tret’iakov AV, Grigor’iants RA, et al. Study of the use of noninvasive ventilation of the lungs in acute respiratory insufficiency due exacerbation of chronic obstructive pulmonary disease. Anesteziol Reanimatol, 1998, (3): 45-51.
3.	Andrea B, Spagnolatti L, Massobrio M, et al. Short-term effects of expiration under positive pressure in patients with acute exacerbation of chronic obstructive pulmonary disease and mild acidosis requiring non-invasive positive pressure ventilation. Intensive Care Med, 2002, 28: 581-585.
4.	Bott J, Carroll MP, Conway JH, et al. Random controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet, 1993, 341: 1555-1557.
5.	Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med, 1995, 333: 817-822.
6.	Zhou R, Chen P, Luo H, et al. Sequential BiPAP following invasive mechanical ventilation in COPD patients with hypercapnic respirastory failure. Hunan Yi Ke Da Xue Xue Bao, 2001, 26(3): 261-22.
7.	Castillo D, Barrot E, Laserna E, et al. Noninvasive positive pressure ventilation for acute respiratory failure in chronic obstructive pulmonary disease in a general respiratory ward. Med Clin(Barc), 2003, 120(17): 647-651.
8.	Dikensoy O, Ikidag B, Filiz A, et al. Comparison of non-invasive ventilation and standard medical therapy in acute hypercapnic respiratory failure: a randomised controlled study at a tertiary health centre in SE Turkey. Int J Clin Pract, 2002, 56(2): 85-88.
9.	Celikel T, Sungur M, Ceyhan B, et al. Comparison of Noninvasive Positive Pressure Ventilation With Standard Medical Therapy in Hypercapnic Acute Respiratory Failure. Chest, 1998, 114, 1636-1642.
10.	Matuska P, Pilarová O, Merta Z, et al. Non-invasive ventilation support in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Vnitr Lek, 2006, 52(3): 241-248.
11.	Plant P, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards:a multicentre randomised controlled trial. Lancet, 2000, 355: 1931-1935.
12.	Kramer N, Meyer TJ, Meharg J, et al. Randomized prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med, 1995, 151(6): 1799-1806.
13.	Thomas J, Jeffrey D, Joseph P, et al. A Randomized, Prospective Evaluation of Noninvasive Ventilation for Acute Respiratory Failure. Am J Respir Crit Care Med, 2000, 161: 807-813.
14.	Thys F, Roeseler J, Reynaert M, et al. Noninvasive ventilation for acute respiratory failure: a prospective randomised placebocontrolled trial. Eur Respir J, 2002, 20: 545-555.
15.	Collaborative Research Group of Noninvasive Mechanical Ventilation for Chronic Obstructive Pulmonary Disease. Early use of non-invasive positive pressure ventilation for acute exacerbations of chronic obstructive pulmonary disease:a multicentre randomized controlled trial. Chin Med J, 2005, 118(24): 2034-2040.
16.	Barbé F, Togores B, Rubí M, et al. Noninvasive ventilatory support does not facilitate recovery from acute respiratory failure in chronic obstructive pulmonary disease. Eur Respir J, 1996, 9, 1240-1245.
17.	Daskalopoulou E, Teara V, Fekete K, et al. Treatment of acute respiratory failure in COPD patients with positive airway pressure via nasal mask (NPPV). Chest, 1993, 103: 271s.
18.	Bardi G, Pierotello R, Desideri M, et al. Nasal ventilation in COPD exacerbations:Early and late results of a prospective controlled study. Eur Respir J, 2000, 15: 98-104.
19.	Stcfano Nava, Nicolino Ambrosino, Enrico Clini, et al. Noninvasive Mechanical Ventilation in the Weaning of Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease. Annals of Internal Medicine, 1998, 128, 722-728.
20.	Conti G, M Antonelli, P Navalesi, et al. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med, 2002, 28: 1701-1707.
21.	Plant PK, Owen JL, Elliott MW, et al. Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome. Thorax, 2001, 56(9): 708-712.

1. 杭燕南. 危重病人的呼吸支持和机械通气治疗. 见: 庄心良,曾因明, 陈伯銮. 主编. 现代麻醉学. 第3版. 北京: 人民卫生出版社, 2006, 2414-2416.
2. Avdeev S, Tret’iakov AV, Grigor’iants RA, et al. Study of the use of noninvasive ventilation of the lungs in acute respiratory insufficiency due exacerbation of chronic obstructive pulmonary disease. Anesteziol Reanimatol, 1998, (3): 45-51.
3. Andrea B, Spagnolatti L, Massobrio M, et al. Short-term effects of expiration under positive pressure in patients with acute exacerbation of chronic obstructive pulmonary disease and mild acidosis requiring non-invasive positive pressure ventilation. Intensive Care Med, 2002, 28: 581-585.
4. Bott J, Carroll MP, Conway JH, et al. Random controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet, 1993, 341: 1555-1557.
5. Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med, 1995, 333: 817-822.
6. Zhou R, Chen P, Luo H, et al. Sequential BiPAP following invasive mechanical ventilation in COPD patients with hypercapnic respirastory failure. Hunan Yi Ke Da Xue Xue Bao, 2001, 26(3): 261-22.
7. Castillo D, Barrot E, Laserna E, et al. Noninvasive positive pressure ventilation for acute respiratory failure in chronic obstructive pulmonary disease in a general respiratory ward. Med Clin(Barc), 2003, 120(17): 647-651.
8. Dikensoy O, Ikidag B, Filiz A, et al. Comparison of non-invasive ventilation and standard medical therapy in acute hypercapnic respiratory failure: a randomised controlled study at a tertiary health centre in SE Turkey. Int J Clin Pract, 2002, 56(2): 85-88.
9. Celikel T, Sungur M, Ceyhan B, et al. Comparison of Noninvasive Positive Pressure Ventilation With Standard Medical Therapy in Hypercapnic Acute Respiratory Failure. Chest, 1998, 114, 1636-1642.
10. Matuska P, Pilarová O, Merta Z, et al. Non-invasive ventilation support in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Vnitr Lek, 2006, 52(3): 241-248.
11. Plant P, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards:a multicentre randomised controlled trial. Lancet, 2000, 355: 1931-1935.
12. Kramer N, Meyer TJ, Meharg J, et al. Randomized prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med, 1995, 151(6): 1799-1806.
13. Thomas J, Jeffrey D, Joseph P, et al. A Randomized, Prospective Evaluation of Noninvasive Ventilation for Acute Respiratory Failure. Am J Respir Crit Care Med, 2000, 161: 807-813.
14. Thys F, Roeseler J, Reynaert M, et al. Noninvasive ventilation for acute respiratory failure: a prospective randomised placebocontrolled trial. Eur Respir J, 2002, 20: 545-555.
15. Collaborative Research Group of Noninvasive Mechanical Ventilation for Chronic Obstructive Pulmonary Disease. Early use of non-invasive positive pressure ventilation for acute exacerbations of chronic obstructive pulmonary disease:a multicentre randomized controlled trial. Chin Med J, 2005, 118(24): 2034-2040.
16. Barbé F, Togores B, Rubí M, et al. Noninvasive ventilatory support does not facilitate recovery from acute respiratory failure in chronic obstructive pulmonary disease. Eur Respir J, 1996, 9, 1240-1245.
17. Daskalopoulou E, Teara V, Fekete K, et al. Treatment of acute respiratory failure in COPD patients with positive airway pressure via nasal mask (NPPV). Chest, 1993, 103: 271s.
18. Bardi G, Pierotello R, Desideri M, et al. Nasal ventilation in COPD exacerbations:Early and late results of a prospective controlled study. Eur Respir J, 2000, 15: 98-104.
19. Stcfano Nava, Nicolino Ambrosino, Enrico Clini, et al. Noninvasive Mechanical Ventilation in the Weaning of Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease. Annals of Internal Medicine, 1998, 128, 722-728.
20. Conti G, M Antonelli, P Navalesi, et al. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med, 2002, 28: 1701-1707.
21. Plant PK, Owen JL, Elliott MW, et al. Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome. Thorax, 2001, 56(9): 708-712.

Chinese Journal of Evidence-Based Medicine

Noninvasive Positive Pressure Ventilation in Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review

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