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. 2022 Jan;85(1):47-55.
doi: 10.4046/trd.2021.0062. Epub 2021 Nov 15.

The Long-term Efficacy of Domiciliary Noninvasive Positive-Pressure Ventilation in Chronic Obstructive Pulmonary Disease: A Meta-Analysis of Randomized Controlled Trials

So Young Park  1 , Kwang Ha Yoo  2 , Yong Bum Park  3 , Chin Kook Rhee  4 , Jinkyeong Park  5 , Hye Yun Park  6 , Yong Il Hwang  7 , Dong Ah Park  8 , Yun Su Sim  9
Affiliations

The Long-term Efficacy of Domiciliary Noninvasive Positive-Pressure Ventilation in Chronic Obstructive Pulmonary Disease: A Meta-Analysis of Randomized Controlled Trials

So Young Park et al. Tuberc Respir Dis (Seoul). 2022 Jan.

Abstract

Background: We evaluated the long-term effects of domiciliary noninvasive positive-pressure ventilation (NIPPV) used to treat patients with chronic obstructive pulmonary disease (COPD).

Methods: Databases were searched to identify randomized controlled trials of COPD with NIPPV for longer than 1 year. Mortality rates were the primary outcome in this meta-analysis. The eight trials included in this study comprised data from 913 patients.

Results: The mortality rates for the NIPPV and control groups were 29% (118/414) and 36% (151/419), suggesting a statistically significant difference (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65-0.95). Mortality rates were reduced with NIPPV in four trials that included stable COPD patients. There was no difference in admission, acute exacerbation and quality of life between the NIPPV and control groups. There was no significant difference in withdrawal rates between the two groups (RR, 0.99; 95% CI, 0.72-1.36; p=0.94).

Conclusion: Maintaining long-term nocturnal NIPPV for more than 1 year, especially in patients with stable COPD, decreased the mortality rate, without increasing the withdrawal rate compared with long-term oxygen treatment.

Keywords: Chronic Obstructive Pulmonary Disease; Mortality; Noninvasive Positive-Pressure Ventilation.

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Conflict of interest statement

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Study flow diagram.
Fig. 2.
Fig. 2.
Forest plot describing the effect of noninvasive positive-pressure ventilation (NIPPV) on all-cause mortality, and the mortality rate according to the status of patients with chronic obstructive pulmonary disease (COPD) [7-9,11-14]. The vertical line depicts the equivalence in mortality rates between the two groups (NIPPV vs. control), and horizontal lines correspond to the 95% confidence intervals (CIs). The size of each square represents the proportion of information provided by each study.
Fig. 3.
Fig. 3.
Forest plot depicting the effect of noninvasive positive-pressure ventilation (NIPPV) on admission (A) and acute exacerbation (B) [7,8,14]. The vertical line depicts the equivalence in mortality rates between the two groups (NIPPV vs. control), and the horizontal lines correspond to the 95% confidence intervals (CIs). The size of each square represents the proportion of information provided by each study.
Fig. 4.
Fig. 4.
Forest plot depicting the effect of noninvasive positive-pressure ventilation (NIPPV) on the Chronic Respiratory Questionnaire [10,14]. The vertical line depicts the equivalence in mortality rates between the two groups (NIPPV vs. control), and the horizontal lines correspond to the 95% confidence intervals (CIs). The size of each square represents the proportion of information provided by each study. SD: standard deviation.
Fig. 5.
Fig. 5.
Forest plot depicting the effect of noninvasive positive-pressure ventilation (NIPPV) on withdrawal rates according to mean level of inspiratory positive airway pressure (IPAP) (≥20 cm H2O) [7-14]. The vertical line depicts the equivalence in mortality rates between the two groups (NIPPV vs. control), and the horizontal lines correspond to the 95% confidence intervals (CIs). The size of each square represents the proportion of information provided by each study.
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