Role of Non-invasive Ventilation (NIV) in Managing Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review

Abstract

Chronic obstructive pulmonary disease (COPD) is a significant global health issue that is characterized by airflow constriction and breathing difficulties. Non-invasive ventilation (NIV) is a recommended treatment for acute exacerbations of COPD (AECOPD), offering benefits over invasive mechanical ventilation (IMV). We aimed to evaluate the effectiveness, safety, and impact of NIV in managing AECOPD. The study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, Medline, Cochrane Library, Embase, and Google Scholar for relevant studies published between 2015 and 2024. Inclusion criteria focused on studies involving AECOPD patients treated with NIV, including randomized controlled, cohort, and observational studies. We included 10 studies that fit our inclusion criteria for a thorough review. From the studies selected, NIV demonstrated significant reductions in mortality rates, intubation rates, and hospital stays compared to IMV. Albeit the need to train healthcare providers is essential, high adherence to NIV guidelines was observed. Different NIV modes showed comparable efficacy, and structured weaning protocols reduced relapse rates. NIV is a highly effective and safe treatment for patients with AECOPD than IMV. High-flow nasal therapy (HFNT) is a viable alternative for patients intolerant to NIV. Further research should standardize treatment protocols and optimize NIV use in clinical practice.

Keywords: chronic obstructive pulmonary disease; copd; high-flow nasal therapy; niv (non-invasive ventilation); respiratory failure.

Figure 1. PRISMA flow diagram.

Figure 2. A summary of studies’ risk of bias of each item.

In the risk of bias summary, which is based on the researcher's judgments of the risk of bias of the study items, red circles indicate high risk, green circles indicate low risk and white unclear risk of bias.

Figure 3. A summary of each studies’ risk of bias of each item.

Figure 4. Funnel plot depicting publication bias.

The standard error is denoted by SE and the relative risk by RR. X-axis, standard error; Y-axis, effect size. COPD, chronic obstructive pulmonary disease.