High-intensity versus low-intensity non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: A systematic review and meta-analysis

Abstract

Background: Non-invasive positive pressure ventilation (NIPPV) is a key treatment for acute exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD). This meta-analysis compares high-versus low-intensity NIPPV.

Methods: A systematic search was conducted across major databases. Studies comparing high- and low-intensity NIPPV in AECOPD were included. Statistical analysis-using RevMan, statistical significance set at p < 0.05, risk ratio for dichotomous data, while mean difference for continuous data with 95 % CI via random effect model, and Higgins I² to measure heterogeneity was carried out following PRISMA guidelines.

Results: Four studies, which consisted of 618 patients, were analyzed. Primary outcomes were intubation need and short-term mortality. Secondary outcomes included PaCO₂ at 48 and 72 h and abdominal distension. High-intensity NIPPV significantly reduced short-term mortality (RR: 0.43, CI: [0.22, 0.85], P = 0.02) but had no significant effect on intubation rates. PaCO₂ levels at 48 and 72 h showed no significant difference. Abdominal distension was more common in the high-intensity group (RR: 1.49, P = 0.02).

Conclusion: High-intensity NIPPV lowers short-term mortality but increases abdominal distension. Further studies are needed.

Keywords: Acute exacerbation; COPD; High-intensity ventilation; Meta-analysis; NIPPV.