Association of Home Noninvasive Positive Pressure Ventilation With Clinical Outcomes in Chronic Obstructive Pulmonary Disease A Systematic Review and Meta-analysis

摘要

Question In patients with chronic obstructive pulmonary disease (COPD) and hypercapnia, is the use of home noninvasive positive pressure ventilation (NIPPV) associated with better outcomes? Findings In this meta-analysis that included 51085 patients with COPD and hypercapnia, home use of bilevel positive airway pressure, compared with no device, was significantly associated with lower risk of mortality (odds ratio [OR], 0.66), fewer patients with hospital admissions (OR, 0.22), and lower need for intubation (OR, 0.34), but no significant difference in quality of life. Noninvasive home mechanical ventilator, compared with no device, was significantly associated with lower risk of hospital admission (rate ratio, 0.50), but there was no significant difference in mortality risk. However, the evidence was low to moderate in quality. Meaning Among patients with COPD and hypercapnia, home NIPPV, compared with no device use, was significantly associated with better clinical outcomes and no significant difference in quality of life. However, the evidence was low to moderate in quality, the evidence on quality of life was insufficient, and the analyses for some outcomes were based on small numbers of studies.