In patients with chronic obstructive pulmonary disease (COPD) and hypercapnia, the use of home noninvasive positive pressure ventilation (NIPPV), compared with the use of no device, was significantly associated with improved clinical outcomes but no significant differences in quality of life (QoL), according to the results of a meta-analysis published in JAMA.
Investigators sought to explore the association of home NIPPV via the use of bilevel positive airway pressure (BPAP) and noninvasive home mechanical (HMV) devices with clinical outcomes and occurrence of adverse events in adult patients with COPD and hypercapnia who had used home NIPPV for >1 month. In their meta-analysis, the researchers included 21 randomized clinical trials and 12 observational studies that had been published between January 1, 1995, and November 6, 2019. The primary study outcomes were mortality, all-cause hospital admissions, need for intubation, and QoL.
A total of 51,085 patients were included (mean age 65.7±2.1 years; 43% women). Of these individuals, 434 deaths were reported and 27 patients underwent intubation.
The use of BPAP devices vs the use of no device was significantly associated with a lower risk for mortality (22.31% vs 28.57%, respectively; odds ratio [OR], 0.66; 95% CI, 0.51-0.87; P =.003), fewer patients with all-cause hospital admissions (39.74% vs 75.00%, respectively; OR, 0.22; 95% CI, 0.11-0.43; P <.001), and a lower need for intubation (5.34% vs 14.71%, respectively; 95% CI, 0.14-0.83; P =.02).
Moreover, the use of noninvasive HMV devices compared with the use of no device was significantly associated with fewer all-cause hospital admissions (rate ratio, 0.50;
95% CI, 0.35-0.71; P <.001) but not with a lower risk for mortality. No statistically significant difference was reported in the number of adverse events in participants using NIPPV vs those using no device (P =.84).
The investigators concluded that despite of the results from this study, “the evidence was low to moderate in quality, the evidence regarding QoL was insufficient, and the analyses for some of the outcomes were based on a small number of studies.”
Wilson ME, Dobler CC, Morrow AS, et al. Association of home noninvasive positive pressure ventilation with clinical outcomes in chronic obstructive pulmonary disease: a systematic review and meta-analysis. JAMA. 2020;323(5):455-465.