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Eur Respir J 2007, doi:10.1183/09031936.00145106
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ORIGINAL ARTICLE |
Systematic review of noninvasive positive pressure ventilation in severe stable COPD
1 NP Pulmonary Medicine, University of Alberta Hospitals, Edmonton, AB
2 Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2G3: Fax: (780) 492-2551 (Fax) E-mail: louise.jensen@ualberta.ca
3 Director of Emergency Medicine, University of Alberta Hospitals, Edmonton, AB
4 Respirologist, Division of Internal Medicine, St. Paul's Hospital
* To whom correspondence should be addressed. E-mail: louise.jensen{at}ualberta.ca.
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Abstract |
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This systematic review examined the effectiveness of bilevel NIPPV in the management of chronic respiratory failure (CRF) due to severe stable COPD.
Randomized controlled trials (RCTs) and non-RCTs (crossover design) of adults with severe stable COPD and CRF receiving bilevel NIPPV via nasal, oronasal, or total face mask were identified from electronic databases and manual screening of journals and reference lists.
Respiratory function (gas exchange, lung function, ventilatory/breathing pattern, respiratory muscle function, and work of breathing) and health-related outcomes (dyspnoea, functional status, exercise tolerance, health related quality of life [HRQOL], morbidity, and mortality) were assessed.
15 studies met inclusion criteria: 6 RCTs and 9 non-RCTs. RCTs did not find improved gas exchange with bilevel NIPPV, while non-RCTs did. Lung hyperinflation and diaphragmatic work of breathing were reduced in a nonrandomized subset. HRQOL and dyspnoea, the least studied outcomes, showed improvement with bilevel NIPPV.
In a subset of individuals on maximal medical treatment regimes for severe stable COPD, bilevel NIPPV may have an adjunctive role in the management of CRF through attenuation of compromised respiratory function and improvement in health-related outcomes.
Keywords: Chronic respiratory failure, COPD, noninvasive positive pressure ventilation, systematic review
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