The effect of domiciliary noninvasive ventilation on clinical outcomes in stable and recently hospitalized patients with COPD: a systematic review and meta-analysis

Janine Dretzke, David Moore, Chirag Dave, Rahul Mukherjee, Malcolm J Price, Sue Bayliss, Xiaoying Wu, Rachel E Jordan, Alice M Turner, Janine Dretzke, David Moore, Chirag Dave, Rahul Mukherjee, Malcolm J Price, Sue Bayliss, Xiaoying Wu, Rachel E Jordan, Alice M Turner

Abstract

Introduction: Noninvasive ventilation (NIV) improves survival among patients with hypercapnic respiratory failure in hospital, but evidence for its use in domiciliary settings is limited. A patient's underlying risk of having an exacerbation may affect any potential benefit that can be gained from domiciliary NIV. This is the first comprehensive systematic review to stratify patients based on a proxy for exacerbation risk: patients in a stable state and those immediately post-exacerbation hospitalization.

Methods: A systematic review of nonrandomized and randomized controlled trials (RCTs) was undertaken in order to compare the relative effectiveness of different types of domiciliary NIV and usual care on hospital admissions, mortality, and health-related quality of life. Standard systematic review methods were used for identifying studies (until September 2014), quality appraisal, and synthesis. Data were presented in forest plots and pooled where appropriate using random-effects meta-analysis.

Results: Thirty-one studies were included. For stable patients, there was no evidence of a survival benefit from NIV (relative risk [RR] 0.88 [0.55, 1.43], I2=60.4%, n=7 RCTs), but there was a possible trend toward fewer hospitalizations (weighted mean difference -0.46 [-1.02, 0.09], I2=59.2%, n=5 RCTs) and improved health-related quality of life. For posthospital patients, survival benefit could not be demonstrated within the three RCTs (RR 0.89 [0.53, 1.49], I2=25.1%), although there was evidence of benefit from four non-RCTs (RR 0.45 [0.32, 0.65], I2=0%). Effects on hospitalizations were inconsistent. Post hoc analyses suggested that NIV-related improvements in hypercapnia were associated with reduced hospital admissions across both populations. Little data were available comparing different types of NIV.

Conclusion: The effectiveness of domiciliary NIV remains uncertain; however, some patients may benefit. Further research is required to identify these patients and to explore the relevance of improvements in hypercapnia in influencing clinical outcomes. Optimum time points for commencing domiciliary NIV and equipment settings need to be established.

Keywords: COPD; domiciliary; hospitalization; meta-analysis; noninvasive ventilation; systematic review.

Figures

Figure 1
Figure 1
PRISMA flow diagram (study selection process). Abbreviations: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCTs, randomized controlled trials; NIV, noninvasive ventilation.
Figure 2
Figure 2
Mortality (relative risk). Notes: *Calculated by authors of this report. +Controlled study with matching. Abbreviations: RR, relative risk; CI, confidence interval; RCT, randomized controlled trial; NIV, noninvasive ventilation.
Figure 3
Figure 3
Hospital admissions per patient per year (weighted mean difference). Notes: *Calculated by authors of this report. #Individual mean differences (95% CI) presented for this outcome. Abbreviations: CI, confidence interval; WMD, weighted mean difference; RCTs, randomized controlled trials; ICU, intensive care unit; NIV, noninvasive ventilation.
Figure 4
Figure 4
PaO2 (mean difference). Notes: *Calculated by authors of this report. aMeasurement performed regardless of oxygen use. bMeasurements both on room air or both on oxygen at the same flow rate. Abbreviations: PaO2, partial pressure of oxygen; NIV, noninvasive ventilation; CI, confidence interval; NR, not reported.
Figure 5
Figure 5
PaCO2 (mean difference). Notes: *Calculated by authors of this report. aMeasurement performed regardless of oxygen use. bMeasurements both on room air or both on oxygen at the same flow rate. Abbreviations: PaCO2, partial pressure of carbon dioxide; NIV, noninvasive ventilation; CI, confidence interval.
Figure 6
Figure 6
Hypercapnia and clinical outcomes. Notes: (A) Mortality (RR) and baseline PaCO2. (B) Mortality (RR) and change in PaCO2. (C) Hospital admissions (MD) and baseline PaCO2. (D) Hospital admissions (MD) and change in PaCO2. Abbreviations: RR, relative risk; PaCO2, partial pressure of carbon dioxide; MD, mean difference.

References

    1. Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187(4):347–365.
    1. Seemungal T, Donaldson G, Paul E, Bestall J, Jeffries D, Wedzicha J. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157(5 Pt 1):1418–1422.
    1. Britton M. The burden of COPD in the U.K.: results from the Confronting COPD survey. Respir Med. 2003;97(Suppl C):S71–S79.
    1. Roberts CM, Lowe D, Bucknall CE, Ryland I, Kelly Y, Pearson MG. Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease. Thorax. 2002;57(2):137–141.
    1. Connors AF, Jr, Dawson NV, Thomas C, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) Am J Respir Crit Care Med. 1996;154(4):959–967.
    1. National Institute for Clinical Excellence (NICE) Chronic obstructive pulmonary disease: national clinical guideline for management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax. 2004;59(Suppl 1):1–232.
    1. Ram FS, Picot J, Lightowler J, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2004;1:CD004104.
    1. Struik FM, Lacasse Y, Goldstein RS, Kerstjens HA, Wijkstra PJ. Nocturnal noninvasive positive pressure ventilation in stable COPD: a systematic review and individual patient data meta-analysis. Respir Med. 2014;108(2):329–337.
    1. Struik FM, Lacasse Y, Goldstein R, Kerstjens HM, Wijkstra PJ. Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013;6:CD002878.
    1. Shi JX, Xu J, Sun WK, Su X, Zhang Y, Shi Y. Effect of noninvasive, positive pressure ventilation on patients with severe, stable chronic obstructive pulmonary disease: a meta-analysis. Chin Med J (Engl) 2013;126(1):140–146.
    1. Chandra K, Blackhouse G, McCurdy B, et al. Cost-effectiveness of interventions for chronic obstructive pulmonary disease (COPD) using an Ontario policy model. Ont Health Technol Assess Ser. 2012;12(12):1–61.
    1. Mullerova H, Maselli DJ, Locantore N, et al. Hospitalized exacerbations of COPD: risk factors and outcomes in the ECLIPSE cohort. Chest. 2015;147(4):999–1007.
    1. Dave C, Turner A, Dretzke J, et al. Protocol for a systematic review and economic evaluation of the clinical and cost-effectiveness of non-hospital-based non-invasive ventilation (NIV) in patients with stable end-stage COPD with hypercapnic respiratory failure. Syst Rev. 2014;3:32.
    1. Janine D, David M, Alice T, et al. Systematic review and economic evaluation of the clinical and cost-effectiveness of community based non-invasive ventilation (NIV) in patients with stable end stage COPD with hypercapnic respiratory failure. PROSPERO 2012:CRD42012003286. Available from: .
    1. Higgins JPT, Deeks JJ, Altman D, Gobot CSMG. Special topics in statistics. [Accessed October 23, 2012]. Available from:
    1. Ottawa Hospital Research Institute PRISMA. Transparent reporting of systematic reviews and meta-analyses. [Accessed October 17, 2012]. Available from:
    1. Bhatt SP, Peterson MW, Wilson JS, Durairaj L. Noninvasive positive pressure ventilation in subjects with stable COPD: a randomized trial. Int J Chron Obstruct Pulmon Dis. 2013;8:581–589.
    1. Garrod R, Mikelsons C, Paul EA, Wedzicha JA. Randomized controlled trial of domiciliary noninvasive positive pressure ventilation and physical training in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000;162(4 Pt 1):1335–1341.
    1. Casanova C, Celli BR, Tost L, et al. Long-term controlled trial of nocturnal nasal positive pressure ventilation in patients with severe COPD. Chest. 2000;118(6):1582–1590.
    1. Duiverman ML, Wempe JB, Bladder G, et al. Nocturnal non-invasive ventilation in addition to rehabilitation in hypercapnic patients with COPD. Thorax. 2008;63(12):1052–1057.
    1. Duiverman ML, Wempe JB, Bladder G, et al. Two-year home-based nocturnal noninvasive ventilation added to rehabilitation in chronic obstructive pulmonary disease patients: a randomized controlled trial. Respir Res. 2011;12(1):112.
    1. Clini E, Vitacca M, Foglio K, Simoni P, Ambrosino N. Long-term home care programmes may reduce hospital admissions in COPD with chronic hypercapnia. Eur Respir J. 1996;9(8):1605–1610.
    1. Köhnlein T, Windisch W, Köhler D, et al. Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial. Lancet Respir Med. 2014;2(9):698–705.
    1. Zhou X, Yang J, Shen C. Effect of non-invasive positive pressure ventilation and long-term oxygen therapy in patients with stable COPD. Clin Med J China. 2008;15(4):486–488.
    1. Kamiński D, Sliwiński P, Bieleń P, Zieliński J. [Noninvasive positive pressure ventilation in COPD patients with hypercapnic respiratory failure]. Nieinwazyjne wspomaganie wentylacji dodatnim ciśnieniem u chorych na POChP w okresie hiperkapnicznej niewydolności oddychania. Pneumonol Alergol Pol. 1999;67:45–52. Polish.
    1. McEvoy RD, Pierce RJ, Hillman D, et al. Nocturnal non-invasive nasal ventilation in stable hypercapnic COPD: a randomised controlled trial. Thorax. 2009;64(7):561–566.
    1. Clini E, Sturani C, Rossi A, et al. The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients. Eur Respir J. 2002;20(3):529–538.
    1. Clini E, Sturani C, Porta R, et al. Outcome of COPD patients performing nocturnal non-invasive mechanical ventilation. Respir Med. 1998;92(10):1215–1222.
    1. Tsolaki V, Pastaka C, Karetsi E, et al. One-year non-invasive ventilation in chronic hypercapnic COPD: effect on quality of life. Respir Med. 2008;102(6):904–911.
    1. Paone G, Conti V, Biondi-Zoccai G, et al. Long-term home noninvasive mechanical ventilation increases systemic inflammatory response in chronic obstructive pulmonary disease: a prospective observational study. Mediators Inflamm. 2014;2014:503145.
    1. Cheung AP, Chan VL, Liong JT, et al. A pilot trial of non-invasive home ventilation after acidotic respiratory failure in chronic obstructive pulmonary disease. Int J Tuberc Lung Dis. 2010;14(5):642–649.
    1. Struik FM, Sprooten RT, Kerstjens HA, et al. Nocturnal non-invasive ventilation in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure: a randomised, controlled, parallel-group study. Thorax. 2014;69(9):826–834.
    1. Xiang PC, Zhang X, Yang JN, et al. The efficacy and safety of long term home noninvasive positive pressure ventilation in patients with stable severe chronic obstructive pulmonary disease. Zhonghua Jie He He Hu Xi Za Zhi. 2007;30(10):746–750. Chinese.
    1. Lu P, Wu XM, Li ZG, Yang CC. Clinical observation of home noninvasive positive pressure ventilation in hypercapnic patient with stable severe chronic obstructive pulmonary disease. Zhonghua Yi Xue Za Zhi. 2012;92(6):401–404. Chinese.
    1. Heinemann F, Budweiser S, Jorres RA, et al. The role of non-invasive home mechanical ventilation in patients with chronic obstructive pulmonary disease requiring prolonged weaning. Respirology. 2011;16(8):1273–1280.
    1. Budweiser S, Hitzl AP, Jorres RA, et al. Impact of noninvasive home ventilation on long-term survival in chronic hypercapnic COPD: a prospective observational study. Int J Clin Pract. 2007;61(9):1516–1522.
    1. Milane J, Jonquet O. Intermittent positive pressure breathing in the treatment of respiratory insufficiency by chronic lung disease. Agressologie. 1985;26(8):651–655.
    1. Dreher M, Storre JH, Schmoor C, Windisch W. High-intensity versus low-intensity non-invasive ventilation in patients with stable hypercapnic COPD: a randomised crossover trial. Thorax. 2010;65(4):303–308.
    1. Oscroft NS, Ali M, Gulati A, et al. A randomised crossover trial comparing volume assured and pressure preset noninvasive ventilation in stable hypercapnic COPD. COPD. 2010;7(6):398–403.
    1. Murphy PB, Brignall K, Moxham J, Polkey MI, Davidson AC, Hart N. High pressure versus high intensity noninvasive ventilation in stable hypercapnic chronic obstructive pulmonary disease: a randomized crossover trial. Int J Chron Obstruct Pulmon Dis. 2012;7:811–818.
    1. Meecham-Jones DJ, Paul EA, Jones PW, Wedzicha JA. Nasal pressure support ventilation plus oxygen compared with oxygen therapy alone in hypercapnic COPD. Am J Respir Crit Care Med. 1995;152(2):538–544.
    1. Turner AM, Tamasi L, Schleich F, et al. Clinically relevant subgroups in COPD and asthma. Eur Respir Rev. 2015;24(136):283–298.
    1. Hurst JR, Vestbo J, Anzueto A, et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010;363(12):1128–1138.
    1. Yang H, Xiang P, Zhang E, et al. Predictors of exacerbation frequency in chronic obstructive pulmonary disease. Eur J Med Res. 2014;19(1):18.
    1. Chung LP, Winship P, Phung S, Lake F, Waterer G. Five-year outcome in COPD patients after their first episode of acute exacerbation treated with non-invasive ventilation. Respirology. 2010;15(7):1084–1091.
    1. Gale N, Jawad M, Dave C, Turner AM. Adapting to domiciliary non-invasive ventilation in chronic obstructive pulmonary disease: a qualitative interview study. Palliat Med. 2015;29(3):268–277.
    1. Costello R, Deegan P, Fitzpatrick M, McNicholas WT. Reversible hypercapnia in chronic obstructive pulmonary disease: a distinct pattern of respiratory failure with a favorable prognosis. Am J Med. 1997;102(3):239–244.
    1. Tuggey JM, Plant PK, Elliott MW. Domiciliary non-invasive ventilation for recurrent acidotic exacerbations of COPD: an economic analysis. Thorax. 2003;58(10):867–871.
    1. Funk GC, Breyer MK, Burghuber OC, et al. Long-term non-invasive ventilation in COPD after acute-on-chronic respiratory failure. Respir Med. 2011;105(3):427–434.
    1. Oscroft NS, Quinnell TG, Shneerson JM, Smith IE. The effects of withdrawing long-term nocturnal non-invasive ventilation in COPD patients. COPD. 2010;7(2):111–116.
    1. Gay PC, Hubmayr RD, Stroetz RW. Efficacy of nocturnal nasal ventilation in stable, severe chronic obstructive pulmonary disease during a 3-month controlled trial. Mayo Clin Proc. 1996;71(6):533–542.
    1. Sin DD, Wong E, Mayers I, et al. Effects of nocturnal noninvasive mechanical ventilation on heart rate variability of patients with advanced COPD. Chest. 2007;131(1):156–163.
    1. Strumpf DA, Millman RP, Carlisle CC, et al. Nocturnal positive-pressure ventilation via nasal mask in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis. 1991;144(6):1234–1239.
    1. De Backer L, Vos W, Dieriks B, et al. The effects of long-term noninvasive ventilation in hypercapnic COPD patients: a randomized controlled pilot study. Int J Chron Obstruct Pulmon Dis. 2011;6:615–624.
    1. Murphy PB, Moxham J, Polkey MI, Hart N. UK HOT-HMV trial: acceptability and tolerability of high pressure domiciliary non-invasive ventilation (NIV) in COPD. Thorax. 2011;66:A55.
    1. Laier-Groeneveld G, Criee CP. [Long-term effects and life expectancy after six years intermittent self ventilation]. Langzeiteffekte und Lebenserwartung nach sechs Jahren unter intermittierender Selbstbeatmung. Med Klin (Munich) 1995;90(1 Suppl):62–63. German.
    1. Pahnke J, Bullemer F, Heindl S, Karg O. [Patient-related rejection of nasal IPPV therapy. Patients, reasons, follow-up]. Patientenbedingte Ablehnung der nasalen IPPV-Therapie. Patienten, Gründe, Verlauf. Med Klin (Munich) 1997;92(Suppl 1):73–74. German.

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