Objective To determine the efficacy and prognosis of noninvasive positive pressure ventilation (NPPV) in exacerbations of chronic obstructive pulmonary disease (COPD).
Methods Trials were located through electronic searches of MEDLINE, EMBASE, Springer, and Foreign Journals Integration System (from the start date to March 2008). We also checked the bibliographies of retrieved articles. Statistical analysis was performed with The Cochrane Collaboration’s software RevMan 4.2.10.
Results A total of 19 trials involving 1 236 patients were included. Results showed that: (1) NPPV vs. conventional therapy: NPPV was superior to conventional therapy in terms of intubation rate (RR 0.36, 95%CI 0.27 to 0.49), failure rate (RR 0.62, 95%CI 0.43 to 0.90), and mortality (RR 0.49, 95%CI 0.34 to 0.69). The length of hospital stay was shorter in the NPPV group compared with the conventional group (WMD – 3.83, 95%CI – 5.78 to – 1.89), but the length of ICU stay was similar. The changes of PaO2, PaCO2, and pH were much more obvious in the NPPV group compared with the conventional group. The change of respiratory rate was more significant in the NPPV group compared with the conventional group (WMD – 3.75, 95%CI – 5.48 to – 2.03). At discharge and follow-up, there were no significant differences in FEV1, pH, PaCO2, PaO2, and vital capacity between the two groups. (2) NPPV vs. invasive ventilation: the mortality was similar between the two groups. The incidence of complications was lower in the NPPV group compared with the invasive group (RR 0.38, 95%CI 0.20 to 0.73). The length of ICU stay, duration of mechanical ventilation, and weaning time were shorter in the NPPV group than those of the invasive group. At discharge and follow-up, clinical conditions were similar between the two groups.
Conclusion The limited current evidence showed that NPPV was superior to conventional therapy in improving intubation rate, mortality, short term of blood-gas change, the change of respiratory rate; and superior to invasive ventilation in the length of hospital stay and the incidence of complication. There were no difference among them in discharge and follow-up.
Citation: SUN Jiehao,HAN Ning,WU Xiuying. Noninvasive Positive Pressure Ventilation in Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(12): 1112-1121. doi: 10.7507/1672-2531.20080241 Copy
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