SESSION TYPE: New Insights into COPD
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: The long-term nocturnal use of NIPPV in severe stable COPD patients remains controversial. The purpose of this study is to determine the effectiveness of NIPPV in management of severe stable COPD patients.
METHODS: We conducted a systematic review of RCTs that compared use of NIPPV with standard medical treatment in severe stable COPD Patients. RCTs were identified from PUBMED, using the criteria “Bi-level”, “NIPPV”, “Nasal ventilation OR Biphasic positive pressure ventilation” and reference list. Only studies with severe COPD patients with FEV1 < 50% predicted and PCO2 > 45 mm Hg receiving BIPAP were included in this review. Outcome measured included mortality, morbidity (recurrent COPD exacerbations, hospital re-admission, ICU readmission), lung function, gas exchange, respiratory muscle function, exercise tolerance and health related quality of life measures (HRQOL).
RESULTS: Out of the 714 studies reviewed only 13 RCTs were included in this review. Total of 582 patients were studied. Use of NIPPV varied from less than 1 month up to 2 years. Compared to standard medical treatment, NIPPV showed a trend in reducing mortality at 1 yr, but the difference was not statistically significant (0.91, 95% C.I. [0.71, 1.16]), however, there was a significant decrease in ICU admission at 1 yr (odds ratio of 0.41,95% C.I [0.17, 0.97]). Use of NIPPV showed improvement in oxygenation (mean difference 2.43 mm Hg, 95% C.I [0.65, 4.21] and reduction in PCO2 when used for more than 3 months (mean difference of -2.96 mm Hg ,95% C.I [-5.21, -0.71]). NIPPV use did not show any significant benefit in improving lung function, but did showed improvement in exercise tolerance test with 6MWD (mean difference 45.15 m, 95% C.I. [14.75, 75.55]).
CONCLUSIONS: Nocturnal use of NIPPV showed significant benefit in improving gas exchange, exercise tolerance and reduction in ICU admission.
CLINICAL IMPLICATIONS: NIPPV can be used as adjuvant treatment for management of severe stable COPD patients.
DISCLOSURE: The following authors have nothing to disclose: Monali Patil, Ali El Solh
No Product/Research Disclosure InformationUniversity at Buffalo, Buffalo, NY