TY - JOUR
T1 - Home non-invasive ventilation in COPD
T2 - a global systematic review
AU - Dretzke, Janine
AU - Wang, Jingya
AU - Yao, Mi
AU - Guan, Naijie
AU - Ling, Myra
AU - Zhang, Erica
AU - Mukherjee, Deyashini
AU - Hall, James
AU - Jowett, Sue
AU - Mukherjee, Rahul
AU - Moore, David J
AU - Turner, Alice M
PY - 2022/4/29
Y1 - 2022/4/29
N2 - Background: Uncertainty remains around the benefit of home non-invasive ventilation (NIV) for stable chronic obstructive pulmonary disease (COPD) patients and those with a recent exacerbation (post-hospital). The aim of this systematic review was to: (1) update the evidence base with studies published in any language, including Chinese language studies not indexed in standard medical databases, and (2) explore the impact of additional studies on the evidence base. Methods: Standard systematic review methodology was used for identifying and appraising studies. Randomized controlled trials (RCTs) and non-randomized studies reporting mortality, hospitalizations, exacerbations, quality of life, adverse events, or adherence were included. Random effects meta-analysis was undertaken for mortality and hospitalizations, with studies sub-grouped by population and study design. Sensitivity analysis was performed to explore the effect of including studies from Western and non-Western countries. Results: A total of 103 studies were included, substantially more than in previous reviews. There was no significant effect on mortality for the stable population. There was a benefit from NIV for the post-hospital population based on non-randomized studies, or RCTs from non-Western countries. There was a small but significant reduction in hospital admissions (1–2/year) with NIV across all sub-groups, and a variable reduction in duration of stay with greater reductions in studies from China. Conclusion: The evidence base on home NIV is considerably larger than previously presented. While NIV may reduce hospital admissions and improve quality of life, there is still little evidence of a reduction in mortality, regardless of country. Individual participant data analysis may clarify which patients would benefit most from NIV.
AB - Background: Uncertainty remains around the benefit of home non-invasive ventilation (NIV) for stable chronic obstructive pulmonary disease (COPD) patients and those with a recent exacerbation (post-hospital). The aim of this systematic review was to: (1) update the evidence base with studies published in any language, including Chinese language studies not indexed in standard medical databases, and (2) explore the impact of additional studies on the evidence base. Methods: Standard systematic review methodology was used for identifying and appraising studies. Randomized controlled trials (RCTs) and non-randomized studies reporting mortality, hospitalizations, exacerbations, quality of life, adverse events, or adherence were included. Random effects meta-analysis was undertaken for mortality and hospitalizations, with studies sub-grouped by population and study design. Sensitivity analysis was performed to explore the effect of including studies from Western and non-Western countries. Results: A total of 103 studies were included, substantially more than in previous reviews. There was no significant effect on mortality for the stable population. There was a benefit from NIV for the post-hospital population based on non-randomized studies, or RCTs from non-Western countries. There was a small but significant reduction in hospital admissions (1–2/year) with NIV across all sub-groups, and a variable reduction in duration of stay with greater reductions in studies from China. Conclusion: The evidence base on home NIV is considerably larger than previously presented. While NIV may reduce hospital admissions and improve quality of life, there is still little evidence of a reduction in mortality, regardless of country. Individual participant data analysis may clarify which patients would benefit most from NIV.
KW - COPD
KW - Systematic review
KW - home non-invasive ventilation
KW - meta-analysis
KW - systematic review
UR - https://journal.copdfoundation.org/JCOPDF-Policies
UR - http://www.scopus.com/inward/record.url?scp=85130912284&partnerID=8YFLogxK
U2 - 10.15326/jcopdf.2021.0242
DO - 10.15326/jcopdf.2021.0242
M3 - Review article
C2 - 35259290
SN - 2372-952X
VL - 9
SP - 237
EP - 251
JO - Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation
JF - Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation
IS - 2
ER -