Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease

Wijkstra PPJ, Lacasse Y, Guyatt GH, Goldstein R, Struik F

Published Online:

January 21, 2009

This review evaluated the benefits of nocturnal NIPPV (non invasive positive pressure ventilation) in COPD patients on lung function, blood gases, six minute walking distance (6MWD), dyspnoea (during daily activities), health status (health-related quality of life measurements), sleep efficiency and respiratory muscle function.

Nocturnal NIPPV for at least three months in patients with COPD who have raised levels of carbon dioxide had no clinically or statistically significant effect on lung function, gas exchange, respiratory muscle strength or sleep efficiency. The high upper limit of the confidence interval for the 6MWD suggested that some people might improve their walking distance. However, the small overall sample size did not allow any definite conclusion regarding the effects of NIPPV in COPD.

Abstract (click to read)

Background:

Nocturnal non-invasive positive pressure ventilation (NIPPV) might be beneficial in stable hypercapnic patients with chronic obstructive pulmonary disease (COPD). However, evidence remains equivocal as conflicting results have been published.

Objectives:

To determine the effect of nocturnal non-invasive positive pressure ventilation via nasal mask or face mask in patients with COPD.

Search strategy:

We carried out an initial search on the Cochrane Airways Group COPD trials register using the search terms: (nasal ventilat* OR positive pressure OR NIPPV). We also handsearched abstracts from meetings of the American Thoracic Society, British Thoracic Society and European Respiratory Society.

Selection criteria:

Randomised controlled trials in stable patients with COPD that compared nocturnal non-invasive positive pressure ventilation plus standard therapy with standard therapy alone.

Data collection and analysis:

Two reviewers performed data extraction working independently.

Main results:

The only outcome for which the 95% confidence interval excluded zero was maximal inspiratory pressure (PI max). The 95% confidence interval (CI) of the other outcomes included zero. These included forced expiratory volume in one second (FEV1), forced vital capacity (FVC), partial pressure of CO2 in arterial blood (PaCO2), sleep efficiency and 6-minute walking distance (6MWD). The mean effect on 6MWD was modest at 27.5 m, but the 95% CI were wide (-28.1 to 81.8 m) suggesting that some patients had a big improvement. Such patients could not be identified a priori.

Authors' conclusions:

Nocturnal NIPPV for at least three months in hypercapnic patients with stable COPD had no consistent clinically or statistically significant effect on lung function, gas exchange, respiratory muscle strength, sleep efficiency or exercise tolerance. However, the small sample sizes of these studies precludes a definite conclusion regarding the effects of NIPPV in COPD.

This record should be cited as:

Wijkstra PPJ, Lacasse Y, Guyatt GH, Goldstein R, Struik F. Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD002878. DOI: 10.1002/14651858.CD002878

Assessed as up to date:

January 2, 2002

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Primary Review Group:

Airways Group

Health topics:

Lungs & airways > Chronic obstructive pulmonary disease (stable) > Ventilation & oxygen

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease

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