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.
journal_name
Int J Chron Obstruct Pulmon Disauthors
Dretzke J,Moore D,Dave C,Mukherjee R,Price MJ,Bayliss S,Wu X,Jordan RE,Turner AMdoi
10.2147/COPD.S104238subject
Has Abstractpub_date
2016-09-16 00:00:00pages
2269-2286eissn
1176-9106issn
1178-2005pii
copd-11-2269journal_volume
11pub_type
杂志文章,meta分析,评审abstract:Background:Phase III studies demonstrated efficacy and safety of nebulized glycopyrrolate inhalation solution (GLY) in subjects with COPD. Secondary analyses were performed to examine the effect of background long-acting beta2-agonist (LABA) use on the efficacy and safety of nebulized GLY. Methods:In two 12-week place...
journal_title:International journal of chronic obstructive pulmonary disease
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.2147/COPD.S172408
更新日期:2018-09-19 00:00:00
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journal_title:International journal of chronic obstructive pulmonary disease
pub_type: 杂志文章,随机对照试验
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journal_title:International journal of chronic obstructive pulmonary disease
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doi:10.2147/COPD.S16975
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doi:10.2147/COPD.S140043
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journal_title:International journal of chronic obstructive pulmonary disease
pub_type: 杂志文章
doi:10.2147/COPD.S91877
更新日期:2015-10-08 00:00:00
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journal_title:International journal of chronic obstructive pulmonary disease
pub_type: 杂志文章
doi:10.2147/COPD.S20067
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doi:10.2147/COPD.S237545
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journal_title:International journal of chronic obstructive pulmonary disease
pub_type: 杂志文章,多中心研究
doi:10.2147/COPD.S99935
更新日期:2016-04-22 00:00:00
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pub_type: 杂志文章
doi:10.2147/COPD.S49521
更新日期:2014-10-15 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
doi:10.2147/COPD.S122382
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pub_type: 杂志文章
doi:10.2147/COPD.S276690
更新日期:2020-12-08 00:00:00
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journal_title:International journal of chronic obstructive pulmonary disease
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.2147/COPD.S72650
更新日期:2015-01-05 00:00:00
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journal_title:International journal of chronic obstructive pulmonary disease
pub_type: 杂志文章,评审
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2018-01-03 00:00:00
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journal_title:International journal of chronic obstructive pulmonary disease
pub_type: 杂志文章,评审
doi:10.2147/COPD.S4215
更新日期:2010-10-05 00:00:00
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journal_title:International journal of chronic obstructive pulmonary disease
pub_type: 杂志文章
doi:10.2147/COPD.S106765
更新日期:2016-06-20 00:00:00
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journal_title:International journal of chronic obstructive pulmonary disease
pub_type: 杂志文章,评审
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更新日期:2014-02-27 00:00:00
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pub_type: 杂志文章
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更新日期:2017-07-18 00:00:00
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pub_type: 杂志文章
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更新日期:2016-01-29 00:00:00
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journal_title:International journal of chronic obstructive pulmonary disease
pub_type: 杂志文章,评审
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更新日期:2014-02-24 00:00:00