Uncertain benefit of home noninvasive positive pressure ventilation for adults with chronic obstructive pulmonary disease

Référence

Wilson ME, Dobler CC, Morrow AS, et al. Association of home noninvasive positive pressure ventilation with clinical outcomes in chronic obstructive pulmonary disease. A systematic review and meta-analysis. JAMA 2020;323(5):455-465.

Sommaire

Although in-hospital use of NIPPV for acute COPD exacerbation reduces morbidity and mortality, the benefit of home use remains uncertain. These investigators thoroughly searched multiple databases, including MEDLINE, EMBASE, the Cochrane Registrar, ClinicalTrials.gov, conference proceedings, and relevant publications, for English language–only randomized trials and comparative studies that evaluated home-based NIPPV. Eligible studies included adults aged at least 18 years with chronic hypercapnic respiratory failure due to COPD who received NIPPV supplied by a home mechanical ventilator or BPAP device for at least 1 month. Two individuals independently performed the search strategy and reviewed trials for inclusion eligibility. Disagreements were resolved through discussion with a third reviewer. Individual trials were assessed for risk of bias using standard scoring tools. A total of 21 randomized controlled trials and 12 observational studies (n = 51,085) met the inclusion criteria. All studies enrolled patients in the home setting, with no studies enrolling patients in assisted living settings. The authors rated the overall risk of bias moderate to high and they performed no formal analysis for publication bias because of the low number of included studies. Home BPAP compared with no device was significantly associated with lower risk of mortality (22.3% vs 28.6%, respectively; number needed to treat = 15), but no significant difference in quality of life. A home mechanical ventilator compared with no device was significantly associated with fewer hospital admissions in one study, but no significant differences in mortality or quality of life.