Non-invasive ventilation for people with respiratory failure due to exacerbation of chronic obstructive pulmonary disease (COPD)

Updated
Authors: 
Osadnik CR, Tee VS, Carson-Chahhoud KV, Picot J, Wedzicha JA, Smith BJ

Why is this question important?

When people have a severe attack of COPD, their breathing becomes very difficult. This can turn into breathing failure (acute hypercapnic respiratory failure (AHRF)) that often requires urgent hospital-based medical care. One of the treatments that may be given is breathing support (intubation and mechanical ventilation). This involves delivery of air and/or oxygen via a ventilator connected to a tube inserted down the throat and into the lungs. This is undoubtedly a lifesaving procedure for patients with severe life-threatening exacerbations of COPD, but it is associated with several possible unwanted side effects.

Non-invasive ventilation (NIV) involves delivery of breathing support via a ventilator connected to a nose mask or a face mask. NIV is used more frequently nowadays to help such patients in many hospitals. This review aimed to determine the effectiveness of adding NIV to usual care for this patient group.

How did we answer the question?

We reviewed all available evidence up to January 2017 regarding effects of NIV combined with usual care compared with usual care alone (involving no ventilation). Because up to 20% of people with COPD who have respiratory failure can die from it, we looked at the number of deaths as the primary outcome. We also looked at need for intubation and time spent in hospital.

What did we find?

We included information from 17 clinical trials involving a total of 1264 patients. Compared with usual care in this patient group, we found that NIV was more beneficial for reducing deaths and the number of patients who needed to be intubated. On average, risk of dying was reduced by 46% and risk of needing intubation was reduced by 65%. Reviewers rated the quality of evidence for both of these findings as 'moderate' (according to GRADE criteria). People who had NIV spent an average of three and a half days less in hospital than those who did not.

Conclusion

This review provides convincing evidence to support the use of NIV as an effective treatment strategy for patients admitted to hospital for acute exacerbations of COPD and respiratory failure.

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