Systematic Review Of High-intensity Noninvasive Positive Pressure Ventilation In The Treatment Of Stable Chronic Obstructive Pulmonary Disease With Hypercapnia

Objective This is a meta-analysis of the efficacy of long-term high-intensity noninvasive positive pressure ventilation in the treatment of patients with stable chronic obstructive pulmonary disease and hypercapnia.Methods Using "noninvasive positive pressure ventilation,non-invasive ventilation,home mechanical ventilation,NPPV,NIV,NIPPV,COPD,Chronic obstructive pulmonary disease,High-intensity,high-intensity noninvasive positive pressure ventilation,hypercapnia,carbon dioxide,exacerbation,mortality" as key words both in Chinese and English to search all the trials in PubMed,OVID,Embase and Cochrane Library,CBM,CNKI and Wanfang Database from the establishment of the database to December 2019.Two researchers independently read the literature and included randomized controlled trials and cohort studies that met the requirements.Revman 5.3.3 was used to carry out combined statistical analysis on the data.Results six randomized controlled trials and one cohort trial were included.Meta-analysis results show that,compared with low-intensity NPPV,long-term high-intensity NPPV treatment can improve hypercapnia in patients with stable COPD(MD =-4.52,95% CI(-5.86,-3.18),P<0.00001),the frequency of acute exacerbations(MD =-0.24,95% CI(-0.46,-0.02),P = 0.03),There was no statistically significant improvement in lung function and dyspnea symptoms,FEV1% pre(MD =0.79,95% CI(-2.68,4.26),P = 0.66),dyspnea symptoms(MD =-0.17,95%CI(-0.43,0.09),P = 0.20).Conclusion Long-term high-intensity NPPV treatment can significantly reduce hypercapnia in patients with stable COPD,reduce the frequency of acute exacerbations in COPD patients.However,after 1 year of treatment with high-intensity NPPV,there was no significant improvement in lung function and dyspnea symptoms.In view of the poor quantity and quality of the included studies,more large,multi-center,long-term randomized controlled trials need to be validated to better evaluate the application of high-intensity NPPV in the treatment of stable COPD patients with hypercapnia.