ATLANTA – Long-term nocturnal use of noninvasive positive pressure ventilation significantly reduced the likelihood of intensive care unit admission in patients with severe stable chronic obstructive pulmonary disease, according to findings from a systematic review of 582 patients in 13 randomized, controlled clinical trials.
After 1 year, noninvasive positive pressure ventilation (NIPPV) was associated with a significant decrease in ICU admissions (odds ratio, 0.41) compared with standard medical therapy. Patients using NIPPV for more than 3 months also had improvements in oxygenation (mean difference of -2.43 mm Hg), reduction in PCO2 (mean difference, -2.96 mm Hg), and an improvement in 6-minute walk distance (mean difference 45.15 m), Dr. Monali Patil reported at the annual meeting of the American College of Chest Physicians.
A trend toward improved mortality at 1 year did not reach statistical significance, and no significant improvements in lung function were noted, said Dr. Patil of the University at Buffalo (N.Y.).
Dr. Patil selected the 13 trials from a review of more than 700 studies conducted between 1991 and 2011. The analysis included only randomized, controlled trials of COPD patients who had an FEV1 less than 50% of predicted and a PCO2 greater than 45 mm Hg and were receiving bilevel positive airway pressure (BIPAP). The patients in the studies were aged 18-75 years, and had no COPD exacerbations within 2 weeks prior to study enrollment.
The long-term use of NIPPV in patients with severe stable COPD has been controversial, but these findings demonstrate significant benefits.
"So NIPPV can be used as adjuvant treatment for management of severe stable COPD patients," she concluded.
Dr Patil reported having no financial disclosures.