Janine Dretzke1, Jingya Wang1, Mi Yao1, Naijie Guan1, Myra Ling2, Erica Zhang2, Deyashini Mukherjee3, James Hall4, Sue Jowett4, Rahul Mukherjee5, David J Moore1, Alice M Turner1,5. 1. Institute of Applied Health Research, University of Birmingham, United Kingdom. 2. Birmingham Medical School, University of Birmingham, United Kingdom. 3. University Hospitals Coventry and Warwickshire, United Kingdom. 4. Health Economics Unit, Institute of Applied Health Research, University of Birmingham, United Kingdom. 5. University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
Abstract
Background: Uncertainty remains around the benefit of home non-invasive ventilation (NIV) for stable chronic obstructive pulmonary disease (COPD) patients and those with a recent exacerbation (post-hospital). The aim of this systematic review was to: (1) update the evidence base with studies published in any language, including Chinese language studies not indexed in standard medical databases, and (2) explore the impact of additional studies on the evidence base. Methods: Standard systematic review methodology was used for identifying and appraising studies. Randomized controlled trials (RCTs) and non-randomized studies reporting mortality, hospitalizations, exacerbations, quality of life, adverse events, or adherence were included. Random effects meta-analysis was undertaken for mortality and hospitalizations, with studies sub-grouped by population and study design. Sensitivity analysis was performed to explore the effect of including studies from Western and non-Western countries. Results: A total of 103 studies were included, substantially more than in previous reviews. There was no significant effect on mortality for the stable population. There was a benefit from NIV for the post-hospital population based on non-randomized studies, or RCTs from non-Western countries. There was a small but significant reduction in hospital admissions (1-2/year) with NIV across all sub-groups, and a variable reduction in duration of stay with greater reductions in studies from China. Conclusions: The evidence base on home NIV is considerably larger than previously presented. While NIV may reduce hospital admissions and improve quality of life, there is still little evidence of a reduction in mortality, regardless of country. Individual participant data analysis may clarify which patients would benefit most from NIV. JCOPDF
Background: Uncertainty remains around the benefit of home non-invasive ventilation (NIV) for stable chronic obstructive pulmonary disease (COPD) patients and those with a recent exacerbation (post-hospital). The aim of this systematic review was to: (1) update the evidence base with studies published in any language, including Chinese language studies not indexed in standard medical databases, and (2) explore the impact of additional studies on the evidence base. Methods: Standard systematic review methodology was used for identifying and appraising studies. Randomized controlled trials (RCTs) and non-randomized studies reporting mortality, hospitalizations, exacerbations, quality of life, adverse events, or adherence were included. Random effects meta-analysis was undertaken for mortality and hospitalizations, with studies sub-grouped by population and study design. Sensitivity analysis was performed to explore the effect of including studies from Western and non-Western countries. Results: A total of 103 studies were included, substantially more than in previous reviews. There was no significant effect on mortality for the stable population. There was a benefit from NIV for the post-hospital population based on non-randomized studies, or RCTs from non-Western countries. There was a small but significant reduction in hospital admissions (1-2/year) with NIV across all sub-groups, and a variable reduction in duration of stay with greater reductions in studies from China. Conclusions: The evidence base on home NIV is considerably larger than previously presented. While NIV may reduce hospital admissions and improve quality of life, there is still little evidence of a reduction in mortality, regardless of country. Individual participant data analysis may clarify which patients would benefit most from NIV. JCOPDF
Authors: A Craig Davidson; Stephen Banham; Mark Elliott; Daniel Kennedy; Colin Gelder; Alastair Glossop; Alistair Colin Church; Ben Creagh-Brown; James William Dodd; Tim Felton; Bernard Foëx; Leigh Mansfield; Lynn McDonnell; Robert Parker; Caroline Marie Patterson; Milind Sovani; Lynn Thomas Journal: Thorax Date: 2016-04 Impact factor: 9.139
Authors: Chirag Dave; Simon Wharton; Rahul Mukherjee; Bandar M Faqihi; Robert A Stockley; Alice M Turner Journal: Can Respir J Date: 2021-02-22 Impact factor: 2.409