医学
慢性阻塞性肺病
相对风险
恶化
随机对照试验
鼻插管
荟萃分析
重症监护医学
梅德林
内科学
急诊医学
置信区间
外科
套管
政治学
法学
作者
Tyler Pitre,Saad Abbasi,George V Kachkovski,Lorna Burns,Peter Huan,Jasmine Mah,Claudia Crimi,Andrea Cortegiani,Bram Rochwerg,Dena Zeraatkar
出处
期刊:Respiratory Care
[Daedalus Enterprises]
日期:2024-04-03
卷期号:: respcare.11805-respcare.11805
标识
DOI:10.4187/respcare.11805
摘要
Background: Home non-invasive positive pressure ventilation (NPPV) may improve chronic hypercarbia in COPD and patient important outcomes. The efficacy of home high flow nasal cannula (HFNC) as an alternative is unclear.Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL, SCOPUS, and Clinicaltrials.gov for randomized trials of patients from inception to March 31st and updated the search on July 14, 2023. We performed a frequentist network meta-analysis and assessed the certainty of the evidence using the GRADE approach. We analyzed randomized trials (RCTs) comparing NPPV, HFNC, or standard care in adult COPD patients with chronic hypercapnic respiratory failure. Outcomes included mortality, COPD exacerbations, hospitalizations, and quality of life (SGRQ).Results: We analyzed twenty-four RCTs (1850 patients). We found that NPPV may reduce death risk compared to standard care (relative risk [RR] 0.82 [95% CI 0.66 to 1.00]) and probably reduces acute exacerbations (RR 0.71 [95% CI 0.58 to 0.87]). HFNC probably reduces acute exacerbations compared to standard care (RR 0.77 [0.68 to 0.88]) but its effect on mortality is uncertain (RR 1.20 [95% CI 0.63 to 2.28]). HFNC probably improves SGRQ scores (mean difference [MD] -7.01 [95% CI -12.27 to -1.77]) and may reduce hospitalizations (RR 0.87 [0.69 to 1.09]) compared to standard care. No significant difference was observed between HFNC and NPPV in reducing exacerbations.Conclusion: Both NPPV and HFNC reduce exacerbation risks in COPD patients compared to standard care. HFNC may offer advantages in improving quality of life.
科研通智能强力驱动
Strongly Powered by AbleSci AI