Noninvasive Ventilators Improve COPD Outcomes

Home bilevel positive airway pressure (BiPAP) is associated with lower risk of mortality, all-cause hospital admission, and intubation, according to a new study.

Researchers at the Mayo Clinic (Rochester, MN, USA) conducted a meta-analysis of randomized clinical trials (RCTs) and comparative observational studies that enrolled adults with chronic obstructive pulmonary disease (COPD) with hypercapnia who used home noninvasive positive pressure ventilation (NIPPV) devices for more than one month in order to evaluate associations between BiPAP and NIPPV devices and long-term outcomes. In all, 33 studies evaluating outcomes for 51,085 patients were included in the analysis.

The primary outcomes including mortality, all-cause hospital admissions, need for intubation, and quality of life. The results revealed that use of a noninvasive ventilator device (either BiPAP or NIPPV) was significantly associated with lower mortality (29.2%) compared to no device (22.3%). The use of a noninvasive ventilator device also led to fewer emergency department visits and hospitalizations, and lower rates of intubation if the patients were subsequently admitted to the hospital. The study was published on February 4, 2020, in JAMA.

“While there does seem to be some clear benefits to using devices such as BiPAP, we should be cautious as the studies included a lot of different types of patients with COPD. We still have a lot more to learn about which machine settings are best for different types of patients,” said lead author pulmonary and critical care physician Michael Wilson, MD. “In addition, although many studies in our review included quality of life measurements, we didn't see an improvement. While some studies showed better quality of life, other studies showed no difference.”

COPD is a debilitating lung disease that makes it difficult to breathe. Many of those who suffer from COPD also suffer from hypercapnia, the retention of carbon dioxide (CO2), a metabolism waste product normally expelled by the lungs during breathing. The combination of COPD and chronic hypercapnia may lead to acute respiratory failure and hospitalization. One of the recommended treatment options is NIPPV using a respiration machine with a mask that helps to improve breathing.

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