Home noninvasive ventilation in severe COPD: in whom does it work and how?
ERJ Open Res
; 10(1)2024 Jan.
Article
en En
| MEDLINE
| ID: mdl-38348241
ABSTRACT
Background:
Not all hypercapnic COPD patients benefit from home noninvasive ventilation (NIV), and mechanisms through which NIV improves clinical outcomes remain uncertain. We aimed to identify "responders" to home NIV, denoted by a beneficial effect of NIV on arterial partial pressure of carbon dioxide (PaCO2), health-related quality of life (HRQoL) and survival, and investigated whether NIV achieves its beneficial effect through an improved PaCO2.Methods:
We used individual patient data from previous published trials collated for a systematic review. Linear mixed-effect models were conducted to compare the effect of NIV on PaCO2, HRQoL and survival, within subgroups defined by patient and treatment characteristics. Secondly, we conducted a causal mediation analysis to investigate whether the effect of NIV is mediated by a change in PaCO2.Findings:
Data of 1142 participants from 16 studies were used. Participants treated with lower pressure support (<14 versus ≥14â cmH2O) and with lower adherence (<5 versus ≥5â h·day-1) had less improvement in PaCO2 (mean difference (MD) -0.30â kPa, p<0.001 and -0.29â kPa, p<0.001, respectively) and HRQoL (standardised MD 0.10, p=0.002 and 0.11, p=0.02, respectively), but this effect did not persist to survival. PaCO2 improved more in patients with severe dyspnoea (MD -0.30, p=0.02), and HRQoL improved only in participants with fewer than three exacerbations (standardised MD 0.52, p=0.03). The results of the mediation analysis showed that the effect on HRQoL is mediated partially (23%) by a change in PaCO2.Interpretation:
With greater pressure support and better daily NIV usage, a larger improvement in PaCO2 and HRQoL is achieved. Importantly, we demonstrated that the beneficial effect of home NIV on HRQoL is only partially mediated through a reduction in diurnal PaCO2.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Tipo de estudio:
Prognostic_studies
Aspecto:
Patient_preference
Idioma:
En
Revista:
ERJ Open Res
Año:
2024
Tipo del documento:
Article
País de afiliación:
Países Bajos