High-intensity versus low-intensity non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: A systematic review and meta-analysis.

BACKGROUND

Non-invasive positive pressure ventilation (NIPPV) is a key treatment for acute exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD). This meta-analysis compares high-versus low-intensity NIPPV.

METHODS

A systematic search was conducted across major databases. Studies comparing high- and low-intensity NIPPV in AECOPD were included. Statistical analysis-using RevMan, statistical significance set at p < 0.05, risk ratio for dichotomous data, while mean difference for continuous data with 95 % CI via random effect model, and Higgins I2 to measure heterogeneity was carried out following PRISMA guidelines.

RESULTS

Four studies, which consisted of 618 patients, were analyzed. Primary outcomes were intubation need and short-term mortality. Secondary outcomes included PaCO2 at 48 and 72 h and abdominal distension. High-intensity NIPPV significantly reduced short-term mortality (RR: 0.43, CI: [0.22, 0.85], P = 0.02) but had no significant effect on intubation rates. PaCO2 levels at 48 and 72 h showed no significant difference. Abdominal distension was more common in the high-intensity group (RR: 1.49, P = 0.02).

CONCLUSION

High-intensity NIPPV lowers short-term mortality but increases abdominal distension. Further studies are needed.