Background Chronic obstructive pulmonary disease (COPD) poses significant challenges in respiratory care, with exacerbations and impaired gas exchange being major concerns. Non-invasive ventilation (NIV) has emerged as a valuable therapeutic approach, mitigating respiratory distress and hospitalization risks without the complications associated with invasive ventilation. This systematic review and meta-analysis aim to consolidate evidence from randomized controlled trials (RCTs) to elucidate the therapeutic benefits of NIV across various stages of COPD, providing insights into its potential to improve patient outcomes. Methods We conducted a comprehensive systematic review and meta-analysis of RCTs using PubMed, Embase, Scopus and Cochrane databases that compared NIV with standard care (including oxygen therapy, medications, and nasal cannula oxygen delivery) in patients with COPD at various stages, including stable and post-exacerbation. The primary outcomes of interest were mortality outcomes (MO), intubation and exacerbation outcomes (IAEO), and arterial blood gas outcomes (ABGO). Odds ratios (ORs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated as summary statistics. Heterogeneity was assessed using the I² statistic. Results Our meta-analysis of 16 RCTs comprising 1,369 patients demonstrated significant benefits of non-invasive ventilation (NIV) in both post-exacerbation chronic obstructive pulmonary disease (PECOPD) and stable COPD patients. The studies demonstrated a low risk of bias and exhibited low heterogeneity (I² statistic) due to consistent interventions, comparators, and patient characteristics. Pooled analysis revealed statistically significant reductions in MO [PECOPD: OR 0.52 (0.43–0.64), p < 0.001; stable COPD: OR 0.56 (0.44–0.71), p < 0.001], intubation frequency [PECOPD: OR 0.64 (0.54–0.76), p < 0.001; stable COPD: OR 0.43 (0.31–0.60), p < 0.001], exacerbation frequency [PECOPD: OR 0.47 (0.38–0.59), p < 0.001; stable COPD: OR 0.37 (0.25–0.53), p < 0.001], and PaCO2 levels [PECOPD: RR 0.55 (0.45–0.67), p < 0.001; stable COPD: RR 0.56 (0.42–0.74), p < 0.001], as well as significant increases in PaO2 levels [PECOPD: RR 0.52 (0.43–0.64), p < 0.001; stable COPD: RR 0.61 (0.48–0.77), p < 0.001]. Conclusions Our meta-analysis demonstrates that NIV significantly improves clinical outcomes in patients with COPD, including reduced mortality, intubation frequency, exacerbation frequency and PaCO2 levels and significant increase in PaO2 levels. These findings support the use of NIV as a valuable therapeutic strategy in managing patients with COPD. However, further studies are warranted to refine patient selection and optimize NIV protocols, thereby maximizing therapeutic benefits.

Efficacy of non-invasive ventilation in chronic obstructive pulmonary disease management: a systematic review and meta-analysis of randomized controlled trials

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2025年10月22日

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Jiukang Li,
Liping Ran

摘要

Background

Chronic obstructive pulmonary disease (COPD) poses significant challenges in respiratory care, with exacerbations and impaired gas exchange being major concerns. Non-invasive ventilation (NIV) has emerged as a valuable therapeutic approach, mitigating respiratory distress and hospitalization risks without the complications associated with invasive ventilation. This systematic review and meta-analysis aim to consolidate evidence from randomized controlled trials (RCTs) to elucidate the therapeutic benefits of NIV across various stages of COPD, providing insights into its potential to improve patient outcomes.

Methods

We conducted a comprehensive systematic review and meta-analysis of RCTs using PubMed, Embase, Scopus and Cochrane databases that compared NIV with standard care (including oxygen therapy, medications, and nasal cannula oxygen delivery) in patients with COPD at various stages, including stable and post-exacerbation. The primary outcomes of interest were mortality outcomes (MO), intubation and exacerbation outcomes (IAEO), and arterial blood gas outcomes (ABGO). Odds ratios (ORs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated as summary statistics. Heterogeneity was assessed using the I² statistic.

Results

Our meta-analysis of 16 RCTs comprising 1,369 patients demonstrated significant benefits of non-invasive ventilation (NIV) in both post-exacerbation chronic obstructive pulmonary disease (PECOPD) and stable COPD patients. The studies demonstrated a low risk of bias and exhibited low heterogeneity (I² statistic) due to consistent interventions, comparators, and patient characteristics. Pooled analysis revealed statistically significant reductions in MO [PECOPD: OR 0.52 (0.43–0.64), p < 0.001; stable COPD: OR 0.56 (0.44–0.71), p < 0.001], intubation frequency [PECOPD: OR 0.64 (0.54–0.76), p < 0.001; stable COPD: OR 0.43 (0.31–0.60), p < 0.001], exacerbation frequency [PECOPD: OR 0.47 (0.38–0.59), p < 0.001; stable COPD: OR 0.37 (0.25–0.53), p < 0.001], and PaCO2 levels [PECOPD: RR 0.55 (0.45–0.67), p < 0.001; stable COPD: RR 0.56 (0.42–0.74), p < 0.001], as well as significant increases in PaO2 levels [PECOPD: RR 0.52 (0.43–0.64), p < 0.001; stable COPD: RR 0.61 (0.48–0.77), p < 0.001].

Conclusions

Our meta-analysis demonstrates that NIV significantly improves clinical outcomes in patients with COPD, including reduced mortality, intubation frequency, exacerbation frequency and PaCO₂ levels and significant increase in PaO₂ levels. These findings support the use of NIV as a valuable therapeutic strategy in managing patients with COPD. However, further studies are warranted to refine patient selection and optimize NIV protocols, thereby maximizing therapeutic benefits.