Deventilation Syndrome in COPD Patients Receiving Long-Term Home Noninvasive Ventilation: A Systematic Scoping Review

Area of Science:

• Respiratory Medicine
• Critical Care Medicine
• Pulmonary Rehabilitation

Background:

• Noninvasive ventilation (NIV) is a standard treatment for COPD patients with chronic hypercapnic respiratory failure.
• Deventilation syndrome (DVS) is characterized by acute dyspnea following the cessation of NIV therapy.
• Existing literature on DVS is sparse, with varying definitions and limited understanding of its pathophysiology.

Purpose of the Study:

• To systematically review and synthesize the available literature on deventilation syndrome (DVS) in patients with COPD and chronic hypercapnic respiratory failure.
• To identify reported definitions, patient characteristics, diagnostic methods, and treatment strategies for DVS.
• To highlight gaps in current knowledge and suggest directions for future research.

Main Methods:

• A systematic scoping review was conducted following PRISMA-ScR guidelines, searching Embase.
• Literature synthesis was performed by three independent reviewers using Rayyan, with a final manual search in February 2023.
• Five eligible studies, including four with original data and three examining treatments, were analyzed, involving 122 patients.

Main Results:

• Deventilation syndrome (DVS) was inconsistently defined across the included studies.
• Patients with DVS exhibited more severe airway obstruction, hyperinflation, and CO2 retention compared to controls.
• Evaluations included blood gas analysis, respiratory muscle assessments, and quality of life questionnaires; studied treatments focused on patient-ventilator asynchrony and pursed-lip breathing.

Conclusions:

• The current evidence base is insufficient to draw definitive conclusions regarding the pathophysiology, etiology, or optimal therapeutic options for DVS.
• Significant heterogeneity exists in DVS definitions and assessment methods across studies.
• Future research should prioritize establishing a consistent definition and elucidating the underlying pathomechanisms of DVS.