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High-intensity versus low-intensity non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary
Haniya Shahid1, Muhammad Ahmed1, Syeda Zuha Sami1
1Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
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.
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