Non‐invasive ventilation used at night by people with chroni | Figure 1

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Non‐invasive ventilation used at night by people with chronic obstructive pulmonary disease (COPD)

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Non‐invasive ventilation (NIV) is a method to assist or replace spontaneous breathing (or normal breathing) with the aid of a machine called a ventilator, using a mask fitted over the nose or both the nose and mouth. NIV can be used chronically at the person's home if they have levels of carbon dioxide in their blood that are persistently too high. We wanted to discover if using chronic NIV at home during the night alongside standard therapy was better or worse than standard therapy alone in people with chronic obstructive pulmonary disease (COPD) who have raised carbon dioxide levels. In 2002 and 2013, we published our original Cochrane Reviews investigating this. It is important to check if new studies have been done that could be added to the existing studies of the original review and would change the findings.

Review question: What is the effect of chronic NIV in people with COPD on blood gases (oxygen and carbon dioxide), exercise capacity, quality of life, lung function, respiratory muscle function, COPD exacerbations and admissions, and survival?

Study characteristics: The evidence is current to 21 December 2020. This review included 21 studies. Ten looked at people in a stable phase (stable COPD) and four looked at people shortly after a COPD hospital admission (post‐exacerbation COPD). For our analyses, we used data from 778 people with stable COPD and 364 people with post‐exacerbation COPD.

Results: In all people with COPD who had raised levels of carbon dioxide, chronic NIV for three and 12 months improved blood gases. In stable COPD, chronic NIV also might have improved quality of life, and survival seemed to be better compared to people who were treated with standard care only. There was no relevant benefit of NIV on exercise capacity. People using chronic NIV after a COPD admission experienced less benefit; carbon dioxide levels decreased, the time to the next hospital admission might have been longer when treated with NIV but quality of life and survival were not affected by chronic NIV.

Our confidence in the certainty is good when looking at the blood gases. For the other outcomes, the certainty of the evidence is moderate to very low because the participants and the researcher were aware of the treatment the people received, and due to a wide range in the observed effect. This means that further research might change the results.

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