Effects of non-invasive positive pressure ventilation (NIPPV) in stable chronic obstructive pulmonary disease (COPD)

This review provides an overview of the randomised controlled trials covering the topic of chronic non-invasive positive pressure ventilation (NIPPV) in severe stable COPD patients. Studies investigating patients receiving bilevel NIPPV via nasal, oronasal or total face mask interfaces for at least 1 week or more, were described. Eight RCTs were included, from which six trials used NIPPV for up to 3 months (short-term) and two trials also obtained long-term effects (3 months to ≥2 years). Outcome parameters were: arterial blood gases, pulmonary function, respiratory mechanics, respiratory muscle strength, dyspnoea, exercise tolerance, health-related quality of life, neuropsychologic function, sleep quality, hospital admissions and survival. We found that NIPPV in addition to standard care can have beneficial effects on certain outcome measures, however results are conflicting. Therefore, evidence is insufficient to recommend NIPPV routinely in stable but severe COPD patients. Nevertheless, it seems that hypercapnic patients, who receive enough time to adjust to the ventilator and so obtain improved ventilation, could benefit from NIPPV.