Zhongguo quanke yixue (Jan 2022)
Meta-analysis and Trial Sequential Analysis of the Effects of Bilevel Positive Pressure Ventilation in the Acute Exacerbation of Chronic Obstructive Pulmonary Disease Complicated with TypeⅡ Respiratory Failure
Abstract
BackgroundPatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) have a significantly increased risk of developing type Ⅱ respiratory failure. In clinical treatment, BiPAP is widely used in this kind of patients to correct respiratory acidosis and delay the deterioration of lung function, but the therapeutic effect of BiPAP in this kind of patients is still controversial.ObjectiveTo systematically review the effect of BiPAP intervention on the treatment of patients with AECOPD complicated with type Ⅱrespiratory failure.MethodsCNKI, Wanfang Database, CQVIP, CBM, PubMed, The Cochrane Library, Springer, Medline, and Web of Science were retrived by computer for the RCTs published from inception to October 2020 regarding the application of BiPAP in patients with AECOPD complicated with type Ⅱ respiratory failure. Two researchers independently screened the retrieved documents, extracted data and evaluated the quality. The first author, country, population characteristics, age, sample size, intervention methods of the experimental group and control group, frequency and duration of intervention of the experimental group, outcome indicators〔pH, partial pressure of carbon dioxide (PaCO2) , partial pressure of oxygen (PaO2) , respiratory frequency (RR) , tracheal intubation rate, incidence of adverse reactions〕 and other information were extracted. The Review Manager 5.4 software was used to conduct a meta-analysis of the included literature, and the TSA v0.9 developed by the Copenhagen Clinical Trial Center was used to complete the trial sequential analysis.ResultsA total of 10 RCTs were included, of which 4 were of high quality and 6 were of medium quality. The experimental group could improve the pH value of patients with acute COPD and type Ⅱ respiratory failure 〔MD=0.04, 95%CI (0.03, 0.04) , P<0.05〕, PaCO2〔MD=-7.22, 95%CI (-8.20, -6.24) , P<0.05〕, PaO2〔MD=6.23, 95%CI (5.31, 7.14) , P<0.05〕, could improve the RR of patients with acute COPD onset and type Ⅱ respiratory failure within 24 h and after 24 h of intervention 〔MD=-3.85, 95%CI (-4.36, -3.35) , P<0.05〕, tracheal intubation rate〔RR=0.50, 95%CI (0.32, 0.78) , P<0.05〕 are better than the control group. The incidence of abdominal distension〔RR=5.95, 95%CI (1.79, 19.77) , P<0.05〕, facial skin damage〔RR=8.04, 95%CI (1.92, 33.76) , P<0.05〕are higher than the control group. The results of trial sequential analysis showed that BiPAP treatment could significantly improve the outcomes of pH, PaCO2, PaO2, RR and intubation rate in patients with typeⅡ respiratory failure due to acute exacerbation of COPD.ConclusionBiPAP therapy in patients with type Ⅱ respiratory failure due to acute exacerbation of COPD can improve patients' conditions of respiratory acidosis and hypoxia, and reduce intubation rate. However, BiPAP treatment may increase the incidence of adverse reactions such as abdominal distension and facial skin damage.
Keywords
