Noninvasive Ventilation in Chronic Respiratory Failure: Effects on Quality of Life

Tsolaki, Vasiliki; Pastaka, Chaido; Κostikas, Κonstantinos; Karetsi, Eleni; Dimoulis, Andreas; Zikiri, Andriani; Koutsokera, Angela; Gourgoulianis, Konstantinos

doi:10.1159/000317138

Cited by 40 publications

(41 citation statements)

References 73 publications

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“…NIHR Journals Library www.journalslibrary.nihr.ac.uk There were three small prospective uncontrolled observational studies, two 106,107 in stable populations (n = 11 and n = 35) and one 108 in a post-hospital population (n = 27) (see Appendix 8 for further details). The study in a post-hospital population did not report before and after (NIV) data and so did not add useful information.…”

Section: Clinical Effectiveness Review Resultsmentioning

confidence: 99%

“…Only three studies (no restriction on sample size or length of follow-up) reported exacerbations. Neither the prospective uncontrolled study by Tsolaki 107 in 2011 nor the retrospective study by Windisch 109 in 2009, both in stable populations, made a distinction between different severities of exacerbation. The report of a further small (n = 20) Japanese study 64 was not translated.…”

Section: Exacerbationsmentioning

confidence: 99%

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The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

Dretzke

Blissett

Dave

et al. 2015

Health Technol Assess

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BackgroundChronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease characterised by non-reversible airflow obstruction. Exacerbations are a key cause of morbidity and mortality and place a considerable burden on health-care systems. While there is evidence that patients benefit from non-invasive ventilation (NIV) in hospital during an acute exacerbation, evidence supporting home use for more stable COPD patients is limited. In the UK, domiciliary NIV is considered on health economic grounds in patients after three hospital admissions for acute hypercapnic respiratory failure.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of domiciliary NIV by systematic review and economic evaluation.Data sourcesBibliographic databases, conference proceedings and ongoing trial registries up to September 2014.MethodsStandard systematic review methods were used for identifying relevant clinical effectiveness and cost-effectiveness studies assessing NIV compared with usual care or comparing different types of NIV. Risk of bias was assessed using Cochrane guidelines and relevant economic checklists. Results for primary effectiveness outcomes (mortality, hospitalisations, exacerbations and quality of life) were presented, where possible, in forest plots. A speculative Markov decision model was developed to compare the cost-effectiveness of domiciliary NIV with usual care from a UK perspective for post-hospital and more stable populations separately.ResultsThirty-one controlled effectiveness studies were identified, which report a variety of outcomes. For stable patients, a modest volume of evidence found no benefit from domiciliary NIV for survival and some non-significant beneficial trends for hospitalisations and quality of life. For post-hospital patients, no benefit from NIV could be shown in terms of survival (from randomised controlled trials) and findings for hospital admissions were inconsistent and based on limited evidence. No conclusions could be drawn regarding potential benefit from different types of NIV. No cost-effectiveness studies of domiciliary NIV were identified. Economic modelling suggested that NIV may be cost-effective in a stable population at a threshold of £30,000 per quality-adjusted life-year (QALY) gained (incremental cost-effectiveness ratio £28,162), but this is associated with uncertainty. In the case of the post-hospital population, results for three separate base cases ranged from usual care dominating to NIV being cost-effective, with an incremental cost-effectiveness ratio of less than £10,000 per QALY gained. All estimates were sensitive to effectiveness estimates, length of benefit from NIV (currently unknown) and some costs. Modelling suggested that reductions in the rate of hospital admissions per patient per year of 24% and 15% in the stable and post-hospital populations, respectively, are required for NIV to be cost-effective.LimitationsEvidence on key clinical outcomes remains limited, particularly quality-of-life and long-term (> 2 years) effects. Economic modelling should be viewed as speculative because of uncertainty around effect estimates, baseline risks, length of benefit of NIV and limited quality-of-life/utility data.ConclusionsThe cost-effectiveness of domiciliary NIV remains uncertain and the findings in this report are sensitive to emergent data. Further evidence is required to identify patients most likely to benefit from domiciliary NIV and to establish optimum time points for starting NIV and equipment settings.Future work recommendationsThe results from this report will need to be re-examined in the light of any new trial results, particularly in terms of reducing the uncertainty in the economic model. Any new randomised controlled trials should consider including a sham non-invasive ventilation arm and/or a higher- and lower-pressure arm. Individual participant data analyses may help to determine whether or not there are any patient characteristics or equipment settings that are predictive of a benefit of NIV and to establish optimum time points for starting (and potentially discounting) NIV.Study registrationThis study is registered as PROSPERO CRD42012003286.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Clinical Effectiveness Review Resultsmentioning

confidence: 99%

Section: Exacerbationsmentioning

confidence: 99%

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

Dretzke

Blissett

Dave

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

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“…It is also applied in COPD patients, although its efficacy is less well demonstrated in this disease. However, the method is inapplicable to some patients with poor mask tolerance and other well-known factors [1] . Recently, high flow rates of room air or room air/oxygen gas mixtures have been tried in situations of sleep apnea and Key Words Nasal high flow ؒ Tidal volume ؒ Hypercapnia ؒ Idiopathic pulmonary fibrosis ؒ COPD Abstract Background: A high flow of air applied by large bore nasal cannulae has been suggested to improve symptoms of chronic respiratory insufficiency.…”

Section: Introductionmentioning

confidence: 99%

Effects of Nasal High Flow on Ventilation in Volunteers, COPD and Idiopathic Pulmonary Fibrosis Patients

Bräunlich¹,

Beyer²,

Mai³

et al. 2012

Respiration

158

136

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rates and minute volumes were reduced in all groups. Capillary pCO 2 decreased in patients with IPF and COPD. Conclusions: nHF resulted in significant effects on respiratory parameters in patients with obstructive and restrictive pulmonary diseases. The rise in pressure amplitude and mean pressure and the decrease in breathing rate and minute volume will support inspiratory efforts, helps to increase effectiveness of ventilation and will contribute to a reduction in the work of breathing. A CO 2 wash-out effect in the upper airway part of the anatomical dead space may contribute to the beneficial effects of the nHF instrument.

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“…Home noninvasive ventilation (NIV) aims to improve quality of life [4], quality of sleep and survival, correct hypoventilation and associated symptoms, and daytime and nocturnal blood gases. Monitoring of the efficacy of home NIV usually relies on daytime arterial blood gases (ABGs) and nocturnal pulse oxymetry (a few centers use polysomnography for monitoring their NIV patients).…”

Section: Introductionmentioning

confidence: 99%

What Does Built-In Software of Home Ventilators Tell Us? An Observational Study of 150 Patients on Home Ventilation

et al. 2011

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Background: Recent home ventilators are equipped with built-in software which provides data such as compliance, estimations of leaks, tidal volume, minute ventilation, respiratory rate, apnea and apnea-hypopnea indexes, and percentage of inspirations triggered by the patient (or ventilator). However, for many of these variables, there is neither consensus nor documentation as to what is to be expected in a population of stable patients under noninvasive ventilation (NIV). Objectives: To document the values and distribution of specific items downloaded from ventilator monitoring software, by diagnostic category. Methods: Analysis of data downloaded from home ventilators in clinically stable patients under long-term NIV, during elective home visits by specialized nurses. Results: Data were collected from home ventilators of 150 patients with chronic obstructive pulmonary disease (n = 32), overlap syndrome (n = 29), obesity-hypoventilation (n = 38), neuromuscular disorders (n = 19), restrictive disorders (n = 21), and central sleep apnea syndrome (n = 11). On average, leaks were low, being lowest in patients with facial masks (vs. nasal masks), and increased with older age. Compliance was excellent in all groups. Patients with neuromuscular diseases triggered their ventilators less and tended to be ‘captured’, while other groups triggered at least half of inspiratory cycles. Most patients had a respiratory rate just slightly above the back-up rate. Residual apneas and hypopneas were highest in patients with central apneas. Conclusions: Built-in software of home ventilators provides the clinician with new parameters, some of which are a useful adjunct to recommended tools for monitoring NIV and may contribute to a better understanding of residual hypoventilation and/or desaturations. However, an independent validation of the accuracy of this information is mandatory.

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Noninvasive Ventilation in Chronic Respiratory Failure: Effects on Quality of Life

Cited by 40 publications

References 73 publications

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

Effects of Nasal High Flow on Ventilation in Volunteers, COPD and Idiopathic Pulmonary Fibrosis Patients

What Does Built-In Software of Home Ventilators Tell Us? An Observational Study of 150 Patients on Home Ventilation

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