Long-Term Noninvasive Ventilation in Chronic Stable Hypercapnic Chronic Obstructive Pulmonary Disease
Long-Term Noninvasive Ventilation in Chronic Stable Hypercapnic Chronic Obstructive Pulmonary Disease
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DOI：
10.1164/rccm.202006-2382st
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发表时间：
2020-08-15
影响因子：
24.7
通讯作者：
Owens, Robert L.
中科院分区：
文献类型：
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作者：
Macrea, Madalina;Oczkowski, Simon;Owens, Robert L.
背景：无创通气（NIV）用于慢性阻塞性肺疾病（COPD）和慢性高碳酸血症患者。然而，临床疗效和最佳治疗管理的证据有限。目标受众：慢性阻塞性肺病患者、照顾他们的临床医生和政策制定者。方法：我们总结了五个PICO（患者、干预、比较物和结果）问题的证据。GRADE（建议分级、评估、发展和评价）方法用于评估证据的确定性并产生可操作的建议。建议由肺病和睡眠医生、呼吸治疗师和方法学家组成的小组使用循证决策框架制定。建议：1)我们建议在常规护理之外，对慢性稳定型高碳酸血症性COPD患者使用夜间NIV（有条件推荐，中度确定性）；2)我们建议慢性稳定型高碳酸血症性COPD患者在开始长期NIV前进行阻塞性睡眠呼吸暂停筛查（有条件推荐，非常低确定性）；3)我们建议在急性慢性高碳酸血症性呼吸衰竭患者入院时不要进行长期NIV，而应在缓解后2-4周重新评估NIV（有条件推荐，低确定性）；4)我们建议在慢性稳定型高碳酸血症性COPD患者开始NIV时，不要使用实验室夜间多导睡眠图来滴定NIV（有条件推荐，非常低的确定性）；5)我们建议在高碳酸血症性COPD患者长期无氧通气时，有针对性地使Pa-CO(2)正常化（有条件推荐，低确定性）。结论：该专家小组针对NW在COPD和慢性稳定型高碳酸血症性呼吸衰竭患者中的应用提供了循证建议。
Background: Noninvasive ventilation (NIV) is used for patients with chronic obstructive pulmonary disease (COPD) and chronic hypercapnia. However, evidence for clinical efficacy and optimal management of therapy is limited.Target Audience: Patients with COPD, clinicians who care for them, and policy makers.Methods: We summarized evidence addressing five PICO (patients, intervention, comparator, and outcome) questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to evaluate the certainty in evidence and generate actionable recommendations. Recommendations were formulated by a panel of pulmonary and sleep physicians, respiratory therapists, and methodologists using the Evidence-to-Decision framework.Recommendations: 1) We suggest the use of nocturnal NIV in addition to usual care for patients with chronic stable hypercapnic COPD (conditional recommendation, moderate certainty); 2) we suggest that patients with chronic stable hypercapnic COPD undergo screening for obstructive sleep apnea before initiation of long-term NIV (conditional recommendation, very low certainty); 3) we suggest not initiating long-term NIV during an admission for acute-on-chronic hypercapnic respiratory failure, favoring instead reassessment for NIV at 2-4 weeks after resolution (conditional recommendation, low certainty); 4) we suggest not using an in-laboratory overnight polysomnogram to titrate NIV in patients with chronic stable hypercapnic COPD who are initiating NIV (conditional recommendation, very low certainty); and 5) we suggest NIV with targeted normalization of Pa-CO(2) in patients with hypercapnic COPD on long-term NIV (conditional recommendation, low certainty).Conclusions: This expert panel provides evidence-based recommendations addressing the use of NW in patients with COPD and chronic stable hypercapnic respiratory failure.