0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Which Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Benefit from Noninvasive Positive-Pressure Ventilation?: A Systematic Review of the Literature

Sean P. Keenan, MD, FRCPC, MSc (Epid); Tasnim Sinuff, MD, FRCPC; Deborah J. Cook, MD, FRCPC, MSc (Epid); and Nicholas S. Hill, MD
[+] Article and Author Information

From Royal Columbian Hospital, New Westminster, and St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; McMaster Faculty of Sciences, Hamilton, Ontario, Canada; and Tufts–New England Medical Center, Boston, Massachusetts.


Grant Support: Dr. Cook is a Critical Care Chair of the Canadian Institute of Health Research. Dr. Sinuff is supported by a Canadian Institute of Health Research Fellowship Award.

Potential Financial Conflicts of Interest:Consultancies: N.S. Hill (ResMed); Honoraria: N.S. Hill (Respironics, Inc., and ResMed); Expert testimony: N.S. Hill (ResMed); Grants received: S.P. Keenan (Respironics, Inc.), N.S. Hill (Respironics, Inc., and ResMed); Grants pending: N.S. Hill (Respironics, Inc., and ResMed).

Requests for Single Reprints: Sean P. Keenan, MD, FRCPC, MSc (Epid), Suite 103, 250 Keary Street, New Westminster, British Columbia V3L 5E7, Canada; e-mail, Sean_Keenan@telus.net.

Current Author Addresses: Dr. Keenan: Suite 103, 250 Keary Street, New Westminster, British Columbia V3L 5E7, Canada.

Drs. Sinuff and Cook: Department of Clinical Epidemiology and Biostatistics, McMaster University Medical Centre, Room 2C10, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.

Dr. Hill: Tufts–New England Medical Center, 750 Washington Street, Boston, MA 02111.

Author Contributions: Conception and design: S.P. Keenan, T. Sinuff.

Analysis and interpretation of the data: S.P. Keenan, D.J. Cook.

Drafting of the article: S.P. Keenan, T. Sinuff.

Critical revision of the article for important intellectual content: T. Sinuff, D.J. Cook, N.S. Hill.

Final approval of the article: S.P. Keenan, T. Sinuff, D.J. Cook, N.S. Hill.

Statistical expertise: S.P. Keenan, D.J. Cook.

Collection and assembly of data: S.P. Keenan, T. Sinuff.


Ann Intern Med. 2003;138(11):861-870. doi:10.7326/0003-4819-138-11-200306030-00007
Text Size: A A A

This systematic review confirms that the addition of NPPV to standard therapy in patients with acute exacerbations of COPD significantly decreases rate of endotracheal intubation, leads to a shorter hospital stay, and decreases in-hospital mortality rates. However, we identified clinically relevant differences in the patient samples studied. These differences contributed, in part, to significant heterogeneity for the outcomes of endotracheal intubation and length of hospital stay, suggesting that the trials differ to such an extent that inferences from the pooled results are weakened. It may be misleading to conclude that the benefit of NPPV reflected by Peter and colleagues' meta-analysis (42) applies to all patients with an exacerbation of COPD.

First Page Preview

View Large
/>
First page PDF preview

Figures

Grahic Jump Location
Figure 1.
Flow diagram of the trial selection process.

COPD = chronic obstructive pulmonary disease; CPAP = continuous positive airway pressure; NPPV = noninvasive positive-pressure ventilation.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Forest plot summarizing the hospital mortality as expressed by risk difference (absolute risk reduction) for individual trials and pooled results for nine trials on patients with severe exacerbations and two trials with patients with nonsevere exacerbations.

Unit of expression equates a reduction of 1.0 as equal to a 100% risk difference or absolute risk reduction. NPPV = noninvasive positive-pressure ventilation.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Forest plot summarizing the rate of endotracheal intubation as expressed by risk difference (absolute risk reduction) for individual trials and pooled results for 11 trials on patients with severe exacerbations and two trials with patients with nonsevere exacerbations.

Unit of expression equates a reduction of 1.0 as equal to a 100% risk difference or absolute risk reduction. NPPV = noninvasive positive-pressure ventilation.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Noninvasive Positive-Pressure Ventilation for Severe Worsening of Chronic Obstructive Pulmonary Disease

The summary below is from the full report titled “Which Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Benefit from Noninvasive Positive-Pressure Ventilation? A Systematic Review of the Literature.” It is in the 3 June 2003 issue of Annals of Internal Medicine (volume 138, pages 861-870). The authors are S.P. Keenan, T. Sinuff, D.J. Cook, and N.S. Hill.

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)