Tim Raveling, Judith M Vonk, Nicholas S Hill, Peter C Gay, Ciro Casanova, Enrico Clini, Thomas Köhnlein, Eduardo Márquez-Martin, Tessa Schneeberger, Patrick B Murphy, Fransien M Struik, Huib A M Kerstjens, Marieke L Duiverman, Peter J Wijkstra
{"title":"严重慢性阻塞性肺疾病的家庭无创通气：对谁有效，如何有效？","authors":"Tim Raveling, Judith M Vonk, Nicholas S Hill, Peter C Gay, Ciro Casanova, Enrico Clini, Thomas Köhnlein, Eduardo Márquez-Martin, Tessa Schneeberger, Patrick B Murphy, Fransien M Struik, Huib A M Kerstjens, Marieke L Duiverman, Peter J Wijkstra","doi":"10.1183/23120541.00600-2023","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Not all hypercapnic COPD patients benefit from home noninvasive ventilation (NIV), and mechanisms through which NIV improves clinical outcomes remain uncertain. We aimed to identify \"responders\" to home NIV, denoted by a beneficial effect of NIV on arterial partial pressure of carbon dioxide (<i>P</i><sub>aCO<sub>2</sub></sub>), health-related quality of life (HRQoL) and survival, and investigated whether NIV achieves its beneficial effect through an improved <i>P</i><sub>aCO<sub>2</sub></sub>.</p><p><strong>Methods: </strong>We used individual patient data from previous published trials collated for a systematic review. Linear mixed-effect models were conducted to compare the effect of NIV on <i>P</i><sub>aCO<sub>2</sub></sub>, HRQoL and survival, within subgroups defined by patient and treatment characteristics. Secondly, we conducted a causal mediation analysis to investigate whether the effect of NIV is mediated by a change in <i>P</i><sub>aCO<sub>2</sub></sub>.</p><p><strong>Findings: </strong>Data of 1142 participants from 16 studies were used. Participants treated with lower pressure support (<14 <i>versus</i> ≥14 cmH<sub>2</sub>O) and with lower adherence (<5 <i>versus</i> ≥5 h·day<sup>-1</sup>) had less improvement in <i>P</i><sub>aCO<sub>2</sub></sub> (mean difference (MD) -0.30 kPa, p<0.001 and -0.29 kPa, p<0.001, respectively) and HRQoL (standardised MD 0.10, p=0.002 and 0.11, p=0.02, respectively), but this effect did not persist to survival. <i>P</i><sub>aCO<sub>2</sub></sub> improved more in patients with severe dyspnoea (MD -0.30, p=0.02), and HRQoL improved only in participants with fewer than three exacerbations (standardised MD 0.52, p=0.03). The results of the mediation analysis showed that the effect on HRQoL is mediated partially (23%) by a change in <i>P</i><sub>aCO<sub>2</sub></sub>.</p><p><strong>Interpretation: </strong>With greater pressure support and better daily NIV usage, a larger improvement in <i>P</i><sub>aCO<sub>2</sub></sub> and HRQoL is achieved. Importantly, we demonstrated that the beneficial effect of home NIV on HRQoL is only partially mediated through a reduction in diurnal <i>P</i><sub>aCO<sub>2</sub></sub>.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"10 1","pages":""},"PeriodicalIF":4.3000,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10860207/pdf/","citationCount":"0","resultStr":"{\"title\":\"Home noninvasive ventilation in severe COPD: in whom does it work and how?\",\"authors\":\"Tim Raveling, Judith M Vonk, Nicholas S Hill, Peter C Gay, Ciro Casanova, Enrico Clini, Thomas Köhnlein, Eduardo Márquez-Martin, Tessa Schneeberger, Patrick B Murphy, Fransien M Struik, Huib A M Kerstjens, Marieke L Duiverman, Peter J Wijkstra\",\"doi\":\"10.1183/23120541.00600-2023\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Not all hypercapnic COPD patients benefit from home noninvasive ventilation (NIV), and mechanisms through which NIV improves clinical outcomes remain uncertain. We aimed to identify \\\"responders\\\" to home NIV, denoted by a beneficial effect of NIV on arterial partial pressure of carbon dioxide (<i>P</i><sub>aCO<sub>2</sub></sub>), health-related quality of life (HRQoL) and survival, and investigated whether NIV achieves its beneficial effect through an improved <i>P</i><sub>aCO<sub>2</sub></sub>.</p><p><strong>Methods: </strong>We used individual patient data from previous published trials collated for a systematic review. Linear mixed-effect models were conducted to compare the effect of NIV on <i>P</i><sub>aCO<sub>2</sub></sub>, HRQoL and survival, within subgroups defined by patient and treatment characteristics. Secondly, we conducted a causal mediation analysis to investigate whether the effect of NIV is mediated by a change in <i>P</i><sub>aCO<sub>2</sub></sub>.</p><p><strong>Findings: </strong>Data of 1142 participants from 16 studies were used. Participants treated with lower pressure support (<14 <i>versus</i> ≥14 cmH<sub>2</sub>O) and with lower adherence (<5 <i>versus</i> ≥5 h·day<sup>-1</sup>) had less improvement in <i>P</i><sub>aCO<sub>2</sub></sub> (mean difference (MD) -0.30 kPa, p<0.001 and -0.29 kPa, p<0.001, respectively) and HRQoL (standardised MD 0.10, p=0.002 and 0.11, p=0.02, respectively), but this effect did not persist to survival. <i>P</i><sub>aCO<sub>2</sub></sub> improved more in patients with severe dyspnoea (MD -0.30, p=0.02), and HRQoL improved only in participants with fewer than three exacerbations (standardised MD 0.52, p=0.03). The results of the mediation analysis showed that the effect on HRQoL is mediated partially (23%) by a change in <i>P</i><sub>aCO<sub>2</sub></sub>.</p><p><strong>Interpretation: </strong>With greater pressure support and better daily NIV usage, a larger improvement in <i>P</i><sub>aCO<sub>2</sub></sub> and HRQoL is achieved. Importantly, we demonstrated that the beneficial effect of home NIV on HRQoL is only partially mediated through a reduction in diurnal <i>P</i><sub>aCO<sub>2</sub></sub>.</p>\",\"PeriodicalId\":11739,\"journal\":{\"name\":\"ERJ Open Research\",\"volume\":\"10 1\",\"pages\":\"\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2024-02-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10860207/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ERJ Open Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1183/23120541.00600-2023\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ERJ Open Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1183/23120541.00600-2023","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
Home noninvasive ventilation in severe COPD: in whom does it work and how?
Background: Not all hypercapnic COPD patients benefit from home noninvasive ventilation (NIV), and mechanisms through which NIV improves clinical outcomes remain uncertain. We aimed to identify "responders" to home NIV, denoted by a beneficial effect of NIV on arterial partial pressure of carbon dioxide (PaCO2), health-related quality of life (HRQoL) and survival, and investigated whether NIV achieves its beneficial effect through an improved PaCO2.
Methods: We used individual patient data from previous published trials collated for a systematic review. Linear mixed-effect models were conducted to compare the effect of NIV on PaCO2, HRQoL and survival, within subgroups defined by patient and treatment characteristics. Secondly, we conducted a causal mediation analysis to investigate whether the effect of NIV is mediated by a change in PaCO2.
Findings: Data of 1142 participants from 16 studies were used. Participants treated with lower pressure support (<14 versus ≥14 cmH2O) and with lower adherence (<5 versus ≥5 h·day-1) had less improvement in PaCO2 (mean difference (MD) -0.30 kPa, p<0.001 and -0.29 kPa, p<0.001, respectively) and HRQoL (standardised MD 0.10, p=0.002 and 0.11, p=0.02, respectively), but this effect did not persist to survival. PaCO2 improved more in patients with severe dyspnoea (MD -0.30, p=0.02), and HRQoL improved only in participants with fewer than three exacerbations (standardised MD 0.52, p=0.03). The results of the mediation analysis showed that the effect on HRQoL is mediated partially (23%) by a change in PaCO2.
Interpretation: With greater pressure support and better daily NIV usage, a larger improvement in PaCO2 and HRQoL is achieved. Importantly, we demonstrated that the beneficial effect of home NIV on HRQoL is only partially mediated through a reduction in diurnal PaCO2.
期刊介绍：
ERJ Open Research is a fully open access original research journal, published online by the European Respiratory Society. The journal aims to publish high-quality work in all fields of respiratory science and medicine, covering basic science, clinical translational science and clinical medicine. The journal was created to help fulfil the ERS objective to disseminate scientific and educational material to its members and to the medical community, but also to provide researchers with an affordable open access specialty journal in which to publish their work.
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