Effect of Intensity of Home Noninvasive Ventilation in Individuals With Neuromuscular and Chest Wall Disorders: A Systematic Review and Meta-Analysis of Individual Participant Data

Mathieu Delorme; Antoine Leotard; Marius Lebret; Claire Lefeuvre; Anda Hazenberg; Mercedes Pallero; Annabel H Nickol; Liam M Hannan; Matthias Boentert; Aycan Yüksel; Wolfram Windisch; Mark E Howard; Nicholas Hart; Peter J Wijkstra; Hélène Prigent; Jean-Louis Pepin; Frederic Lofaso; Charles Khouri; Jean-Christian Borel

doi:10.1016/j.arbres.2023.05.002

Effect of Intensity of Home Noninvasive Ventilation in Individuals With Neuromuscular and Chest Wall Disorders: A Systematic Review and Meta-Analysis of Individual Participant Data

Arch Bronconeumol. 2023 Aug;59(8):488-496. doi: 10.1016/j.arbres.2023.05.002. Epub 2023 May 11.

[Article in English, Spanish]

Authors

Mathieu Delorme¹, Antoine Leotard², Marius Lebret³, Claire Lefeuvre⁴, Anda Hazenberg⁵, Mercedes Pallero⁶, Annabel H Nickol⁷, Liam M Hannan⁸, Matthias Boentert⁹, Aycan Yüksel¹⁰, Wolfram Windisch¹¹, Mark E Howard¹², Nicholas Hart¹³, Peter J Wijkstra⁵, Hélène Prigent¹⁴, Jean-Louis Pepin¹⁵, Frederic Lofaso¹⁶, Charles Khouri¹⁷, Jean-Christian Borel¹⁸

Affiliations

¹ Université Paris-Saclay, UVSQ, ERPHAN, Versailles, France; AFM-Téléthon, Direction des Actions Médicales, Evry, France.
² Service de Physiologie et explorations fonctionnelles, GHU APHP - Paris Saclay - Hôpital Raymond Poincaré (APHP), Garches, France; Université Paris-Saclay, UVSQ, INSERM U1179, Equipe 3 «END:ICAP», Versailles, France.
³ Université Paris-Saclay, UVSQ, ERPHAN, Versailles, France.
⁴ Neurology Department, Raymond Poincaré University Hospital, Garches, APHP, France; Nord-Est-Ile-de-France Neuromuscular Reference Center, FHU PHENIX, France.
⁵ University of Groningen, University Medical Center Groningen, Department of Pulmonology and Tuberculosis, Department of Home Mechanical Ventilation, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, GRIAC Research Institute, The Netherlands.
⁶ Respiratory Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
⁷ Oxford Centre for Respiratory Medicine, Oxford University Hospital NHS Foundation Trust, Oxford, UK; The Royal Brompton Hospital, London, UK.
⁸ Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Melbourne, Australia; Dept of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
⁹ Department of Neurology, Münster University Hospital (UKM), Münster, Germany; Department of Medicine, UKM-Marienhospital Steinfurt, Steinfurt, Germany.
¹⁰ Ufuk University, Faculty of Medicine, Rıdvan Ege Hospital, Department of Pulmonology and Tuberculosis, Ankara, Turkey.
¹¹ Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln, gGmbH, Witten/Herdecke University, Germany.
¹² Institute for Breathing and Sleep, Melbourne, Australia; Dept of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.
¹³ Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Science, King's College London, London, UK.
¹⁴ Service de Physiologie et explorations fonctionnelles, GHU APHP - Paris Saclay - Hôpital Raymond Poincaré (APHP), Garches, France; Université Paris-Saclay, UVSQ, INSERM U1179, Equipe 3 «END:ICAP», Versailles, France; FHU Phenix - GHU APHP - Paris Saclay - Hôpital Raymond Poincaré (APHP), Garches, France.
¹⁵ HP2 (Hypoxia and Physio-Pathologies) Laboratory, Inserm (French National Institute of Health and Medical Research), University Grenoble Alpes, Grenoble, France; EFCR (Cardiovascular and Respiratory Function) Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
¹⁶ Université Paris-Saclay, UVSQ, ERPHAN, Versailles, France; Service de Physiologie et explorations fonctionnelles, GHU APHP - Paris Saclay - Hôpital Raymond Poincaré (APHP), Garches, France.
¹⁷ HP2 (Hypoxia and Physio-Pathologies) Laboratory, Inserm (French National Institute of Health and Medical Research), University Grenoble Alpes, Grenoble, France; Centre Régional de pharmacovigilance, Centre d'Investigation Clinique, CHU Grenoble Alpes, France.
¹⁸ HP2 (Hypoxia and Physio-Pathologies) Laboratory, Inserm (French National Institute of Health and Medical Research), University Grenoble Alpes, Grenoble, France; Research and Development Department, AGIR à dom Association, Meylan, France. Electronic address: [email protected].

PMID: 37217384
DOI: 10.1016/j.arbres.2023.05.002

Abstract

Introduction: Home noninvasive ventilation (NIV), targeting a reduction of carbon dioxide with a combination of sufficient inspiratory support and backup-rate improves outcomes in patients with chronic obstructive pulmonary disease. The aim of this systematic review with individual participant data (IPD) meta-analysis was to evaluate the effects of intensity of home NIV on respiratory outcomes in individuals with slowly progressive neuromuscular (NMD) or chest-wall disorders (CWD).

Methods: Controlled, non-controlled and cohort studies indexed between January-2000 and December-2020 were sought from Medline, Embase and the Cochrane Central Register. Outcomes were diurnal PaCO₂, PaO₂, daily NIV usage, and interface type (PROSPERO-CRD 42021245121). NIV intensity was defined according to the Z-score of the product of pressure support (or tidal volume) and backup-rate.

Results: 16 eligible studies were identified; we obtained IPD for 7 studies (176 participants: 113-NMD; 63-CWD). The reduction in PaCO₂ was greater with higher baseline PaCO₂. NIV intensity per se was not associated with improved PaCO₂ except in individuals with CWD and the most severe baseline hypercapnia. Similar results were found for PaO₂. Daily NIV usage was associated with improvement in gas exchange but not with NIV intensity. No association between NIV intensity and interface type was found.

Conclusion: Following home NIV initiation in NMD or CWD patients, no relationship was observed between NIV intensity and PaCO₂, except in individuals with the most severe CWD. The amount of daily NIV usage, rather than intensity, is key to improving hypoventilation in this population during the first few months after introduction of therapy.

Keywords: Chest wall disorders; Meta-analysis; Neuromuscular diseases; Noninvasive ventilation; Systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Humans
Hypercapnia / etiology
Hypercapnia / therapy
Noninvasive Ventilation* / methods
Pulmonary Disease, Chronic Obstructive*
Respiration, Artificial
Respiratory Insufficiency* / etiology
Respiratory Insufficiency* / therapy
Thoracic Wall*