P11 Long-term home non-invasive ventilation

A meta-analysis of 8 RCTs and 5 observational studies (Wilson 2020) concluded that home bilevel ventilation reduces mortality (22.31% vs. 28.57%; risk difference [RD] −5.53% (95% CI −10.29% to −0.76%); OR 0.66 (95% CI 0.51 to 0.87); P=0.003).  13 studies were included in this analysis with 1,423 patients.  The authors rated strength of evidence for this finding as moderate.  Note is made of significant differences in trial design and NIV pressures delivered.  The use of home NIV was also associated with a reduction in all cause hospitalisation and no significant difference in quality of life.  Smoking status was not reported.  A sensitivity analysis found that the mortality benefit was only present if the home NIV was commenced in stable patients (PaCO2 greater than 45mmHg at least two weeks after an exacerbation) rather than at the time of a COPD exacerbation.  Although this meta-analysis did not evaluate NIV pressures, the recent trials with positive outcomes used inspiratory pressures above 20cm (Kohnlein 2014, Murphy 2017).

Long term NIV should be considered in suitable patients with severe stable COPD and hypercapnia.  Such patients should be referred to a centre with expertise in home NIV.