Noninvasive ventilation with helium–oxygen mixture in hypercapnic COPD exacerbation: aggregate meta-analysis of randomized controlled trials
When used as a driving gas during NIV in hypercapnic COPD exacerbation, a helium–oxygen (He/O 2 ) mixture reduces the work of breathing and gas trapping. The potential for He/O 2 to reduce the rate of NIV failure leading to intubation and invasive mechanical ventilation has been evaluated in several...
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| Published in: | Annals of intensive care Vol. 7; no. 1; p. 59 |
|---|---|
| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Cham
Springer International Publishing
06-06-2017
Springer Nature B.V SpringerOpen |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | When used as a driving gas during NIV in hypercapnic COPD exacerbation, a helium–oxygen (He/O
2
) mixture reduces the work of breathing and gas trapping. The potential for He/O
2
to reduce the rate of NIV failure leading to intubation and invasive mechanical ventilation has been evaluated in several RCTs. The goal of this meta-analysis is to assess the effect of NIV driven by He/O
2
compared to air/O
2
on patient-centered outcomes in hypercapnic COPD exacerbation. Relevant RCTs were searched using standard procedures. The main endpoint was the rate of NIV failure. The effect size was computed by a fixed-effect model, and estimated as odds ratio (OR) with 95% confidence interval (CI). Additional endpoints were ICU mortality, NIV-related side effects, and the length and costs of ICU stay. Three RCTs fulfilled the selection criteria and enrolled a total of 772 patients (386 patients received He/O
2
and 386 received air/O
2
). Pooled analysis showed no difference in the rate of NIV failure when using He/O
2
mixture compared to air/O
2
: 17 vs 19.7%, respectively; OR 0.84, 95% CI 0.58–1.22; p = 0.36;
I
2
for heterogeneity = 0%, and no publication bias. ICU mortality was also not different: OR 0.8, 95% CI 0.45–1.4; p = 0.43;
I
2
= 5%. However, He/O
2
was associated with less NIV-related adverse events (OR 0.56, 95% CI 0.4–0.8, p = 0.001), and a shorter length of ICU stay (difference in means = −1.07 day, 95% CI −2.14 to −0.004, p = 0.049). Total hospital costs entailed by hospital stay and NIV gas were not different: difference in means = −279$, 95% CI −2052–1493, p = 0.76. Compared to air/O
2
, He/O
2
does not reduce the rate of NIV failure in hypercapnic COPD exacerbation. It is, however, associated with a lower incidence of NIV-related adverse events and a shortening of ICU length of stay with no increase in hospital costs. |
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| Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 |
| ISSN: | 2110-5820 2110-5820 |
| DOI: | 10.1186/s13613-017-0273-6 |