Non-invasive ventilation as an airway clearance adjunct in exacerbations on non-CF bronchiectasis

Judy Bradley, Fidelma Moran, Amanda J. Piper, Oonagh Hewitt, Evie McCrum-Gardner, M. King, Joseph Elborn

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Abstract

Background
Non-invasive ventilation (NIV) has been proposed as a means to temporarily reverse or slow the progression of respiratory failure in cystic fibrosis (CF).

Objectives
To compare the effect of NIV versus no NIV in people with CF.

Search strategy
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group trials register comprising references identified from comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. The reference lists of each trial were searched for additional publications that may contain other trials.

Most recent search: April 2004

Selection criteria
Randomised controlled trials in which a form of pressure preset or volume preset NIV versus no NIV was used in people with acute or chronic respiratory failure in CF.

Data collection and analysis
Three reviewers independently assessed trials for inclusion criteria and methodological quality, and extracted data.

Main results
Ten trials were identified, five trials met the inclusion criteria with a total of 81 participants. All trials evaluated single treatment sessions only.

Three trials (62 participants) evaluated NIV for airway clearance compared with an alternative physiotherapy method. These trials showed that airway clearance may be easier and people with CF may prefer NIV for airway clearance. We were unable to find any evidence that NIV increases sputum expectoration, but it did improve some lung function parameters.

Two trials (19 participants) evaluated NIV for overnight ventilatory support. Of the primary outcomes examined in this review, only lung function was evaluated within the two trials. Due to the small numbers of participants and the differing statistical techniques used within the review and the primary trials, there were discrepancies in the results obtained by the RevMan analysis and the original trial analysis. No clear differences were found between NIV compared with either oxygen or room air.

Authors' conclusions
Non-invasive ventilation may be a useful adjunct to other airway clearance techniques, particularly in people with CF who have difficulty expectorating sputum. It has been established that non-invasive ventilation, when used in addition to oxygen, may improve gas exchange during sleep to a greater extent than oxygen therapy alone in moderate to severe disease. These benefits of NIV have only been demonstrated in single treatment sessions, and its efficacy, safety and acceptability in the longer term are unknown. There is a need for long-term randomised controlled trials to determine the clinical effects of non-invasive ventilation in CF airway clearance and exercise.
Original languageEnglish
Article number46
JournalCochrane database of systematic reviews (Online)
Issue number2
DOIs
Publication statusPublished - 20 Feb 2017

Keywords

  • ventilation
  • airway clearance
  • exacerbation
  • Non-cystic fibrosis bronchiectasis

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