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Evidence summaries

Nocturnal Mechanical Ventilation for Chronic Hypoventilation in Patients with Neuromuscular and Chest Wall Disorders

Nocturnal mechanical ventilation may improve chronic hypoventilation symptoms and survival in neuromuscular diseases. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 10 studies with a total of 173 subjects. The pooled risk ratio (RR) of dying was 0.62 (95% CI 0.42 to 0.91; 4 studies) in favour of nocturnal mechanical ventilation compared to spontaneous breathing. The pooled RR of unplanned hospitalization was 0.25 (95% CI 0.08 to 0.82; 2 studies) in favour of nocturnal mechanical ventilation. For most of the outcome measures there was no significant long-term difference between nocturnal mechanical ventilation and no ventilation.

Volume-cycled ventilation as compared with pressure-cycled ventilation was associated with less sleep time spent with an arterial oxygen saturation below 90% (mean difference [MD] 6.83 minutes, 95% CI 4.68 to 8.98; p = 0.00001; 2 cross-over trials) and a lower apnoea-hypopnoea (per sleep hour) index (MD -0.65, 95% CI -0.84 to -0.46, p = 0.00001). No studies comparing invasive and non-invasive mechanical ventilation or intermittent positive pressure versus negative pressure ventilation were found.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in studied patients, interventions and outcomes) and by imprecise results (limited study size for each comparison).

References

  • Annane D, Orlikowski D, Chevret S. Nocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders. Cochrane Database Syst Rev 2014;(12):CD001941. [PubMed]

Primary/Secondary Keywords