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  • Nasal versus oronasal masks for home non-invasive ventilation in patients with chronic hypercapnia: a systematic review and individual participant data meta-analysis

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Non-invasive ventilation
Original research
Nasal versus oronasal masks for home non-invasive ventilation in patients with chronic hypercapnia: a systematic review and individual participant data meta-analysis
  1. Marius Lebret1,
  2. Antoine Léotard2,
  3. Jean Louis Pépin3,
  4. Wolfram Windisch4,5,6,
  5. Emelie Ekkernkamp7,
  6. Mercedes Pallero8,9,
  7. M-Ángeles Sánchez-Quiroga10,
  8. Nicholas Hart11,
  9. Julia L Kelly12,
  10. Maxime Patout13,
  11. Georg Chistian Funk14,
  12. Marieke L Duiverman15,
  13. Juan F Masa16,
  14. Anita Simonds17,18,
  15. Patrick Brian Murphy19,
  16. Peter J Wijkstra20,
  17. Michael Dreher21,
  18. Jan Storre22,23,
  19. Charles Khouri24,
  20. Jean-Christian Borel24
  1. 1 Pneumology Department, Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Quebec, Canada
  2. 2 Physiology, Hopital Raymond-Poincare, Garches, France
  3. 3 HP2 Laboratory INSERM U1042, Univ. Grenoble Alpes, Grenoble, France
  4. 4 Department of Pneumology and Critical Care Medicine, Cologne Merheim Hospital, Cologne, Germany
  5. 5 Depatment of Pneumology, Kliniken der Stadt Köln gGmbH, Cologne, Germany
  6. 6 Faculty of Health, Witten/Herdecke University, Witten, Germany
  7. 7 Department of Pneumology, University Hospital Freiburg, Freiburg, Germany
  8. 8 Respiratory Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  9. 9 CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
  10. 10 Respiratory, Hospital Virgen del Puerto, Plasencia, Extremadura, Spain
  11. 11 Lane Fox Respiratory Service, Guy's & St Thomas' NHS Foundation Trust, London, UK
  12. 12 NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
  13. 13 Departement of pneumology and intensive care, University Hospital, Rouen, France
  14. 14 Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Vienna, Austria
  15. 15 Pulmonary Diseases and Home Mechanical Ventilation, University Medical Centre Groningen, Groningen, Netherlands
  16. 16 San Pedro de Alcantara Hospital, Caceres, Spain
  17. 17 National Institute of Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  18. 18 Respiratory Medicine, Imperial College London, London, UK
  19. 19 Lane Fox Respiratory Unit, Guy's & St.Thomas' NHS Foundation Trust, London, UK
  20. 20 Pulmonary Diseases, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
  21. 21 Pneumology and Intensive Care Medicine, Universitatsklinikum Aachen, Aachen, Nordrhein-Westfalen, Germany
  22. 22 Pneumology Department, University Medical Center Freiburg, Freiburg, Germany
  23. 23 Praxis Pneumologie Solln, Munich, Germany
  24. 24 HP2 Laboratory INSERM 1042, Grenoble Universites, Saint-Martin-d'Heres, France
  1. Correspondence to Dr Jean-Christian Borel, HP2 Laboratory INSERM 1042, Grenoble Universites, Saint-Martin-d'Heres 38043, France; j.borel{at}agiradom.com

Abstract

Background The optimal interface for the delivery of home non-invasive ventilation (NIV) to treat chronic respiratory failure has not yet been determined. The aim of this individual participant data (IPD) meta-analysis was to compare the effect of nasal and oronasal masks on treatment efficacy and adherence in patients with COPD and obesity hypoventilation syndrome (OHS).

Methods We searched Medline and Cochrane Central Register of Controlled Trials for prospective randomised controlled trials (RCTs) of at least 1 month’s duration, published between January 1994 and April 2019, that assessed NIV efficacy in patients with OHS and COPD. The main outcomes were diurnal PaCO2, PaO2 and NIV adherence (PROSPERO CRD42019132398).

Findings Of 1576 articles identified, 34 RCTs met the inclusion criteria and IPD were obtained for 18. Ten RCTs were excluded because only one type of mask was used, or mask data were missing. Data from 8 RCTs, including 290 IPD, underwent meta-analysis. Oronasal masks were used in 86% of cases. There were no differences between oronasal and nasal masks for PaCO2 (0.61 mm Hg (95% CI −2.15 to 3.38); p=0.68), PaO2 (−0.00 mm Hg (95% CI −4.59 to 4.58); p=1) or NIV adherence (0·29 hour/day (95% CI −0.74 to 1.32); p=0.58). There was no interaction between the underlying pathology and the effect of mask type on any outcome.

Interpretation Oronasal masks are the most used interface for the delivery of home NIV in patients with OHS and COPD; however, there is no difference in the efficacy or tolerance of oronasal or nasal masks.

  • non invasive ventilation
  • COPD pathology
  • sleep apnoea

Data availability statement

No data are available. All of the anonymised individual participant data collected in this systematic review and meta-analyisis must be asked to each authors individually.

https://doi.org/10.1136/thoraxjnl-2020-215613

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    Data availability statement

    No data are available. All of the anonymised individual participant data collected in this systematic review and meta-analyisis must be asked to each authors individually.

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    Footnotes

    • CK and J-CB are joint senior authors.

    • ML and AL are joint first authors.

    • Twitter @mariuslebret, @NickHartThorax, @maximepatout, @mlduiverman

    • Contributors All the authors have written or edited the manuscript. WW, EE, MP, JFM, NH, JLK, MP, GCF, MD, PBM, PJW, MLD and JS have provided complete IPD from their respective RCTs. Accordingly, each coauthor: made substantial contributions to the manuscript; drafted sections of the manuscript and revised it critically; provided final approval of the version to be published; agreed to be accountable for all aspects of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests ML has no conflict of interest to declare related to the present work. He received speaker fees from Air Liquide Medical System, and Sefam, and non-financial support from Nomics outside the context of the submitted work. He received a salary from Air Liquide Medical System as a medical trainer. A Léotard has no conflict of interest to declare related to the present work. JC Borel is salaried by AGIR à dom, a home-care provider. JL Pépin and his department has received research support and personal fees from Philips Respironics, Sefam, Fisher and Paykel, and ResMed. JLP is supported by the French National Research Agency in the framework of the "Investissements d’avenir” program (ANR-15-IDEX-02) and the “e-health and integrated care and trajectories medicine and MIAI artificial intelligence” Chairs of excellence from the Grenoble Alpes University Foundation. This work has been partially supported by MIAI @ Grenoble Alpes (ANR-19-P3IA-0003). M Dreher has received speaking and advisor fees from companies in the field of mechanical ventilation; in addition, his study group received an open research grant from ResMed. JH Storre reports grants and personal fees for lectures from Heinen und Löwenstein and VitalAire, grants, personal fees for lectures and non-financial support for meeting attendance from Vivisol GmbH, grants from Weinmann Deutschland, personal fees for consultancy/advisory board work from Breas Medical AB regarding the submitted work; personal fees for consultancy and lectures, and non-financial support for meeting attendance from Boehringer Ingelheim Pharma, personal fees for consultancy and lectures from SenTec AG, Keller Medical GmbH, Linde Deutschland and Santis GmbH, outside the submitted work. M Patout reports personal fees from Resmed, Philips Respironics, grants and non-financial support from Fisher & Paykel, non-financial support and personal fees from Asten, research grants from B& D Electromedical and Fisher & Paykel, personal fees and non-financial support from Chiesi outside the submitted work. GC Funk received speaker fees from Draeger and Getinge. PJ Wijkstra reports grants and personal fees from Philips, grants and personal fees from RESMED, grants from Vital Air, grants from VIVISOL, grants from Goedegebuure, personal fees from Synapse, personal fees from Bresotec, outside the submitted work.

    • Provenance and peer review Not commissioned; externally peer reviewed.