Home and outpatient versus in-hospital initiation of non-invasive ventilation in people with neuromuscular and restrictive thoracic disorders: a network meta-analysis.

However, evidence supporting the non-inferiority of this strategy is limited in people with neuromuscular diseases (NMDs) or restrictive thoracic disorders (RTDs).

然而，在神经肌肉疾病（NMDs）或限制性胸部疾病（RTDs）患者中，支持这种策略非劣效性的证据有限。

Methods

Systematic reviewand network meta-analysis(NMA) to compare the effect of three NIV initiation settings (home, outpatient and in-hospital) on long-term NIV efficacy in people with NMD or RTD.

系统评价和网络荟萃分析（NMA），比较三种无创通气（NIV）启动设置（家庭、门诊和住院）对患有NMD或RTD的人群长期NIV疗效的影响。

We used MEDLINE, Web of Science and the CENTRAL (Cochrane Central Register of Controlled Trials) to identify randomised controlled trials (RCTs), controlled and uncontrolled prospective studies comparing NIV efficacy between home and outpatient, and in-hospital initiation.

我们使用MEDLINE、Web of Science和CENTRAL（Cochrane中央控制试验登记册）来识别随机对照试验（RCTs）、对照和非对照前瞻性研究，比较家庭和门诊以及住院启动的NIV疗效。

Studies published between January 2000 and February 2023 with endpoints ≥1 month were included.

纳入了2000年1月至2023年2月期间发表的、研究终点≥1个月的研究。

The main outcomes were diurnal arterial carbon dioxide pressure (PaCO2) (primary), oxygen partial blood pressure (PaO2), bicarbonate (HCO3-), quality-of-life and NIV adherence.

主要结果包括昼夜动脉二氧化碳分压（PaCO2）（主要的）、氧分压（PaO2）、碳酸氢盐（HCO3-）、生活质量以及无创通气（NIV）的依从性。

Results

Eight studies (five RCTs), comprising 350 individuals with PaCO2 measurements (144, 119 and 87 individuals for in-hospital, home and outpatient NIV initiation, respectively) were included.

纳入了八项研究（五项随机对照试验），共包括350名PaCO2测量值的个体（分别为144、119和87名，用于院内、家庭和门诊NIV启动）。

Home and outpatient initiation were not inferior to in-hospital initiation in terms of mean PaCO2 change (Δ) based on the adjusted Bayesian NMA model.

基于调整后的贝叶斯网络荟萃分析模型，家庭和门诊启动在平均PaCO2变化（Δ）方面并不逊色于院内启动。

No significant difference was found for any secondary outcomes: PaO2, HCO3-, adherence and quality of life.

未发现任何次要结果之间存在显著差异：PaO2、HCO3-、依从性和生活质量。

Conclusions

Despite the limited number of studies included in this NMA, we found no evidence suggesting that home or outpatient NIV initiation is less effective than in-hospital initiation for individuals with NMD or RTD who are deemed suitable for home or outpatient care.

尽管本网络荟萃分析纳入的研究数量有限，但我们未发现任何证据表明，对于被判定适合家庭或门诊护理的NMD或RTD患者，家庭或门诊无创通气(NIV)启动的效果不如在医院启动。

Home NIV initiation may therefore be a particularly valuable strategy, especially when hospital resources are limited or when patient autonomy is compromised.

因此，家庭无创通气(NIV)启动可能是一个特别有价值的战略，特别是当医院资源有限或患者自主性受损时。

prospero_registration_number

CRD42023403339.

CRD42023403339。