Non-invasive ventilation with intelligent volume-assured pressure support versus pressure-controlled ventilation: effects on the respiratory event rate and sleep quality in COPD with chronic hypercapnia

• Published in: International journal of chronic obstructive pulmonary disease Vol. 12; pp. 1039 - 1045
• Main Authors: Nilius, Georg, Katamadze, Nato, Domanski, Ulrike, Schroeder, Maik, Franke, Karl-Josef
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01-01-2017; Dove Medical Press Ltd; Dove Medical Press
• Subjects: Acidosis; Adult; Aged; Airway management; Blood Gas Monitoring, Transcutaneous; Carbon dioxide; Care and treatment; Chronic Disease; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Clinical Trial Report; Comparative analysis; Complications and side effects; COPD; Cross-Over Studies; Development and progression; Eye movements; Female; Germany; Humans; Hypercapnia; Hypercapnia - diagnosis; Hypercapnia - physiopathology; Hypercapnia - therapy; Hypoventilation; Interactive Ventilatory Support - adverse effects; Interactive Ventilatory Support - methods; iVAPS; Lung - physiopathology; Male; Mechanical ventilation; Middle Aged; NIV; Noninvasive Ventilation - adverse effects; Noninvasive Ventilation - methods; Oxygen saturation; Oxygen therapy; Patient outcomes; Patients; Physiological aspects; Polysomnography; Pressure; Prognosis; Prospective Studies; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - therapy; Questionnaires; Respiration; Risk factors; Sleep; Sleep Wake Disorders - diagnosis; Sleep Wake Disorders - physiopathology; Sleep Wake Disorders - therapy; Time Factors; Treatment Outcome; Ventilators; Germany; NIV; IVAPS; hypercapnia; COPD
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S126970

COPD patients who develop chronic hypercapnic respiratory failure have a poor prognosis. Treatment of choice, especially the best form of ventilation, is not well known.
This study compared the effects of pressure-controlled (spontaneous timed [ST]) non-invasive ventilation (NIV) and NIV with intelligent volume-assured pressure support (IVAPS) in chronic hypercapnic COPD patients regarding the effects on alveolar ventilation, adverse patient/ventilator interactions and sleep quality.
This prospective, single-center, crossover study randomized patients to one night of NIV using ST then one night with the IVAPS function activated, or vice versa. Patients were monitored using polysomnography (PSG) and transcutaneous carbon dioxide pressure (PtcCO
) measurement. Patients rated their subjective experience (total score, 0-45; lower scores indicate better acceptability).
Fourteen patients were included (4 females, age 59.4±8.9 years). The total number of respiratory events was low, and similar under pressure-controlled (5.4±6.7) and IVAPS (8.3±10.2) conditions (
=0.064). There were also no clinically relevant differences in PtcCO
between pressure-controlled and IVAPS NIV (52.9±6.2 versus 49.1±6.4 mmHg). Respiratory rate was lower under IVAPS overall; between-group differences reached statistical significance during wakefulness and non-rapid eye movement sleep. Ventilation pressures were 2.6 cmH
O higher under IVAPS versus pressure-controlled ventilation, resulting in a 20.1 mL increase in breathing volume. Sleep efficiency was slightly higher under pressure-controlled ventilation versus IVAPS. Respiratory arousals were uncommon (24.4/h [pressure-controlled] versus 25.4/h [IVAPS]). Overall patient assessment scores were similar, although there was a trend toward less discomfort during IVAPS.
Our results show that IVAPS NIV allows application of higher nocturnal ventilation pressures versus ST without affecting sleep quality or inducing ventilation- associated events.