Efficacy of non-invasive intelligent volume assured pressure support (iVAPS) and pressure support ventilation (PSV) in clinical practice

Abstract

AIMS OF THE STUDY: Noninvasive ventilation (NIV) is a well-established treatment option for hypercapnic respiratory failure; however, the best mode of ventilation remains unknown. The aim of this retrospective study was to compare patients' adherence to NIV using either pressure support ventilation (PSV) or intelligent volume-assured pressure support (iVAPS). PATIENTS AND METHODS:In this retrospective cohort study, we assessed in-and outpatients suffering from hypercapnic respiratory failure of various aetiologies (chronic obstructive pulmonary disease [COPD], obese COPD [body mass index >30 kg/m 2 ], obesity hypoventilation syndrome and other diseases such as amyotrophic lateral sclerosis or interstitial lung disease) after NIV initiation with PSV or iVAPS. Adherence to treatment was compared between these modes using the Wilcoxon test. Within-group differences were tested using linear regression models. Mortality and emergency hospital readmission rates were modelled using Kaplan-Meier estimates and Cox proportional hazards models. RESULTS: Adherence to treatment was similar in both groups throughout the observation period -after 6 weeks: PSV 363 min/night (interquartile range [IQR] 200-448), iVAPS 369 min/night (IQR 310-468) (p = 0.619); after 1 year: PSV 423 (323-500), iVAPS 429 (298-475) (p = 0.901); at the last follow up: PSV 481 (395-586), iVAPS 426 (391-565) (p = 0.284). NIV reduced PaCO 2 significantly compared with baseline at all follow-ups: PSV −1.29/−1.49/−1.49 kPa, iVAPS −1.47/−1.23/−1.24 kPa, p <0.001 each, PSV vs iVAPS: p = 0.250, 0.756 and 0.352, respectively. Median survival time (PSV 5.06 years, iVAPS median not reached; p = 0.800) and time to first readmission (PSV 3.6 years, iVAPS 7.33 years, p = 0.200) did not differ between groups. Obese COPD patients had a longer time to hospital readmission than lean COPD patients (3.8 vs 1.5 years, hazard ratio (HR) 0.39, 95% confidence interval [CI] 0.16-0. 74; p = 0.007). Good adherence (>4 h/ night and >80% nightly usage) was associated with a lower mortality rate (HR 0.34, 95% CI 0.15-0.77; p = 0.010).CONCLUSION: In a real-world setting of a mixed population with hypercapnic respiratory failure, iVAPS and PSV seem to be similarly effective in improving gas exchange and demonstrate excellent adherence to treatment. A longer survival was noted in NIV-adherent patients. Randomised controlled studies are necessary to identify patients who might benefit more from hybrid ventilation modes.

The prevalence and risk factors of facial pressure injuries related to adult non‐invasive ventilation equipment: A systematic review and meta‐analysis

“…Such lesions should be staged using the NPIAP staging system. Non-invasive ventilation equipment, as a respiratory assistance therapy technology for the treatment of patients with acute and chronic respiratory failure, [3][4][5] can effectively improve the lung ventilation, relieve respiratory muscle fatigue and correct respiratory failure. 6 Multiple studies 7,8 have shown that non-invasive ventilation is a common cause of MDRPI.…”

“…Medical device‐related pressure injury (MDRPI) was 1 , 2 defined as “a description of the etiology that results from the use of a diagnostic or therapeutic related device, the appearance of which is consistent with the style or shape of the medical device.” Such lesions should be staged using the NPIAP staging system. Non‐invasive ventilation equipment, as a respiratory assistance therapy technology for the treatment of patients with acute and chronic respiratory failure, 3 , 4 , 5 can effectively improve the lung ventilation, relieve respiratory muscle fatigue and correct respiratory failure. 6 Multiple studies 7 , 8 have shown that non‐invasive ventilation is a common cause of MDRPI.…”

Volume assured pressure support mode use for non‐invasive ventilation in pediatrics

“…VAPS has seen increasing use in adult patients, with multiple studies showing VAPS modes to be non‐inferior to conventional pressure support ventilation modes in providing adequate oxygenation, ventilation, improving sleep quality and maintaining positive airway pressure (PAP) adherence in adults with chronic obstructive pulmonary disease, obesity hypoventilation syndrome and neuromuscular disease (NMD) 1,8–13 . Pediatric use of VAPS has been comparatively limited, but previous literature has also supported its use in populations with congenital central hypoventilation syndrome (CCHS), obesity hypoventilation syndrome, and NMD.…”

Effects of different dressings in the prevention of facial skin pressure injury related to non‐invasive ventilation: Systematic review and network meta‐analysis

“…MDRPI accounts for 29.0% to 34.5% of hospital‐acquired pressure injuries 3,4 . Non‐invasive ventilation is the equipment of choice for the treatment of acute respiratory failure, which can efficiently enhance lung ventilation, alleviate respiratory muscle fatigue and rectify respiratory failure 5–7 . Multiple studies 8–10 have shown that patients using non‐invasive ventilation need to wear nasal masks or oronasal masks for a long time, which increases the risk of pressure damage in the region of facial bone prominence.…”

“… 3 , 4 Non‐invasive ventilation is the equipment of choice for the treatment of acute respiratory failure, which can efficiently enhance lung ventilation, alleviate respiratory muscle fatigue and rectify respiratory failure. 5 , 6 , 7 Multiple studies 8 , 9 , 10 have shown that patients using non‐invasive ventilation need to wear nasal masks or oronasal masks for a long time, which increases the risk of pressure damage in the region of facial bone prominence. A common complication of using non‐invasive equipment is facial pressure injury, 10 which will cause patients to become less tolerant of ventilator therapy and less compliant with it.…”