Mask Proportional Assist vs Pressure Support Ventilation in Patients in Clinically Stable Condition With Chronic Ventilatory Failure

Porta, Roberto; Appendini, Lorenzo; Vitacca, Michele; Bianchi, Luca; Donner, Claudio F.; Poggi, R.; Ambrosino, Nicolino

doi:10.1378/chest.122.2.479

Cited by 42 publications

(24 citation statements)

References 23 publications

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“…A portion of the total mechanical workload, i.e. elastance and resistance, is taken over according to a level of assistance, which has been decided by the caregiver and can specifically unload the resistive burden (flow assist) and the elastic burden (volume assist) [33,[50][51][52]. DOLMAGE and GOLDSTEIN [53] determined whether PAV applied during constant power submaximal exercise could enable severe, stable COPD patients (mean FEV1 29% pred) to increase their exercise tolerance.…”

Section: Noninvasive Ventilation and Exercisementioning

confidence: 99%

New strategies to improve exercise tolerance in chronic obstructive pulmonary disease

Ambrosino¹,

Strambi²

2004

Eur Respir J

137

106

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Breathlessness is the most common symptom limiting exercise in patients with chronic obstructive pulmonary disease (COPD). Exercise training can improve both exercise tolerance and health status in these patients, intensity being of key importance. Nevertheless, in these patients extreme breathlessness and/or peripheral muscle fatigue may prevent patients from higher levels of intensity. In this review article the literature concerning the different ways to optimise exercise tolerance in patients with COPD, with the objective of enhancing the tolerance to higher exercise training intensity, is summarised.Continuous positive airway pressure and different modalities of noninvasive positive pressure ventilation (NPPV) may reduce breathlessness and increase exercise tolerance in these patients. Respiratory muscle unloading and reduction in intrinsic positive end-expiratory pressure have been considered among mechanisms underlying these effects. Nevertheless, the role of NPPV in pulmonary rehabilitation, if any, is still controversial. The addition of nocturnal domiciliary NPPV during a daily exercise programme in patients with severe COPD resulted in an improvement in exercise tolerance and quality of life.In patients with severe COPD application of electrical stimulation combined with active limb mobilisation significantly improved muscle strength, and interval training has been shown capable of inducing physiological training effects.Oxygen supplementation in patients who do not desaturate during exercise seems to be the most promising treatment, since it allows for higher exercise intensities and, therefore, superior training efficacy.In conclusion, further studies are needed to define the appropriate patients in order to generalise such interventions. The modalities discussed should be used as adjuncts to a well designed comprehensive respiratory rehabilitation programme.

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Section: Noninvasive Ventilation and Exercisementioning

confidence: 99%

New strategies to improve exercise tolerance in chronic obstructive pulmonary disease

Ambrosino¹,

Strambi²

2004

Eur Respir J

137

106

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“…Therefore, with PAV, the airway pressure is amplified according to patient respiratory mechanics and the chosen level of assistance (from 0 to 100%). However, in its first description, despite a better response to the patient's demand [7][8][9], PAV required a manual adaptation to any changes of patient ventilatory load [1-3], representing a major obstacle to its clinical diffusion.…”

Section: Introductionmentioning

confidence: 99%

Technological development in mechanical ventilation

Conti

Costa

2010

Current Opinion in Critical Care

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The recently reported results with proportional assist ventilation with load-adjustable gain factors, neurally adjusted ventilatory assist, and adaptive support ventilation are, till now, mainly based on preliminary physiologic and clinical studies; although they seem to be promising, suggesting that closed loop-based modes could represent a real innovation in the field of mechanical ventilation, further clinical evaluation is needed before their widespread diffusion into clinical practice.

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“…However, PAV has been investigated in only a few patients with restrictive chest wall disease (10,11), and the PAV working hypothesis, i.e., the possibility of PAV to unload respiratory muscles during an increase in the subjects inspiratory effort, has not been previously reported in patients with restrictive chest wall disease.…”

mentioning

confidence: 99%

Proportional-assist ventilation compared with pressure-support ventilation during exercise in volunteers with external thoracic restriction

Wysocki

Meshaka²,

Richard³

et al. 2004

Critical Care Medicine

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Mask Proportional Assist vs Pressure Support Ventilation in Patients in Clinically Stable Condition With Chronic Ventilatory Failure

Cited by 42 publications

References 23 publications

New strategies to improve exercise tolerance in chronic obstructive pulmonary disease

New strategies to improve exercise tolerance in chronic obstructive pulmonary disease

Technological development in mechanical ventilation

Proportional-assist ventilation compared with pressure-support ventilation during exercise in volunteers with external thoracic restriction

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