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

Abstract

BackgroundCOPD patients who develop chronic hypercapnic respiratory failure have a poor prognosis. Treatment of choice, especially the best form of ventilation, is not well known.ObjectivesThis 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.MethodsThis 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 (PtcCO2) measurement. Patients rated their subjective experience (total score, 0–45; lower scores indicate better acceptability).ResultsFourteen 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 (P=0.064). There were also no clinically relevant differences in PtcCO2 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 cmH2O 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.ConclusionOur results show that IVAPS NIV allows application of higher nocturnal ventilation pressures versus ST without affecting sleep quality or inducing ventilation- associated events.

Comparing the effects and compliance between volume‐assured and pressure support non‐invasive ventilation in patients with chronic respiratory failure

“…The 2019 update resulted in eight RCTs that met the inclusion criteria. 2,6,[9][10][11][12][13][14] The details of the search and exclusion criteria are displayed in the flow diagram ( Figure 1).…”

Automatic EPAP intelligent volume‐assured pressure support is effective in patients with chronic respiratory failure: A randomized trial

“…VAPS has already been examined for the treatment of chronic respiratory failure, OHS and NMD. [6][7][8][9][10][11] There is growing evidence that VAPS is as effective as manually titrated pressure support (PS) ventilation for treating respiratory insufficiency or failure. 6,10,[12][13][14][15] Some conditions that could be treated with VAPS may also have a component of upper airway obstruction; patients might therefore benefit from automatically adjusting EPAP (AutoEPAP).…”

“…Advances in technology demonstrate that NIV devices could meet changes in ventilation demand by automatically adjusting inspiratory pressure via the volume‐assured pressure support (VAPS) algorithm. VAPS has already been examined for the treatment of chronic respiratory failure, OHS and NMD . There is growing evidence that VAPS is as effective as manually titrated pressure support (PS) ventilation for treating respiratory insufficiency or failure …”

Advances in non‐invasive positive airway pressure technology

“…Most studies around the use of Va‐BPAP have been conducted in patients with obesity hypoventilation syndrome or COPD presenting with chronic respiratory failure . However, Va‐BPAP has also been successfully used in congenital central hypoventilation syndrome and restrictive chest wall disorders .…”

“…Most studies around the use of Va-BPAP have been conducted in patients with obesity hypoventilation syndrome or COPD presenting with chronic respiratory failure. [52][53][54][55][56][57] However, Va-BPAP has also been successfully used in congenital central hypoventilation syndrome 58 and restrictive chest wall disorders. [59][60][61] Early studies reported better control of nocturnal CO 2 with volume assurance compared to fixed pressure BPAP, 53,57 although this was often achieved at the expense of poorer sleep quality.…”