Non-invasive ventilation with pursed lips breathing mode for patients with COPD and hypercapnic respiratory failure: A retrospective analysis

Abstract

Long-term non-invasive ventilation (NIV) is recommended for patients with stable chronic obstructive lung disease (COPD) and chronic hypercapnia. High inspiratory pressure NIV (hiNIV) and a significant reduction of arterial pCO 2 have been shown to prolong survival. Often, patients on hiNIV describe severe respiratory distress, known as "deventilation syndrome", after removal of the NIV mask in the morning. Mechanical pursed lips breathing ventilation (PLBV) is a new non-invasive ventilation mode that mimics the pressure-curve of pursed lips breathing during expiration. The clinical impact of switching patients from standard NIV to PLBV has not been studied so far. Patients and methods In this hypothesis generating study, we retrospectively analysed the effects of switching COPD patients (stage GOLD III-IV) from conventional NIV to PLBV. Medical records of all patients who had an established NIV and were switched to PLBV between March 2016 and October 2017 were screened. Patients were included if they complained of shortness of breath on mask removal, used their conventional NIV regularly, and had a documented complete diagnostic workup including lung function testing, blood gas analysis and 6-minute walk test (6MWT) before and after 3-7 days of PLBV. Results Six male and 10 female patients (median age 65.4 years; IQR 64.0-71.3) with a previous NIV treatment duration of 38 months (median; IQR 20-42) were analysed. After PLVB initiation, the median inspiratory ventilation pressure needed to maintain the capillary pre-switch

Characteristics of the deventilation syndrome in COPD patients treated with non-invasive ventilation: an explorative study

“…After the patients were switched to PLBV, morning dyspnea decreased and this was associated with an increased inspiratory vital capacity. This confirms results of our previous retrospective study on PLBV [8]. It can be assumed that an increase in airway pressure during exhalation results in better airflow control allowing a harmonization of alveolar filling pressure and prevention of small airway collapse.…”

“…At higher IPAP values, PLBD and PLBP are usually also set higher. The setting of PLBV mode was made together with the patients in the afternoon before the third night [8].…”

“…Although approximately 30% of NIV-patients with COPD may suffer from the deventilation syndrome [7], the underlying mechanism remains unclear. A correlation between patient-ventilator-asynchrony, Auto-PEEP-phenomena and morning dyspnea has been described [7,8]. This suggests that dynamic hyperinflation, exacerbated by high inspiratory pressure may cause the deventilation syndrome [7].…”

“…Other explanations discussed are chronic muscle fatigue after rapid cessation of positive ventilation pressure or poor sleeping patterns [9]. In addition to optimizing ventilation settings [7], a potential therapy for morning dyspnea could be ventilation in pursed-lips-breathing-ventilation (PLBV) [8]. This ventilation mode is characterized by a dynamic increase in pressure during the expiratory phase followed by a slow pressure decay, which could prevent airway collapse and thus lead to more adequate expiration and less air trapping.…”

Efficacy evaluation and potential pharmacological mechanism of tanreqing injection in the treatment of COPD combined with respiratory failure based on meta-analysis and network pharmacology

“…FEV1/FVC% is the ratio of the first second forceful expiratory volume to all expiratory volumes [ 44 ], and it is a sensitive indicator of obstructive ventilation dysfunction, and in the early stage [ 2 ]. Mechanical ventilation is used to maintain airway patency, improve ventilation and oxygenation, and prevent hypoxia and CO2 accumulation with the help of a ventilator [ 24 ], It is a more effective means of treating COPD combined with RF [ 19 ]. Both FEV1/FVC and mechanical ventilation time can reflect the respiratory function (2021).…”