The use of volume-assured pressure support noninvasive ventilation in acute and chronic respiratory failure: a practical guide and literature review

Pluym, Mark; Kabir, Asad; Gohar, Ashraf

doi:10.1080/21548331.2015.1110475

Cited by 19 publications

(12 citation statements)

References 45 publications

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“…Abbreviations: AVAPS, average volume-assured pressure support; BiPAP, bilevel positive airway pressure; CPAP, continuous positive airway pressure; EPAP, expiratory positive airway pressure; IPAP, inspiratory positive airway pressure; LOS, length of hospital stay; LRTI, lower respiratory tract infection; pCO 2 , partial pressure of carbon dioxide; PICU, pediatric intensive care unit; SaO 2 , oxygen saturation; TTV, targeted tidal volume per kg; TV, tidal volume per kg; URTI, upper respiratory tract infection.sizes but have shown some promise. The benefits noted with AVAPS, however, did not translate into increased survival, decreased hospitalizations, or improved quality of life compared to BiPAP 7.…”

mentioning

confidence: 78%

The prevalence of hypercapnia during acute infection in children on chronic noninvasive ventilation: A retrospective study

Beyltjens

Leede

Eekelen

et al. 2020

Pediatric Pulmonology

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Background/Aim Children on chronic noninvasive ventilation are at risk for nonelective hospitalizations, mainly for acute infections. This study examined the prevalence of hypercapnia in children on chronic ventilatory support during an acute admission. Methods This retrospective study included children aged 0 to 18 years who regularly used bilevel positive airway pressure or continuous positive airway pressure at home, and who were diagnosed with an acute infection, and were hospitalized at the pediatrics department or pediatric intensive care unit. Capillary blood gas analysis and parameters of the built‐in software of the home ventilator were recorded. Results Among the 43 cases included, hypercapnia was prevalent in 23% with a mean partial pressure of carbon dioxide of 51.7 ± 6.4 mm Hg. These children also had lower oxygen saturation levels. The respiratory rate 48 hours before admission was significantly higher in the hypercapnic group and the volume guarantee mode was less frequently used in the hypercapnic group. Conclusion Approximately, a quarter of the cases of chronic home ventilation experience hypercapnia during an acute infection. Our data warrant a prospective study on the monitoring of respiratory rate in patients with chronic respiratory insufficiency as an indicator for hospitalizations with hypercapnia; we also recommend the use of volume guarantee mode of ventilation to prevent hypercapnia.

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mentioning

confidence: 78%

The prevalence of hypercapnia during acute infection in children on chronic noninvasive ventilation: A retrospective study

Beyltjens

Leede

Eekelen

et al. 2020

Pediatric Pulmonology

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“…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).…”

Section: Summary At a Glancementioning

confidence: 99%

“…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 …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Background and objective Patients with chronic respiratory failure are increasingly managed with domiciliary non‐invasive ventilation (NIV). There may be limited ability to provide NIV titration for these complex patients, and ventilatory requirements and upper airway support needs may change over time. Therefore, an automatically adjusting expiratory positive airway pressure (AutoEPAP) algorithm may offer advantages over manually adjusted EPAP for treating these patients. This study compared 4% oxygen desaturation index (ODI4%) values during the use of an AutoEPAP algorithm versus manual EPAP titration with the intelligent volume‐assured pressure support (iVAPS) algorithm. Methods This prospective, single‐blind, randomized, crossover study was conducted at six US sites. Patients with chronic respiratory failure (neuromuscular disease, chronic obstructive pulmonary disease, obesity hypoventilation and other aetiologies) and an apnoea–hypopnoea index of >5/h who were already established NIV users underwent a single night of NIV with the iVAPS manual EPAP and iVAPS AutoEPAP in the sleep laboratory in random order. Results A total of 38 patients constituted the study population. Mean ODI4% was statistically non‐inferior with AutoEPAP versus manual EPAP (P < 0.0001). There was no difference in the effect on ODI4% across respiratory failure subgroups. Ventilation parameters and gas exchange were similar with either NIV mode, indicating equally effective treatment of respiratory failure. Sleep parameters were improved during AutoEPAP versus manual EPAP. Conclusion A single night of NIV using the iVAPS with AutoEPAP algorithm was non‐inferior to a single night of iVAPS with manual EPAP titration in patients with respiratory failure.Clinical Trial Registration: NCT02683772 at http://clinicaltrials.gov

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“…17 Other studies comparing the use of AVAPS to PS-NIV in patients with stable hypercapnia due to COPD have shown that the two modes have comparable efficacy in improving oxygenation and reducing PaCO 2 levels. 18 Both AVAPS and PS-NIV are effective treatment options for patients with chronic hypercapnia due to COPD and obesity hypoventilation patients.…”

Section: Arterial Blood Gasesmentioning

confidence: 99%

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

Huang

et al. 2019

Clinical Respiratory J

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Introduction Standard bi‐level non‐invasive ventilation with fixed‐level pressure support (PS) delivery may not maintain ventilation during the changes in pulmonary mechanics that occur throughout day and night, so average volume‐assured pressure support (AVAPS) modes that target a preset volume by adjustment of PS may be effective. Objective Our meta‐analysis wants to compare AVAPS and pressure support non‐invasive ventilation (PS‐NIV) regarding arterial blood gases (ABGs), sleep efficiency and compliance. Method Relevant publications indexed in PubMed, Cochrane Library, Embase, Web of Science, Wanfang Data, China National Knowledge Infrastructure and VIPI were identified. Appropriate articles identified from the reference lists of the above searches were also reviewed. We included randomized controlled trials involved the use of AVAPS and PS‐NIV ventilation for chronic respiratory failure. Each included study weighted mean differences, and 95% confidence intervals (CI) were calculated for continuous outcomes. Statistical heterogeneity was assessed using the I2 value ≤ 50% were considered as no statistical heterogeneity and used fixed effects model. Otherwise, a random effects model was used. Results Eight trials were eligible. No significant difference was observed between AVAPS and PS‐NIV groups to compare PaCO2 (OR −0.97, CI‐2.54‐0.61, P = 0.23) and PaO2 (OR −1.81, CI‐4.29‐0.67, P = 0.15) in ABGs. There was no significant difference between the two groups with sleep efficiency (OR −3.31, CI‐7.58‐0.95, P = 0.13) and visual analog scale (OR 0.32, CI‐6.97‐7.61, P = 0.93). Conclusions The evidence shows there is no significant difference in clinical outcomes when comparing AVAPS and PS‐NIV used for chronic respiratory failure patients.

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The use of volume-assured pressure support noninvasive ventilation in acute and chronic respiratory failure: a practical guide and literature review

Cited by 19 publications

References 45 publications

The prevalence of hypercapnia during acute infection in children on chronic noninvasive ventilation: A retrospective study

The prevalence of hypercapnia during acute infection in children on chronic noninvasive ventilation: A retrospective study

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

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

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