Use of noninvasive mechanical ventilation with pressure support guaranteed with average volume in de novo hypoxaemic respiratory failure. A pilot study

Abstract

Background: This study was designed to determine the results associated with the use of noninvasive mechanical ventilation (NIV) using the BiPAP S/T-AVAPS ventilation strategy in subjects with mild to moderate de novo hypoxaemic respiratory failure. Methods: This is a prospective study that includes subjects with de novo hypoxaemic respiratory failure (not produced by acute exacerbations of COPD, chronic lung disease, or congestive heart failure) with mild to moderate PaO 2 /FiO 2 , who were admitted to the Intensive Care Unit (ICU) of Santa Maria Clinic in Guayaquil, Ecuador. Subjects were divided into two groups and compared according to their PaO 2 /FiO 2 : higher than 100 and up to 200 mm Hg (moderate ARDS) or between 200 and 300 mm Hg (mild ARDS) (both groups were ventilated with the BiPAP S/T-AVAPS strategy). Results: A total of 38 subjects were analysed in this study. The total rate of intubation was 34.2% while the mortality rate was 28.9%. Significant differences were observed when comparing success versus failure in exhaled tidal volumes heart rate (P = 0.04), peak inspired pressure (P < 0.001), PaO 2 (P < 0.001), SaO 2 (P < 0.002), PaO 2 /FiO 2 (P < 0.002), arterial blood pressure (P < 0.001), HR (P < 0.001), and inspiratory time (P = 0.029) measured at baseline and at 12-hour, 24-hour and 48-hour intervals. Conclusion: The BiPAP S/T-AVAPS ventilatory mode can be used in subjects with de novo hypoxaemic respiratory failure with special vigilance concerning exhaled tidal volumes and inspired pressure.

Noninvasive Mechanical Ventilation with Average Volume-Assured Pressure Support versus BiPAP S/T in De Novo Hypoxemic Respiratory Failure

“…We evaluated the BiPAP·S/T–AVAPS mode in patients with de novo hypoxemic respiratory failure and observed that it provides a better approach to protective ventilation in a selected group of subjects with mild-to-moderate hypoxemic respiratory insufficiency and spontaneous breathing to control the exhaled TV and inspired pressures [ 12 ].…”

Treatment of critically ill patients with acute hypercarbic respiratory failure by average volume‐assured pressure support mode

“…AVAPS mode has been studied in patients with chronic respiratory failure due to obesity hypoventilation, COPD and neuromusculoskeletal disorders, and reported not to be inferior to BPAP mode in term of NIMV efficacy 4‐6 . In addition, there are a limited number of studies examining AVAPS mode in acute hypoxic and hypercarbic respiratory failures 7‐10 . The available evidence suggests that AVAPS ventilation is at least equal to BPAP ventilation in its ability to treat acute respiratory failure.…”

“…[4][5][6] In addition, there are a limited number of studies examining AVAPS mode in acute hypoxic and hypercarbic respiratory failures. [7][8][9][10] The available evidence suggests that AVAPS ventilation is at least equal to BPAP ventilation in its ability to treat acute respiratory failure.…”

Non-invasive mechanical ventilation with average volume-assured pressure support. Results according to the aetiology of acute respiratory failure

“…Moreover, values above this threshold have the potential of causing overdrive and ventilator-induced lung injury (VILI), even in patients with spontaneous breathing. Additionally, some authors have demonstrated that high tidal volumes above 9.5 mL kg -1 are predictors of NIV failure, especially among ARF patients with moderate to severe hypoxaemia [17,23].…”