Use of Noninvasive Ventilation with Volume-Assured Pressure Support to Avoid Tracheostomy in Severe Obstructive Sleep Apnea

Diaz‐Abad, Montserrat; Isaiah, Amal; Rogers, Valerie; Pereira, Kevin D.; Lasso‐Pirot, Anayansi

doi:10.1155/2018/4701736

Cited by 11 publications

(8 citation statements)

References 15 publications

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“…Given that CPAP treatment failure can lead to many patients with OSA in whom treatment cannot be offered, the results suggest that AVAPS may be an effective alternative. Consistent with our results, a case report describing very severe OSA in a pediatric patient with CPAP treatment failure showed that AVAPS successfully treated the condition, avoiding tracheostomy 28 .…”

Section: Discussionsupporting

confidence: 91%

“…Thus, the ventilatory assist mode adjusts pressures to achieve a target tidal volume and will adjust the pressure regimen depending on the patient’s ventilatory pattern, and also can adjust the EPAP level to treat OSA. There is at least one case report showing that AVAPS could in fact function as a rescue modality in severe OSA that failed CPAP therapy 28 . Another study showed iVAPS (intelligent volume-assured pressure support - essentially equivalent to AVAPS) with auto-titrating EPAP was equivalent for control of disordered breathing events compared to iVAPS using a fixed EPAP level pre-determined from an in-laboratory titration, in patients with hypoventilation and concomitant OSA 29 .…”

Section: Introductionmentioning

confidence: 99%

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Average volume-assured pressure support for patients with obstructive sleep apnea with failed CPAP titration

Watanabe¹,

Levri²,

Peng³

et al. 2022

Sleep Sci

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Objectives: Obstructive sleep apnea (OSA) is a common disease, often treated using continuous positive airway pressure (CPAP) therapy. In many cases, patients fail a CPAP titration study due to inadequate control of the apnea-hypopnea index (AHI, events/hour) or due to treatment-emergent central sleep apnea (TE-CSA). We report our experience using a mode of non-invasive ventilation for alternative treatment of these patients. Material and Methods: We reviewed records of adults who had OSA with AHI≥15 diagnosed on polysomnography (PSG) with failed CPAP titration and in whom titrations with average volume-assured pressure support (AVAPS) with auto-titrating expiratory positive airway pressure were performed. Results: Forty-five patients, age 57.9±13.1 y, 26 males, body mass index (BMI) 40.2±8.7kg/m 2 . Reasons for CPAP titration failure included: TE-CSA (25, 55.6%) and inadequate control of AHI at maximum CPAP of 20cm H2O (20, 44.4%). Changes noted from baseline PSG to AVAPS titration: AHI: 65.3±29.3 decreased to 22.3±16.1 (p<0.001). Median time SpO2 ≤88%: 63.7 to 6.9min (p<0.001). In 16 patients the AHI was reduced to <15 and in 16 additional patients the AHI was reduced to <30. Improvement in AHI was not related to gender, age, or opioid use, but was correlated with BMI: ΔAHI=12.2 -(1.4 * BMI); p=0.05. AVAPS resulted in improved sleep architecture: median N3 sleep increased: 1.4% to 19.6% total sleep time (TST) (p<0.001), and median R sleep increased: 6.4% to 13.6% TST (p<0.01). Discussion: For patients with OSA for whom CPAP titration failed, titration with AVAPS may be an effective treatment.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Average volume-assured pressure support for patients with obstructive sleep apnea with failed CPAP titration

Watanabe¹,

Levri²,

Peng³

et al. 2022

Sleep Sci

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“…With the obesity epidemic, rates of treatment failures with surgical intervention and traditional PAP therapy may increase and consideration of alternatives is important. NIV therapy may be a treatment option in severe cases of OSA when other therapies fail to avoid surgical interventions of last resort such as tracheostomy [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Due to the novelty of the mode and its recent introduction to the pediatric population, there are limited data on AVAPS therapy as a treatment modality for hypoventilation in children, with mostly case reports published despite increasing interest and use over time. We have previously shown AVAPS to be effective in treating very severe OSA and nocturnal hypoventilation in a child both in the sleep laboratory and long term as outpatient avoiding the need for tracheostomy [ 7 ]. This modality has also been used successfully in a group of 45 adult patients with OSA who failed a prior CPAP titration [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Respiratory Failure in a Patient with Prader-Willi Syndrome with Noninvasive Ventilation with AVAPS

Hwig

Diaz‐Abad

Peng

et al. 2023

Case Reports in Medicine

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Prader-Willi syndrome (PWS) is the most prevalent syndromic form of obesity, which starts during early childhood in the setting of hyperphagia. Due to the development of obesity, there is a high prevalence of obstructive sleep apnea (OSA) among these patients. This case report presents a patient with PWS with morbid obesity, severe OSA, and obesity hypoventilation syndrome admitted to the hospital for hypoxemic and hypercapnic respiratory failure. Noninvasive ventilation (NIV) with average volume-assured pressure support, a newer NIV modality, was used successfully to treat this patient, achieving major clinical and gas exchange improvement both during the hospitalization and long term after discharge.

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“…This mode is increasingly used for the management of children poorly responsive to the previously described modes. Successful experiences have been described in infants, children, and adolescents with neuromuscular disease (congenital myopathy) ( 21 ), disorders of ventilatory drive (congenital central hypoventilation syndrome) ( 22 – 24 ), and morbid obesity ( 25 ).…”

Section: Hybrid Modesmentioning

confidence: 99%

Ventilators and Ventilatory Modalities

et al. 2020

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Non-invasive ventilation is increasingly used in children for acute and chronic respiratory failure. Ventilators available for clinical use have different levels of complexity, and clinicians need to know in detail their characteristics, setting variables, and performances. A wide range of ventilators are currently used in non-invasive ventilation including bi-level ventilators, intermediate ventilators, and critical care ventilators. Simple or advanced continuous positive airway pressure devices are also available. Differences between ventilators may have implications on the development of asynchronies and air leaks and may be associated with discomfort and poor patient tolerance. Although pressure-targeted (controlled) mode is preferable in children because of barotrauma concerns, volume-targeted (controlled) ventilators are also available. Pressure support ventilation represents the most used non-invasive ventilation mode, as it is more physiological. The newest ventilators allow the clinicians to use the hybrid modes that combine the advantages of volume- and pressure-targeted (controlled) ventilation while limiting their drawbacks. The use of in-built software may help clinicians to optimize the ventilator setting as well as to objectively monitor patient adherence to the treatment. The present review aims to help the clinician with the choice of the ventilator and its ventilation modalities to ensure a successful non-invasive ventilation program.

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Use of Noninvasive Ventilation with Volume-Assured Pressure Support to Avoid Tracheostomy in Severe Obstructive Sleep Apnea

Cited by 11 publications

References 15 publications

Average volume-assured pressure support for patients with obstructive sleep apnea with failed CPAP titration

Average volume-assured pressure support for patients with obstructive sleep apnea with failed CPAP titration

Successful Treatment of Respiratory Failure in a Patient with Prader-Willi Syndrome with Noninvasive Ventilation with AVAPS

Ventilators and Ventilatory Modalities

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