Volume-assured pressure support mode for noninvasive ventilation: can it improve overnight adherence in children with neuromuscular disease?

Abstract

Purpose Volume-assured pressure support in noninvasive ventilation (VAPS-NIV) is a newer mode providing automatic pressure support adjustment to ensure a constant alveolar ventilation. Previous studies have shown that NIV effectiveness depends on patient adherence and tolerance. The aim of this study was to determine the adherence and efficacy of VAPS-NIV compared to spontaneous-time (S/T) mode in pediatric patients with neuromuscular disease (NMD). Methods This was a prospective observational study. Children with NMD who utilized NIV at home for ≥ 3 months were recruited from the Long-term ventilation clinic at The Hospital for Sick Children, Toronto, Canada, from July 1, 2015, to July 1, 2019. Baseline characteristics, date of initiation of NIV, and pulmonary function tests were recorded. Polysomnogram (PSG) data and adherence were recorded and analyzed comparing VAPS and S/T modes. Results Twenty children with NMD (17 male, 85%) were enrolled. The mean (SD) age at initiation of NIV was 11.6 ± 4.6 years. The median (IQR) duration of ventilation was 1.36 (0.80-2.98) years. The mean average daily usage and the median daily usage for VAPS mode and S/T mode were 8.4 ± 1.6 versus 7.2 ± 2.5 h (p = 0.012) and 8.6 ± 1.4 versus 7.8 ± 2.1 h (p = 0.022), respectively. There was no difference in sleep architecture, gas exchange, or parent proxy report of NIV tolerance between S/T and VAPS modes. Conclusion VAPS was associated with an improvement in adherence to therapy in children with NMD compared to S/T mode. Longitudinal studies are required to evaluate long-term clinical outcomes using VAPS mode in children with NMD.

Volume assured pressure support mode use for non‐invasive ventilation in pediatrics

“…This intuitive automatic adjustment of pressures results in more stable ventilation over the course of the night, which is also thought to have an impact on therapy adherence. In a 2020 study by Sunkonkit et al 21 comparing BPAP with S/T mode versus iVAPS mode in 20 children with NMD, VAPS was associated with an improvement in therapy adherence (mean average daily usage and the median daily usage for VAPS mode and S/T mode were 8.4 ± 1.6 vs. 7.2 ± 2.5 h [ p = .012] and 8.6 ± 1.4 vs. 7.8 ± 2.1 h [ p = .022], respectively). There was no difference in sleep architecture, gas exchange, or parental report of NIV tolerance 21 …”

“…There was no difference in sleep architecture, gas exchange, or parental report of NIV tolerance. 21 However, further studies are needed to assess the benefits of VAPS modes and build standardized recommendation for NIV therapy in the pediatric population. Therefore, VAPS mode is typically not recommended to be used as an initial over pressure support ventilation.…”

Non‐invasive ventilation usage and adherence in children and adults with Duchenne muscular dystrophy: A multicenter analysis

“…Although NIV is highly beneficial for treating SDB in individuals with NMD, the efficacy of NIV is limited by low adherence 12 . To date, there are a limited number of studies reporting on NIV adherence in children and adults with NMD 13–16 . Two cross‐sectional, single‐center studies of NIV adherence in individuals with DMD have thus far been published 12,17 .…”

“…12 To date, there are a limited number of studies reporting on NIV adherence in children and adults with NMD. [13][14][15][16] Two crosssectional, single-center studies of NIV adherence in individuals with DMD have thus far been published. 12,17 Multicenter studies are needed to enhance the external validity of the findings of these studies.…”

Pediatric Average Volume Assured Pressure Support

“…It offers several advantages over fixed pressure NIV support such as its ability to compensate for the changes in tidal volume which occur with changes in lung compliance and sleep stages. It intuitively varies the inspiratory pressure, using higher pressure during REM sleep compared to NREM sleep resulting in a more stable ventilation and potentially improving adherence ( 5 , 8 ). Despite its advantages, data on its use in children are sparse and recommendations on initiation and settings are extrapolated from adult experience.…”