Volume-Targeted Versus Pressure-Limited Noninvasive Ventilation in Subjects With Acute Hypercapnic Respiratory Failure: A Multicenter Randomized Controlled Trial

Cao, Zhixin; Luo, Zujin; Hou, Aiqin; Nie, Qingrong; Xie, Baoyuan; An, Xingwei; Wan, Zifen; Ye, Xianwei; Yan-ju, XU; Chen, Xisheng; Zhang, Honghai; Xu, Zhiyun; Wang, Jinxiang; An, Fucheng; Li, Pengfei; Yu, Chunxiao; Liang, Yandong; Zhang, Yongxiang; Ma, Yingmin

doi:10.4187/respcare.04619

Cited by 29 publications

(37 citation statements)

References 35 publications

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“…Despite this, no difference between groups was seen in the course of CO 2 improvement, duration of NIV or length of hospital stay. These findings echo those of another randomized trial comparing BPAP‐ST to Va‐BPAP‐ST performed on general respiratory wards in patients with acute hypercapnic respiratory failure . Reductions in PaCO 2 after 2 and 6 h of therapy, need for intubation and in‐hospital mortality did not differ between therapy modes.…”

Section: Volume‐assured Pressure Supportsupporting

confidence: 81%

Advances in non‐invasive positive airway pressure technology

Piper

2019

Respirology

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Non‐invasive ventilation (NIV) has become the standard of care for patients with a range of respiratory and sleep breathing disorders. Technological advances have enabled the development of several newer modes of automatically adapting NIV suitable for patients with more complex breathing abnormalities that may be difficult to manage effectively with more traditional positive airway pressure therapy. These modes allow for more stable ventilation when fluctuating ventilation requirements occur such as in positional upper airway obstruction or state‐related variations in respiratory mechanics and drive. Adaptive servoventilation (ASV) is designed for patients with periodic breathing and central apnoeas in whom carbon dioxide levels are normal to low, with the goal of therapy to dampen and stabilize ventilation. In contrast, volume‐assured pressure support is used in diagnostic groups characterized by hypoventilation, where targeting an effective level of ventilation irrespective of sleep stage or body position is required. These newer modes have the potential to simplify and optimize ventilation, although at present there is no evidence that they are clinically superior to standard home ventilation techniques. The complexity and differences in algorithms and features of various device brands, along with a limited evidence base documenting longer term outcomes, complicate decisions around which patient phenotypes are best suited to these newer modes. In‐built sensor and data storage capabilities of newer home ventilation devices provide the opportunity for earlier recognition of issues with ventilation and to guide corrective action. Further work is needed to determine how this impacts longer term clinical outcomes.

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Section: Volume‐assured Pressure Supportsupporting

confidence: 81%

Advances in non‐invasive positive airway pressure technology

Piper

2019

Respirology

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“…1 We agree that P aO 2 /F IO 2 could not be accurately calculated in our study, because supplemental oxygen was delivered through a port in the mask, and the noninvasive ventilator that we used did not provide accurate F IO 2 .…”

Section: P Ao 2 /F Io 2 Is Not a Guestimationreplymentioning

confidence: 55%

P _{aO
₂} /F _{IO
₂} Is Not a Guestimation—Reply

Luo

Cao

2017

Respir Care

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“…This ventilatory strategy has been demonstrated to be useful in patients with chronic respiratory insufficiency [6,7] and in subjects with acute hypercapnic respiratory insufficiency [8,9]. Briones Claudett et al [8] reported the first case-control study with benefits in 11 subjects with COPD and hypercapnic encephalopathy.…”

mentioning

confidence: 99%

“…Briones Claudett et al [8] reported the first case-control study with benefits in 11 subjects with COPD and hypercapnic encephalopathy. Cao et al [9] described the results from a multi-centre randomised controlled trial comparing pressure-limited NIV versus volume-targeted NIV in 58 subjects with acute hypercapnic respiratory failure who had underlying chronic obstructive pulmonary disease (COPD). Ciftci Fatma, et al [10] evaluated the feasibility of using BiPAP S/T-AVAPS.…”

mentioning

confidence: 99%

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

Claudett

Rodriguez

Briones-Claudett³

et al. 2018

Anaesthesiol Intensive Ther

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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.

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Volume-Targeted Versus Pressure-Limited Noninvasive Ventilation in Subjects With Acute Hypercapnic Respiratory Failure: A Multicenter Randomized Controlled Trial

Abstract: Regardless of whether a VT- or PL-NIV strategy is employed, it is possible to provide similar support to subjects with AHRF. (ClinicalTrials.gov registration NCT02538263.).

Cited by 29 publications

References 35 publications

Advances in non‐invasive positive airway pressure technology

Advances in non‐invasive positive airway pressure technology

P _{aO
₂} /F _{IO
₂} Is Not a Guestimation—Reply

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

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Volume-Targeted Versus Pressure-Limited Noninvasive Ventilation in Subjects With Acute Hypercapnic Respiratory Failure: A Multicenter Randomized Controlled Trial

Abstract: Regardless of whether a VT- or PL-NIV strategy is employed, it is possible to provide similar support to subjects with AHRF. (ClinicalTrials.gov registration NCT02538263.).

Cited by 29 publications

References 35 publications

Advances in non‐invasive positive airway pressure technology

Advances in non‐invasive positive airway pressure technology

P aO 2 /F IO 2 Is Not a Guestimation—Reply

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

Contact Info

Product

Resources

About

P _{aO
₂} /F _{IO
₂} Is Not a Guestimation—Reply