Randomized trial of 'intelligent' autotitrating ventilation versus standard pressure support non-invasive ventilation: impact on adherence and physiological outcomes.

Abstract

BACKGROUND AND OBJECTIVE:

Effective non-invasive ventilation (NIV) therapy is dependent on optimal ventilator settings to maximize clinical benefit and patient tolerance. Intelligent volume-assured pressure support (iVAPS) is a hybrid mode of servoventilation, providing constant automatic adjustment of pressure support (PS) to achieve a target ventilation determined by the patient's requirements. In a randomized crossover trial, we tested the hypothesis that iVAPS, with automated selection of ventilator settings, was non-inferior to standard PS ventilation, with settings determined by an experienced health-care professional, for controlling nocturnal hypoventilation in patients naive to NIV.

METHODS:

Eighteen patients referred to a ventilator clinic with chronic obstructive or restrictive lung disease and newly diagnosed nocturnal hypoventilation (10 male, median (interquartile range): age 54(41-61) years, mean daytime PaO2 9.25(8.59-10.31) kPa, -PaCO2 6.38(5.93-6.65) kPa were randomized to iVAPS and standard PS. Polysomnography with transcutaneous CO2 monitoring was performed at baseline and 1 month after each treatment period. Nightly hours of therapy were recorded by the ventilator.

RESULTS:

iVAPS delivered a lower median PS compared with standard PS (8.3(5.6-10.4) vs 10.0(9.0-11.4) cmH2 O; P = 0.001) for the same ventilatory outcome (mean overnight: SpO2 96(95-98) vs 96(93-97)%; P = 0.13 and PtcCO2 6.5(5.8-6.8) vs 6.2(5.8-6.9); P = 0.54). There was no difference in outcome between ventilator modes for spirometry, respiratory muscle strength, sleep quality, arousals or O2 desaturation index. Adherence was greater with iVAPS (5:40(4:42-6:49) vs 4:20(2:27-6:17) hh:mm/night; P = 0.004).

CONCLUSIONS:

iVAPS servoventilation with automation of ventilation settings is as effective as PS ventilation initiated by a skilled health-care professional in controlling nocturnal hypoventilation and produced better overnight adherence in patients naive to NIV.

• Authors: Julia L Kelly, Jay Jaye, Rachel E Pickersgill, Michelle Chatwin, Mary J Morrell, Anita K Simonds
• Journal: Respirology (Carlton, Vic.) (Respirology) Vol. 19 Issue 4 Pg. 596-603 (May 2014) ISSN: 1440-1843 [Electronic] Australia
• PMID: 24661390 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 Asian Pacific Society of Respirology.

Topics

• Female
• Humans
• Interactive Ventilatory Support (instrumentation, methods, psychology)
• Male
• Middle Aged
• Noninvasive Ventilation (instrumentation, methods, psychology)
• Patient Compliance (psychology)
• Polysomnography (methods)
• Positive-Pressure Respiration (methods)
• Pulmonary Disease, Chronic Obstructive (complications, diagnosis, physiopathology, therapy)
• Respiration
• Respiratory Insufficiency (complications, diagnosis, physiopathology, therapy)
• Sleep Apnea Syndromes (diagnosis, etiology, physiopathology, prevention & control)
• Treatment Outcome
• Ventilators, Mechanical (standards)