Efficacy and comfort of volume-guaranteed pressure support in patients with chronic ventilatory failure of neuromuscular origin
Corresponding Author
GRAZIA CRESCIMANNO
Italian National Research Council, Institute of Biomedicine and Molecular Immunology
First Unit of Pneumology, ‘V. Cervello’ Hospital, Palermo
Grazia Crescimanno, Istituto di Biomedicina ed Immunologia Molecolare del C.N.R., Via Ugo La Malfa 153, 90146 Palermo, Italy. Email: [email protected]Search for more papers by this authorORESTE MARRONE
Italian National Research Council, Institute of Biomedicine and Molecular Immunology
Search for more papers by this authorANDREAW VIANELLO
Respiratory Pathophysiology Unit, City Hospital of Padova, Padova, Italy
Search for more papers by this authorCorresponding Author
GRAZIA CRESCIMANNO
Italian National Research Council, Institute of Biomedicine and Molecular Immunology
First Unit of Pneumology, ‘V. Cervello’ Hospital, Palermo
Grazia Crescimanno, Istituto di Biomedicina ed Immunologia Molecolare del C.N.R., Via Ugo La Malfa 153, 90146 Palermo, Italy. Email: [email protected]Search for more papers by this authorORESTE MARRONE
Italian National Research Council, Institute of Biomedicine and Molecular Immunology
Search for more papers by this authorANDREAW VIANELLO
Respiratory Pathophysiology Unit, City Hospital of Padova, Padova, Italy
Search for more papers by this authorABSTRACT
Background and objective: Although non-invasive ventilation is widely used for the management of patients with neuromuscular disease, it remains unclear which ventilatory mode is associated with optimal patient–ventilator interaction and provides more effective gas exchange. The effects of volume-guaranteed pressure support (PSV-VTG) as compared with pressure support ventilation (PSV) and assisted pressure controlled ventilation (APCV) on breathing pattern and patient–ventilator synchrony during sleep, blood gases and subjective comfort were evaluated in a group of stable patients with neuromuscular disease.
Methods: PSV-VTG, PSV and APCV were applied in random order on three consecutive nights, during which cardio-respiratory monitoring was performed. Arterial blood gases were measured at the end of each ventilatory session. Evaluation of subjective sleep quality, comfort and perception of patient–ventilator synchrony was performed using a 10-item visual analogue questionnaire.
Results: Twenty-eight patients were included in the study. The different ventilatory modes showed similar effects on breathing pattern during sleep, arterial blood gases and degree of subjective comfort. Ineffective efforts were only observed during PSV-VTG and were inversely correlated with the variability of leaks (r = −0.61, P = 0.015). A greater number of prolonged inspirations was observed with PSV-VTG and PSV compared with APCV (P = 0.048 and 0.029, respectively). There were no correlations between patient comfort and physiological variables or ventilator setting.
Conclusions: PSV-VTG did not outperform older modes of ventilation in terms of efficacy on breathing pattern and blood gases. In addition, application of PSV-VTG was associated with a higher rate of patient–ventilator dyssynchrony.
REFERENCES
- 1 Simonds AK. Recent advances in respiratory care for neuromuscular disease. Chest 2007; 130: 1879–86.
- 2 Toussaint M, Chatwin M, Soudon P. Mechanical ventilation in Duchenne patients with chronic respiratory insufficiency: clinical implications of 20 years published experience. Chron. Respir. Dis. 2007; 4: 167–77.
- 3 Guilleminault C, Philip P, Robinson A. Sleep and neuromuscular disease: bilevel positive airway pressure by nasal mask as a treatment for sleep disordered breathing in patients with neuromuscular disease. J. Neurol. Neurosurg. Psychiatry 1998; 65: 225–32.
- 4 Robert D, Argaud L. Non-invasive positive ventilation in the treatment of sleep-related breathing disorders. Sleep Med. 2007; 8: 441–52.
- 5 Bach JR, Bianchi C, Finder J et al. Tracheostomy tubes are not needed for Duchenne muscular dystrophy. Eur. Respir. J. 2007; 30: 179–80.
- 6 Vianello A, Bevilacqua M, Salvador V et al. Long-term nasal intermittent positive pressure ventilation in advanced Duchenne's muscular dystrophy. Chest 1994; 105: 445–8.
- 7 Girault C, Richard JC, Chevron V et al. Comparative physiologic effects of noninvasive assist-control and pressure support ventilation in acute hypercapnic respiratory failure. Chest 1997; 11: 1639–48.
- 8 Betensley AD, Khalid I, Crawford J et al. Patient comfort during pressure support and volume controlled-continuous mandatory ventilation. Respir. Care 2008; 53: 897–902.
- 9 MacIntyre N, Nishimura M, Usada Y et al. The Nagoya Conference on system design and patient ventilator interaction during pressure support ventilation. Chest 1990; 97: 1463–6.
- 10 Sassoon CS, Mahutte CK, Light RW. Ventilator modes: old and new. Crit. Care Clin. 1990; 6: 605–34.
- 11 Rao GSU. Newer ventilatory modes and strategies. J. Anaesth. Clin. Pharmacol. 2004; 20: 3–16.
- 12 Orlikowski D, Mroue G, Prigent H et al. Automatic air-leak compensation in neuromuscular patients: a feasibility study. Respir. Med. 2009; 103: 173–9.
- 13 Fauroux B, Leroux K, Pépin JL et al. Are home ventilators able to guarantee a minimal tidal volume? Intensive Care Med. 2010; 36: 1008–14.
- 14 Calderini E, Confalonieri M, Puccio PG et al. Patient-ventilator asynchrony during noninvasive ventilation: the role of expiratory trigger. Intensive Care Med. 1999; 25: 662–7.
- 15 Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD and nocturnal hypoventilation—a consensus conference report. Chest 1999; 115: 521–34.
- 16 Finder JD, Birnkrant D, Carl J et al.; American Thoracic Society. Respiratory care of the patient with Duchenne muscular dystrophy: ATS consensus statement. Am. J. Respir. Crit. Care Med. 2004; 170: 456–65.
- 17 Hess DR. Noninvasive ventilation in neuromuscular disease: equipment and application. Respir. Care 2006; 51: 896–911.
- 18 Ficker JH, Wiest GH, Wilpert J et al. Evaluation of a portable recording device (Somnocheck) for use in patients with suspected obstructive sleep apnoea. Respiration 2001; 68: 307–12.
- 19 Guo YF, Sforza E, Janssens JP. Respiratory patterns during sleep in obesity-hypoventilation patients treated with nocturnal pressure support: a preliminary report. Chest 2007; 131: 1090–9.
- 20 Hukins C. Comparative study of autotitrating and fixed-pressure CPAP in the home: a randomized, single-blind crossover trial. Sleep 2004; 27: 1512–17.
- 21 Winck JC, Vitacca M, Morais A et al. Tolerance and physiologic effects of nocturnal mask pressure support vs proportional assist ventilation in chronic ventilatory failure. Chest 2004; 126: 382–8.
- 22 Meecham Jones DJ, Wedzicha JA. Comparison of pressure and volume preset nasal ventilator systems in stable chronic respiratory failure. Eur. Respir. J. 1993; 6: 1060–4.
- 23 Elliott MW, Aquilina R, Green M et al. A comparison of different modes of non-invasive ventilatory support: effects on ventilation and inspiratory muscle effort. Anaesthesia 1994; 49: 279–83.
- 24 Schonhofer B, Sonneborn M, Haidl P et al. Comparison of two different modes for noninvasive mechanical ventilation in chronic respiratory failure: volume versus pressure controlled device. Eur. Respir. J. 1997; 10: 184–91.
- 25 Smith IE, Shneerson JM. Secondary failure of nasal intermittent positive pressure ventilation using the Monnal D: effects of changing ventilator. Thorax 1997; 52: 89–91.
- 26 Perrin C, Wolter P, Berthier F et al. Comparison of volume preset and pressure preset ventilators during daytime nasal ventilation in chronic respiratory failure. Rev. Mal. Respir. 2001; 18: 41–8.
- 27 Fauroux B, Pigeot J, Polkey MI et al. In vivo physiologic comparison of two ventilators used for domiciliary ventilation in children with cystic fibrosis. Crit. Care Med. 2001; 29: 2097–105.
- 28 Laserna E, Barrot E, Beiztegui A et al. Non-invasive ventilation in kyphoscoliosis. A comparison of a volumetric ventilator and a BIPAP support pressure device. Arch. Bronconeumol. 2003; 39: 13–18.
- 29 Tuggey JM, Elliott MW. Randomised crossover study of pressure and volume non-invasive ventilation in chest wall deformity. Thorax 2005; 60: 859–64.
- 30 Windisch W, Storre JH, Sorichter S et al. Comparison of volume- and pressure-limited NPPV at night: a prospective randomized cross-over trial. Respir. Med. 2005; 99: 52–9.
- 31 Cinnella G, Conti G, Lofaso F et al. Effects of assisted ventilation on the work of breathing: volume-controlled versus pressure-controlled ventilation. Am. J. Respir. Crit. Care Med. 1996; 153: 1025–33.
- 32 Chadda K, Clair B, Orlikowski D et al. Pressure support versus assisted controlled non invasive ventilation in neuromuscular disease. Neurocrit. Care 2004; 1: 429–34.
- 33 Chiumello D, Pelosi P, Calvi E et al. Different modes of assisted ventilation in patients with acute respiratory failure. Eur. Respir. J. 2002; 20: 925–33.
- 34 Amato MB, Barbas CS, Bonassa J et al. Volume-assured pressure support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory failure. Chest 1992; 102: 1225–34.
- 35 Haas CF, Branson RD, Folk LM. Patient determined inspiratory flow during assisted mechanical ventilation. Respir. Care Clin. N. Am. 1995; 40: 716–21.
- 36 MacIntyre NR, Gropper C, Westfall T. Combining pressure-limiting and volume-cycling features in a patient-interactive mechanical breath. Crit. Care Med. 1994; 22: 353–7.
- 37 Mehta S, McCool FD, Hill NS. Leak compensation in positive pressure ventilators: a lung model study. Eur. Respir. J. 2001; 17: 259–67.
- 38 Ferreira JC, Chipman DW, Hill NS et al. Bilevel vs ICU ventilators providing noninvasive ventilation: effect of system leaks: a COPD lung model comparison. Chest 2009; 136: 448–56.
- 39 Vignaux L, Tassaux D, Jolliet P. Performance of noninvasive ventilation modes on ICU ventilators during pressure support: a bench model study. Intensive Care Med. 2007; 33: 1444–51.
- 40 Jolliet P, Tassaux D, Vignaux L. Patient-ventilator interaction during non-invasive ventilation. In: Springer (ed.) Yearbook of Intensive Care and Emergency Medicine. 2009; IX: 350–8.
- 41 Vignaux L, Vargas F, Roeseler J et al. Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study. Intensive Care Med. 2009; 35: 840–6.
- 42 Nava S, Ceriana P. Patient-ventilator interaction during noninvasive positive pressure ventilation. Respir. Care Clin. N. Am. 2005; 11: 281–93.
- 43 Fabry B, Guttmann J, Eberhard L et al. An analysis of desynchronization between the spontaneously breathing patient and ventilator during inspiratory pressure support. Chest 1995; 107: 1387–94.
- 44 Tobin MJ, Jubran A, Laghi F. Patient-ventilator interaction. Am. J. Respir. Crit. Care Med. 2001; 163: 1059–63.
- 45 Vitacca M, Bianchi L, Zanotti E et al. Assessment of physiologic variables and subjective comfort under different levels of pressure support ventilation. Chest 2004; 126: 851–9.
- 46
Rabarimanantsoa H,
Achour L,
Letellier C
et al.
Objective evaluation of patient ventilator interactions during noninvasive ventilation (NIV).
Eur. Respir. J.
2008; 17: 22–3.
10.1183/09059180.00010706 Google Scholar
- 47 Rabec C, Georges M, Kabeya N et al. Evaluating noninvasive ventilation using a monitoring system coupled to a ventilator: a bench-to-bedside study. Eur. Respir. J. 2009; 34: 902–13.
- 48 Aslanian P, El Atrous S, Isabey D et al. Effects of flow triggering on breathing effort during partial ventilatory support. Am. J. Respir. Crit. Care Med. 1998; 157: 135–43.
- 49 Nava S, Ambrosino N, Bruschi C et al. Physiological effects of flow and pressure triggering during non-invasive mechanical ventilation in patients with chronic obstructive pulmonary disease. Thorax 1997; 52: 249–54.
- 50 Silva GE, Goodwin JL, Sherrill DL et al. Relationship between reported and measured sleep times: The Sleep Heart Health Study (SHHS). J. Clin. Sleep Med. 2007; 3: 622–30.
