Source: Annual Congress 2008 - Progress and a new era for noninvasive mechanical ventilation
Disease area: Airway diseases, Respiratory critical care, Sleep and breathing disorders

Abstract

To compare the efficacy of Average Volume Assured Pressure Support mask ventilation (AVAPS) during sleep against spontaneous PS mask ventilation, we have studied 9 stable hypercapnic COPD patients (age 74±4 years, FEV₁ 40±5 % pred, PaCO₂ 59±6 mmHg). AVAPS or PS were randomly delivered during night-time in two 5-d periods over two consecutive weeks in a single-blind cross-over trial. The Synchronyâ ventilator (Respironics Inc.-USA) was set at 8 mL/kg of ideal body weight (as the targeted inspiratory tidal volume) with IPAP ranging from the EPAP level up to 30 cmH₂O for AVAPS, or at the patient‘s highest tolerated IPAP level for PS. EPAP was set at the minimum level for both modalities and oxygen was added (if requested) at a fixed inspiratory fraction to maintain SaO₂ above 90%.
Arterial blood gases (pH, PaCO₂, PaO₂/FiO₂), comfort (VAS) and sleep quality (SQ) were measured at baseline (T0), and after 3 (T1) and 5 (T2) nights during both treatment period. Mean usage (hour/night) was also recorded.
Baseline values were similar between the two treatment periods. PaCO₂ and comfort-VAS similarly improved on AVAPS and PS at T2 (p<0.05), whereas SQ significantly improved at T2 in AVAPS (from 5.1±2.0 to 4.1±2.2, p=0.001) but not in PS (from 5.1±1.7 to 4.7±1.3, p=0.219). No difference in mean usage was found between the two modalities.AVAPS is as comfortable and effective at reducing PaCO₂ as PS mask ventilation in COPD patients with chronic hypercapnia but produces better subjective effects on sleep.
Stufy granted by Respironics International.

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Citations should be made in the following way:
E. M. Clini, E. Crisafulli, O. Coletti, D. Dell‘Orso, G. Rossi, L. M. Fabbri (Pavullo (MO), Modena, Italy). Average volume assured pressure support mask ventilation in patients with hypercapnic COPD: a pilot study on night-time efficacy. Eur Respir J 2008; 32: Suppl. 52, 366

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