Abstract
BACKGROUND: High-intensity noninvasive ventilation (HI-NIV) is the most effective means of improving several physiological and clinical parameters in subjects with chronic hypercapnic COPD. Whether the newer hybrid mode using target tidal volume noninvasive ventilation (target VT NIV) provides additional benefits remains unclear.
METHODS: Subjects with COPD successfully established on long-term HI-NIV were switched to target VT NIV. Optimal target VT settings according to nocturnal transcutaneous PCO2 measurements were achieved following a randomized crossover trial using 8 mL/kg ideal body weight and 110% of individual VT during HI-NIV, respectively. The following parameters were compared at the beginning of the trial while subjects were on HI-NIV, and after 3 months on optimal target VT NIV: sleep quality by polysomnography, overnight gas exchange, subjects' tolerance, overnight pneumotachygraphic measurements during NIV, health-related quality of life (severe respiratory insufficiency questionnaire), exercise capacity (6-min walk test), and lung function.
RESULTS: Ten of 14 subjects completed the study. There were no differences between HI-NIV and target VT NIV in any of the above-mentioned parameters. Specifically, the mean overnight transcutaneous PCO2 was equivalent under each form of ventilation (both 45 ± 5 mm Hg, P = .75).
CONCLUSIONS: Switching subjects from well-established HI-NIV to target VT NIV shows no clinical benefits in chronic hypercapnic COPD. In particular, sleep quality, the control of nocturnal hypoventilation, daytime hypercapnia, overnight ventilation patterns, subjects' tolerance, health-related quality of life, lung function, and exercise capability were all similar in subjects who underwent HI-NIV and target VT NIV. Nevertheless, target VT NIV might offer some physiological advantages in breathing pattern and might be beneficial in some individual patients. (German Clinical Trials Register [www.drks.de] Registration DRKS00000450.)
- Chronic obstructive pulmonary disease
- mechanical ventilation
- sleep quality
- target volume
- ventilation mode
Footnotes
- Correspondence: Jan Hendrik Storre MD, Department of Pneumology, Cologne-Merheim Hospital Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, D-51109 Cologne, Germany. E-mail: storrej{at}kliniken-koeln.de.
Dr Storre presented this work in abstract form at the European Respiratory Society Annual Congress, held September 1–5, 2012, in Vienna, Austria.
The study group received open research grants from Breas Medical, Respironics, ResMed Germany, Weinmann, and Vivisol. Study devices and consumables were provided by Breas Medical. Dr Storre received speaking fees from the following companies: Breas Medical, Respironics, ResMed Germany, Heinen und Löwenstein, Werner und Müller Medizintechnik, SenTec AG, Radiometer Medical Aps and Keller Medical; honoraria from Respironics and Boehringer Ingelheim Pharma for expertise; and travel funding for national and international research congresses from Breas Medical, Heinen und Löwenstein, Respironics, SenTec, Vivisol, Weinmann, and Werner und Müller Medizintechnik. Dr Ekkernkamp received travel funding for national and international research congresses from Vivisol Germany and ResMed Germany. Dr Walker received speaking fees from Heinen und Löwenstein, and travel funding for national and international research congresses from Vivisol Germany, Sapio Life, and Bayer. Dr Dreher received speaking fees from VitalAire, ResMed, Dräger Medical, and Respironics; travel funding from ResMed and Vivisol; funding for research and funding for a member of staff from ResMed; and consulting fees from Linde. Dr Windisch was reimbursed by Maquet for attending conferences on intensive care medicine; received speaking fees from Dräger Medical, Heinen und Löwenstein, Respironics, Weinmann, ResMed, Covidien, Linde, Maquet, and Siare; and the following funds for research: grants from Respironics grants from Breas Medical, and a research grant from Weinmann and Vivisol in 2013; and received honoraria from Maquet, for having attended advisory board meetings. The other authors have disclosed no conflicts of interest.
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