@article {Cao1440, author = {Zhixin Cao and Zujin Luo and Anna Hou and Qingrong Nie and Baoyuan Xie and Xiaojie An and Zifen Wan and Xianwei Ye and Yanju Xu and Xisheng Chen and Honghai Zhang and Zhenyang Xu and Jinxiang Wang and Fucheng An and Pengfei Li and Chunxiao Yu and Yandong Liang and Yongxiang Zhang and Yingmin Ma}, title = {Volume-Targeted Versus Pressure-Limited Noninvasive Ventilation in Subjects With Acute Hypercapnic Respiratory Failure: A Multicenter Randomized Controlled Trial}, volume = {61}, number = {11}, pages = {1440--1450}, year = {2016}, doi = {10.4187/respcare.04619}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Volume-targeted noninvasive ventilation (VT-NIV), a hybrid mode that delivers a preset target tidal volume (VT) through the automated adjustment of pressure support, could guarantee a relatively constant target VT over pressure-limited noninvasive ventilation (PL-NIV) with fixed-level pressure support. Whether VT-NIV is more effective in improving ventilatory status in subjects with acute hypercapnic respiratory failure (AHRF) remains unclear. Our aim was to verify whether, in comparison with PL-NIV, VT-NIV would be more effective in correcting hypercapnia, hence reducing the need for intubation and improving survival in subjects with AHRF.METHODS: We performed a prospective randomized controlled trial in the general respiratory wards of 8 university-affiliated hospitals in China over a 12-month period. Subjects with AHRF, defined as arterial pH \<7.35 and >=7.25 and PaCO2 \>45 mm Hg, were randomly assigned to undergo PL-NIV or VT-NIV. The primary end point was the decrement of PaCO2 from baseline to 6 h after randomization. Secondary end points included the decrement of PaCO2 from baseline to 2 h after randomization as well as outcomes of subjects (eg, need for intubation, in-hospital mortality).RESULTS: A total of 58 subjects were assigned to PL-NIV (29 subjects) or VT-NIV (29 subjects) and included in the analyses. The decrement of PaCO2 from baseline to 6 h after randomization was not statistically different between the PL-NIV group and the VT-NIV group (9.3 {\textpm} 12.6 mm Hg vs 11.7 {\textpm} 12.9 mm Hg, P = .48). There were no differences between the PL-NIV group and the VT-NIV group in the decrement of PaCO2 from baseline to 2 h after randomization (6.4 {\textpm} 12.7 mm Hg vs 5.0 {\textpm} 15.8 mm Hg, P = .71) as well as in the need for intubation (17.2\% vs 10.3\%, P = .70), and in-hospital mortality (10.3\% vs 6.9\%, P \> .99).CONCLUSIONS: 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.)}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/61/11/1440}, eprint = {https://rc.rcjournal.com/content/61/11/1440.full.pdf}, journal = {Respiratory Care} }