@article {Oppersmarespcare.07159, author = {Eline Oppersma and Jonne Doorduin and Lisanne H Roesthuis and Johannes G van der Hoeven and Peter H Veltink and Leo MA Heunks}, title = {Patient-Ventilator Interaction During Noninvasive Ventilation in Subjects With Exacerbation of COPD: Effect of Support Level and Ventilator Mode}, elocation-id = {respcare.07159}, year = {2020}, doi = {10.4187/respcare.07159}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Patient-ventilator synchrony in patients with COPD is at risk during noninvasive ventilation (NIV). NIV in neurally-adjusted ventilatory assist (NAVA) mode improves synchrony compared to pressure support ventilation (PSV). The current study investigated patient-ventilator interaction at 2 levels of NAVA and PSV mode in subjects with COPD exacerbation.METHODS: NIV was randomly applied at 2 levels (5 and 15 cm H2O) of PSV and NAVA. Patient-ventilator interaction was evaluated by comparing airway pressure and electrical activity of the diaphragm waveforms with automated computer algorithms.RESULTS: 8 subjects were included. Trigger delay was longer in PSV high (268 {\textpm} 112 ms) than in PSV low (161 {\textpm} 118 ms, P = .043), and trigger delay during NAVA was shorter than PSV for both low support (49 {\textpm} 24 ms for NAVA, P = .035) and high support (79 {\textpm} 276 ms for NAVA, P = .003). No difference in cycling error for low and high levels of PSV (PSV low -100 {\textpm} 114 ms and PSV high 56 {\textpm} 315 ms) or NAVA (NAVA low -5 {\textpm} 18 ms, NAVA high 12 {\textpm} 36 ms) and no difference between PSV and NAVA was found.CONCLUSIONS: Increasing PSV levels during NIV caused a progressive mismatch between neural effort and pneumatic timing. Patient-ventilator interaction during NAVA was more synchronous than during PSV, independent of inspiratory support level. (ClinicalTrials.gov registration NCT01791335.)}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/early/2020/03/10/respcare.07159}, eprint = {https://rc.rcjournal.com/content/early/2020/03/10/respcare.07159.full.pdf}, journal = {Respiratory Care} }