TY - JOUR T1 - Patient-Ventilator Interaction During Noninvasive Ventilation in Subjects With Exacerbation of COPD: Effect of Support Level and Ventilator Mode JF - Respiratory Care SP - 1315 LP - 1322 DO - 10.4187/respcare.07159 VL - 65 IS - 9 AU - Eline Oppersma AU - Jonne Doorduin AU - Lisanne H Roesthuis AU - Johannes G van der Hoeven AU - Peter H Veltink AU - Leo MA Heunks Y1 - 2020/09/01 UR - http://rc.rcjournal.com/content/65/9/1315.abstract N2 - 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 ± 112 ms) than in PSV low (161 ± 118 ms, P = .043), and trigger delay during NAVA was shorter than PSV for both low support (49 ± 24 ms for NAVA, P = .035) and high support (79 ± 276 ms for NAVA, P = .003). No difference in cycling error for low and high levels of PSV (PSV low −100 ± 114 ms and PSV high 56 ± 315 ms) or NAVA (NAVA low −5 ± 18 ms, NAVA high 12 ± 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.) ER -