RT Journal Article
SR Electronic
T1 Home Mechanical Ventilation for COPD: High-Intensity Versus Target Volume Noninvasive Ventilation
JF Respiratory Care
FD American Association for Respiratory Care
SP 1389
OP 1397
DO 10.4187/respcare.02941
VO 59
IS 9
A1 Storre, Jan H
A1 Matrosovich, Elena
A1 Ekkernkamp, Emelie
A1 Walker, David J
A1 Schmoor, Claudia
A1 Dreher, Michael
A1 Windisch, Wolfram
YR 2014
UL http://rc.rcjournal.com/content/59/9/1389.abstract
AB 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.)