Abstract
Introduction: Noninvasive ventilation (NIV) is being increasingly used in patients with chronic neuromuscular disorders, but the optimal ventilation mode remains unknown. We compared physiological short-term effects of assist/controlled ventilation (ACV) and two pressure-limited modes (pressure-support ventilation [PSV] and assist pressure-controlled ventilation [ACPV]) in patients with neuromuscular disease who needed NIV.
Methods: Tidal volume was 10 to 12 mL/kg. The ACPV mode used the same respiratory cycle timing as the volume-limited mode. The level of inspiratory support was set to achieve the same tidal volume during the other ventilatory modes.
Results: Thirteen patients with neuromuscular disease who met international criteria for NIV were included. The three ventilatory modes increased alveolar ventilation and decreased respiratory effort indices. However, no difference in breathing or respiratory effort was found among the three modes, with the exception that inspiratory peak flow and percentage of triggered cycles were higher during PSV than volume-limited ventilation. Interestingly, no relationship was observed between subjective patient preference and inspiratory effort indices or percentage of triggered cycles.
Conclusion: In chronic, stable patients with neuromuscular disease, both noninvasive ACV, ACPV, and PSV had similar effects on alveolar ventilation and respiratory muscle unloading, despite some differences in the pattern of breathing and percentage of triggered cycles.
Article PDF
Similar content being viewed by others
References
Bach JR, Alba AS. Management of chronic alveolar hypoventilation by nasal ventilation. Chest 1990;97(1):52–57.
Ellis ER, Bye PT, Bruderer JW, Sullivan CE. Treatment of respiratory failure during sleep in patients with neuromuscular disease. Positive-pressure ventilation through a nose mask. Am Rev Respir Dis 1987;135(1):148–152.
Kerby GR, Mayer LS, Pingleton SK. Nocturnal positive pressure ventilation via nasal mask. Am Rev Respir Dis 1987;135:738–740.
Rideau Y, Gatin G, Bach J, Gimes G. Prolongation of life in Duchenne muscular dystrophy. Acta Neurol 1983;5:118–124.
Leger P, Jennequin J, Gerard M, Lassonnery S, Robert D. Home positive pressure ventilation via nasal mask for patients with neuromusculoskeletal disorders. Eur Respir J Suppl 1989;7:640s-644s.
MacIntyre NR. Respiratory function during pressure support ventilation. Chest 1986;89:677–683.
Brochard L. Pressure support ventilation. In: Principles and practice of mechanical ventilation. (Tobin, J, ed.) McGraw-Hill, New York, 1994, 239–257.
Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease. N Engl J Med 1995;333:817–822.
Lofaso F, Brochard L, Hang T, Lorino H, Harf A, Isabey D. Home versus intensive-care pressure support devices, experimental and clinical comparison. Am J Respir Crit Care Med 1996;153:1591–1599.
Fauroux B, Pigeot J, Polkey MI, Isabey D, Clément A, Lofaso F. In vivo physiologic comparison of two ventilators used for domiciliary ventilation in children with cystic fibrosis. Crit Care Med 2001;29:2097–2105.
Boysen PG, McGough E. Pressure-control and pressure-support ventilation: flow patterns, inspiratory time, and gas distribution. Respir Care 1988;33:126–134.
Consensus conference. Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal hypoventilation: a Consensus Conference Report. Chest 1999;116:521–534.
Leger P, Jennequin J, Gerard M, Robert D. Home ventilation pressure ventilation via nasal masks in patients with neuromuscular weakness and restrictive lung or chest wall disease. Respir Care 1989;34:73–79.
Make BJ, Hill NS, Goldberg AI, Bach JR, Criner GJ, Dunne PE, et al. Mechanical ventilation beyond the intensive care unit. Report of a consensus conference of the American College of Chest Physicians. Chest 1998;113(5 Suppl):289S-344S.
Baydur A, Behrakis PK, Zin M. A simple method for assessing the validity of the esophageal balloon technique. Am Rev Respir Dis 1982;126:788–791.
Aslanian P, Altrous EP, Isabey D, et al. Effects of flow triggering on breathing effort during partial ventilatory support. Am J Respir Crit Care Med 1998;157:135–143.
Brochard L, Harf A, Lorino H, Lemaire F. Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. Am Rev Respir Dis 1989;139(2):513–521.
Lessard MR, Lofaso F, Brochard L. Expiratory muscle activity increases intrinsic positive end-expiratory pressure independently of dynamic hyperinflation in mechanically ventilated patients. Am J Respir Crit Care Med 1995;151(2 Pt 1):562–569.
Bye PTP, Ellis ER, Issa FG, Donnely PM, Sullivan CE. Respiratory failure and sleep in neuromuscular disease. Thorax 1990;45:241–247.
Teschler H, Stampa J, Raguette R, et al. Effect of mouth leak on effectiveness of nasal bilevel ventilatory assistance and sleep architecture. Eur Respir J 1999;14:1251–1257.
Schonhofer B, Geibel M, Sonneborn M, Haidl P, Kohler D. Daytime mechanical ventilation in chronic respiratory insufficiency. Eur Respir J 1997;10:2840–2846.
Lofaso F, Aslanian P, Richard JC, et al. Expiratory valves used for home devices: experimental and clinical comparison. Eur Respir J 1998;11(6):1382–1388.
Marini JJ, Capps JS, Culver BH. The inspiratory work of breathing during assisted mechanical ventilation. Chest 1985;87:612–618.
Cinnella G, Conti G, Lofaso F, et al. Effects of assisted ventilation on the work of breathing: volume-controlled versus pressure-controlled ventilation. Am J Respir Crit Care Med 1996;153(3):1025–1033.
Bergowsky EH. State of the art: respiratory failure in disorders of the thoracic cage. Am Rev Respir Dis 1979;119:643–669.
Fabry B, Guttmann J, Eberhard L, Bauer T, Haberthur C, Wolff G. An analysis of desynchronization between the spontaneously breathing patient and ventilator during inspiratory pressure support. Chest 1995;107(5):1387–1394.
Gibson GJ, Pride NB, Newsone-Davis J, et al. Pulmonary mechanics in patients with respiratory muscles weakness. Am Rev Respir Dis 1977;115:389–395.
Girault C, Richard JC, Chevron V, et al. Comparative physiologic effects of noninvasive assist-control and pressure support ventilation in acute hypercapnic respiratory failure. Chest 1997;111:1639–1648.
Bellemare F, Grassino A. Effect of pressure and timing of contraction on human diaphragm fatigue. J Appl Physiol 1982;53:1190–1195.
Jubran A, Van de Graff WB, Tobin J. Variability of patient-ventilator interaction with pressure support ventilation in patients with chronic obstructive disease. Am J Respir Crit Care Med 1995;152:129–136.
Koessler W, Wanke TH, Winkler G, et al. 2 years’ experience with inspiratory muscle training in patients with neuromuscular diseases. Chest 2001;120:765–769.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chadda, K., Clair, B., Orlikowski, D. et al. Pressure support versus assisted controlled noninvasive ventilation in neuromuscular disease. Neurocrit Care 1, 429–434 (2004). https://doi.org/10.1385/NCC:1:4:429
Issue Date:
DOI: https://doi.org/10.1385/NCC:1:4:429