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Research ArticleOriginal Research

Short-Term Effects of Pressure Controlled Versus Volume Controlled Noninvasive Ventilation in Subjects With Amyotrophic Lateral Sclerosis

Grazia Crescimanno, Francesca Greco, Manuela Bertini, Salvo Arrisicato and Oreste Marrone
Respiratory Care October 2021, 66 (10) 1593-1600; DOI: https://doi.org/10.4187/respcare.09021
Grazia Crescimanno
Italian National Research Council, Institute for Biomedical Research and Innovation, Palermo, Italy.
Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy.
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  • For correspondence: [email protected]
Francesca Greco
Italian Union Against Muscular Dystrophy, branch of Palermo, Palermo, Italy.
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Manuela Bertini
Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy.
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Salvo Arrisicato
Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy.
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Oreste Marrone
Italian National Research Council, Institute for Biomedical Research and Innovation, Palermo, Italy.
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Abstract

BACKGROUND: Comparison of the effects of pressure controlled and volume controlled noninvasive ventilations (NIV) has usually been limited to the degree of improvement in blood gases. We compared sleep quality, abnormal respiratory events, and patient-ventilator asynchronies during administration of pressure controlled continuous mandatory ventilation (PC-CMV) and volume controlled continuous mandatory ventilation (VC-CMV) in subjects with amyotrophic lateral sclerosis naive to NIV after titration aimed at maximally improving nocturnal arterial blood gases.

METHODS: A crossover evaluation of PC-CMV and VC-CMV was performed in 27 subjects with amyotrophic lateral sclerosis. After baseline polysomnography, ventilators were set in random order so as to warrant similar and satisfactory oxygen saturation and transcutaneous Embedded Image in both NIV modalities during day and night. Soon after titration, polysomnography was repeated during administration of each type of NIV.

RESULTS: With respect to the baseline night, non-rapid eye movement 3, and rapid eye movement sleep stages increased, and the arousal index decreased during PC-CMV (P = .005, P = .02, and P = .01, PC-CMV vs VC-CMV, respectively) but not during VC-CMV. The arousal index during NIV was correlated to the peak pressure delivered by the ventilators (ρ = 0.47, P < .001). Few abnormal respiratory events were observed in both NIV modes. Patient-ventilator asynchronies were more frequent during VC-CMV (median [IQR] 20.8 [0.0 – 22.0] vs 31.8 [30.1 – 34.0] no./h, PC-CMV vs VC-CMV; P = .002). Twenty-one subjects declared that they preferred PC-CMV therapy.

CONCLUSIONS: In the short term, PC-CMV may be a preferred NIV modality to VC-CMV for patients with amyotrophic lateral sclerosis, even when both NIV modes are similarly effective in the correction of hypoventilation. Evaluation of the effectiveness of NIV should not be limited to the assessment of blood gas correction.

  • Pressure control continuous mandatory ventilation
  • Volume control continuous mandatory ventilation; amyotrophic lateral sclerosis
  • hypoventilation
  • abnormal respiratory events
  • patient-ventilator asynchrony

Footnotes

  • Correspondence: Grazia Crescimanno MD, Italian National Research Council, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146 Palermo, Italy. E-mail: grazia.crescimanno{at}irib.cnr.it
  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • The study was supported by the Italian Union Against Muscular Dystrophy, branch of Palermo, Palermo, Italy.

  • The authors have disclosed no conflict of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (10)
Respiratory Care
Vol. 66, Issue 10
1 Oct 2021
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Short-Term Effects of Pressure Controlled Versus Volume Controlled Noninvasive Ventilation in Subjects With Amyotrophic Lateral Sclerosis
Grazia Crescimanno, Francesca Greco, Manuela Bertini, Salvo Arrisicato, Oreste Marrone
Respiratory Care Oct 2021, 66 (10) 1593-1600; DOI: 10.4187/respcare.09021

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Short-Term Effects of Pressure Controlled Versus Volume Controlled Noninvasive Ventilation in Subjects With Amyotrophic Lateral Sclerosis
Grazia Crescimanno, Francesca Greco, Manuela Bertini, Salvo Arrisicato, Oreste Marrone
Respiratory Care Oct 2021, 66 (10) 1593-1600; DOI: 10.4187/respcare.09021
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Keywords

  • Pressure control continuous mandatory ventilation
  • Volume control continuous mandatory ventilation; amyotrophic lateral sclerosis
  • hypoventilation
  • abnormal respiratory events
  • patient-ventilator asynchrony

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