Chest
Clinical Investigations in Critical Care: NIPPVComparative Physiologic Effects of Noninvasive Assist-Control and Pressure Support Ventilation in Acute Hypercapnic Respiratory Failure
Section snippets
Materials and Methods
The study was conducted in a medical ICU and approved by the Ethical Committee of the Charles Nicolle University Hospital. All patients or their families gave a written informed consent. Patients enrolled in the study had known COPD or a high probability of the disease on the basis of the clinical history, results of physical examination, chest radiograph, and/or previous pulmonary function tests data. Additional criteria for enrollment included AHRF requiring NIV according to the following
Results
The main clinical and respiratory characteristics of the 15 COPD patients are shown in Table 1. All patients showed evidence of severe AHRF requiring NIV. These AHRF episodes were related to bronchial superinfection in 14 cases and pneumonia in one case (patient 3). Table 1 also shows the main individual ventilatory settings finally used with ACV and PSV mode during the trial.
In comparison with SB mode, NIV strongly decreased the inspiratory effort. The WOBinsp parameters (WOBinsp/eyele,
Discussion
This prospective randomized study emphasizes the physiologic mechanisms underlying the clinical benefit of noninvasive ACV and PSV mode in the management of AHRF in COPD patients. To our knowledge, our study is the first to compare the physiologic effects of ACV and PSV in these circumstances. It shows that, using settings adapted to patient's tolerance and mask air leaks, both ACV and PSV modes may decrease the inspiratory muscle effort and similarly improve breathing pattern and gas exchange.
ACKNOWLEDGMENTS
The authors would like to thank Jean-François Gibon, Françoise Burel, and Yann Lacoume for their valuable technical assistance.
References (42)
- et al.
Randomized controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease
Lancet
(1993) - et al.
Noninvasive pressure support ventilation in patients with acute respiratory failure: a randomized comparison with conventional therapy
Chest
(1995) - et al.
Noninvasive pressure support ventilation in patients with acute respiratory failure
Chest
(1993) Intermittent volume cycled mechanical ventilation via nasal mask in patients with respiratory failure due to COPD
Chest
(1991)- et al.
Nasal mask ventilation in acute respiratory failure: experience in elderly patients
Chest
(1992) - et al.
Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure
Chest
(1991) - et al.
Ventilator muscle support in respiratory failure with nasal positive pressure ventilation
Chest
(1990) - et al.
Acute exacerbations in severe COLD patients: treatment using positive pressure ventilation by nasal mask
Chest
(1992) - et al.
Chest surface recording of diaphragm potentials in man
Electroencephalogr Clin Neurophysiol
(1989) - et al.
The inspiratory work of breathing during assisted mechanical ventilation
Chest
(1985)
The Nagoya Conference on system design and patient-ventilator interactions during pressure support ventilation
Chest
Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease
N Engl J Med
Randomized prospective trial of noninvasive positive pressure ventilation in acute respiratory failure
Am J Respir Crit Care Med
Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask
N Engl J Med
Pressure support ventilation via face mask in acute respiratory failure in hypercapnic COPD patients
Intensive Care Med
Non-invasive modalities of positive pressure ventilation improve the outcome of acute exacerbations in COLD patients
Intensive Care Med
A simplified acute physiologic score for ICU patients
Crit Care Med
Improved technique for estimating pleural pressure from esophageal balloons
J Appl Physiol
Topography of esophageal pressure as a function of posture in man
J Appl Physiol
A simple method for assessing the validity of the esophageal balloon technique
Am Rev Respir Dis
Impact of PEEP on lung mechanics and work of breathing in severe airflow obstruction
J Appl Physiol
Cited by (152)
Chronic mechanical ventilation
2023, Pulmonary Assessment and Management of Patients with Pediatric Neuromuscular DiseaseNoninvasive ventilation in acute asthma
2014, Journal of Critical CareCitation Excerpt :Applied CPAP alone likely has several physiological benefits in asthma including direct bronchodilation [34,37,38,67,68], off-setting intrinsic PEEP [30,32], alveolar recruitment and improvement in ventilation/perfusion mismatch [50,51], and reduced work of breathing [34,35]. The addition of an inspiratory pressure above that of the expiratory pressure has been shown to significantly reduce the load on the inspiratory muscles while increasing tidal volume and reducing RR in COPD studies [69,70]. Bilevel positive airway pressure (BPAP) therefore is the almost universally implemented mode in acute exacerbations of COPD necessitating noninvasive ventilatory support [64,71,72].
Mechanical Ventilation
2013, Benumof and Hagberg's Airway ManagementNon-invasive ventilation
2013, Oh's Intensive Care Manual, Seventh EditionMechanical Ventilation
2012, Benumof and Hagberg's Airway Management: Third Edition