Physiological changes during low- and high-intensity noninvasive ventilation

J. Lukácsovits, A. Carlucci, N. Hill, P. Ceriana, L. Pisani, A. Schreiber, P. Pierucci, G. Losonczy, S. Nava

Research output: Contribution to journalArticle

Abstract

In a physiological randomised cross-over study performed in stable hypercapnic chronic obstructive disease patients, we assessed the short-term effects of two settings of noninvasive ventilation. One setting was aimed at maximally reducing arterial carbon dioxide tension (Pa,CO2) (high-intensity (Hi) noninvasive positive pressure ventilation (NPPV)): mean±SD 27.6±2.1 cmH2O of inspiratory positive airway pressure, 4±0 cmH2O of expiratory positive airway pressure and respiratory rate of 22 breaths·min-1. The other was performed according to the usual parameters used in earlier studies (low-intensity (Li)-NPPV): 17.7±1.6 cmH2O of inspiratory positive airway pressure, 4±0 cmH2O of expiratory positive airway pressure and respiratory rate of 12 breaths·min-1. Both modes of ventilation significantly improved gas exchange compared with spontaneous breathing (SB), but to a greater extent using Hi-NPPV (Pa,CO2 59.3±7.5, 55.2±6.9 and 49.4±7.8 mmHg for SB, Li-NPPV and Hi-NPPV, respectively). Similarly, Hi-NPPV induced a greater reduction in the pressure-time product of the diaphragm per minute from 323±149 cmH2O·s·min-1 during SB to 132±139 cmH2O·s· min-1 during Li-NPPV and 40±69 cmH2O·s·min-1 during Hi-NPPV, while in nine out of 15 patients, it completely abolished SB activity. Hi-NPPV also induced a marked reduction in cardiac output (CO) measured noninvasively with a Finometer PRO (Finapres Medical Systems BV, Amsterdam, the Netherlands) compared with Li-NPPV. We conclude that while Hi-NPPV is more effective than Li-NPPV in improving gas exchange and in reducing inspiratory effort, it induces a marked reduction in CO, which needs to be considered when Hi-NPPV is applied to patients with pre-existing cardiac disease. Copyright

Original languageEnglish
Pages (from-to)869-875
Number of pages7
JournalEuropean Respiratory Journal
Volume39
Issue number4
DOIs
Publication statusPublished - Apr 1 2012

Keywords

  • Chronic obstructive pulmonary disease
  • Noninvasive ventilation
  • Respiratory mechanics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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  • Cite this

    Lukácsovits, J., Carlucci, A., Hill, N., Ceriana, P., Pisani, L., Schreiber, A., Pierucci, P., Losonczy, G., & Nava, S. (2012). Physiological changes during low- and high-intensity noninvasive ventilation. European Respiratory Journal, 39(4), 869-875. https://doi.org/10.1183/09031936.00056111