The appropriate setting of noninvasive pressure support ventilation in stable COPD patients

M. Vitacca, S. Nava, M. Confalonieri, L. Bianchi, R. Porta, E. Clini, N. Ambrosino

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Study objective: To evaluate the short-term physiologic effects of two settings of nasal pressure-support ventilation (NPSV) in stable COPD patients with chronic hypercapnia. Design: Randomized controlled physiologic study. Setting: Lung function units and outpatient clinic of two affiliated pulmonary rehabilitation centers. Patients: Twenty-three patients receiving domiciliary nocturnal NPSV for a mean (± SD) duration of 31 ± 20 months. Methods: Evaluation of arterial blood gases, breathing pattern, respiratory muscles, and dynamic intrinsic positive end-expiratory pressure (PEEPi,dyn) during both unassisted and assisted ventilation. Two settings of NPSV were randomly applied for 30 min each: (1) usual setting (U), the setting of NPSV actually used by the individual patient at home; and (2) physiologic setting (PHY), the level of inspiratory pressure support (IPS) and external positive end-expiratory pressure (PEEPe) tailored to patient according to invasive evaluation of respiratory muscular function and mechanics. Results: All patients tolerated NPSV well throughout the procedure. Mean U was IPS, 16 ± 3 cm H2O and PEEPe, 3.6 ± 1.4 cm H2O; mean PHY was IPS, 15 ± 3 cm H2O and PEEPe, 3.1 ± 1.6 cm H2O. NPSV was able to significantly (p <0.01) improve arterial blood gases independent of the setting applied. When compared with spontaneous breathing, both settings induced a significant increase in minute ventilation (p <0.01). Both settings were able to reduce the diaphragmatic pressure-time product, but the reduction was significantly greater with PHY (by 64%; p <0.01) than with U (56%; p <0.05). Eleven of 23 patients (48%) with U and 7 of 23 patients (30%) with PHY showed ineffective efforts (IE); the prevalence of IE (20 ± 39% vs 6 ± 11% of their respiratory rate with U and PHY, respectively) was statistically different (p <0.05). Conclusion: In COPD patients with chronic hypercapnia, NPSV is effective in improving arterial blood gases and in unloading inspiratory muscles independent of whether it is set on the basis of patient comfort and improvement in arterial blood gases or tailored to a patient's respiratory muscle effort and mechanics. However, setting of inspiratory assistance and PEEPe by the invasive evaluation of lung mechanics and respiratory muscle function may result in reduction in ineffective inspiratory efforts. These short-term results must be confirmed in the long-term clinical setting.

Original languageEnglish
Pages (from-to)1286-1293
Number of pages8
JournalChest
Volume118
Issue number5
Publication statusPublished - 2000

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Chronic Obstructive Pulmonary Disease
Ventilation
Pressure
Nose
Positive-Pressure Respiration
Respiratory Muscles
Gases
Hypercapnia
Mechanics
Lung
Respiration
Respiratory Mechanics
Rehabilitation Centers
Respiratory Rate
Ambulatory Care Facilities
Muscles

Keywords

  • Breathing pattern
  • Hypercapnia
  • Noninvasive mechanical ventilation
  • Respiratory failure
  • Respiratory muscles

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Vitacca, M., Nava, S., Confalonieri, M., Bianchi, L., Porta, R., Clini, E., & Ambrosino, N. (2000). The appropriate setting of noninvasive pressure support ventilation in stable COPD patients. Chest, 118(5), 1286-1293.

The appropriate setting of noninvasive pressure support ventilation in stable COPD patients. / Vitacca, M.; Nava, S.; Confalonieri, M.; Bianchi, L.; Porta, R.; Clini, E.; Ambrosino, N.

In: Chest, Vol. 118, No. 5, 2000, p. 1286-1293.

Research output: Contribution to journalArticle

Vitacca, M, Nava, S, Confalonieri, M, Bianchi, L, Porta, R, Clini, E & Ambrosino, N 2000, 'The appropriate setting of noninvasive pressure support ventilation in stable COPD patients', Chest, vol. 118, no. 5, pp. 1286-1293.
Vitacca, M. ; Nava, S. ; Confalonieri, M. ; Bianchi, L. ; Porta, R. ; Clini, E. ; Ambrosino, N. / The appropriate setting of noninvasive pressure support ventilation in stable COPD patients. In: Chest. 2000 ; Vol. 118, No. 5. pp. 1286-1293.
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abstract = "Study objective: To evaluate the short-term physiologic effects of two settings of nasal pressure-support ventilation (NPSV) in stable COPD patients with chronic hypercapnia. Design: Randomized controlled physiologic study. Setting: Lung function units and outpatient clinic of two affiliated pulmonary rehabilitation centers. Patients: Twenty-three patients receiving domiciliary nocturnal NPSV for a mean (± SD) duration of 31 ± 20 months. Methods: Evaluation of arterial blood gases, breathing pattern, respiratory muscles, and dynamic intrinsic positive end-expiratory pressure (PEEPi,dyn) during both unassisted and assisted ventilation. Two settings of NPSV were randomly applied for 30 min each: (1) usual setting (U), the setting of NPSV actually used by the individual patient at home; and (2) physiologic setting (PHY), the level of inspiratory pressure support (IPS) and external positive end-expiratory pressure (PEEPe) tailored to patient according to invasive evaluation of respiratory muscular function and mechanics. Results: All patients tolerated NPSV well throughout the procedure. Mean U was IPS, 16 ± 3 cm H2O and PEEPe, 3.6 ± 1.4 cm H2O; mean PHY was IPS, 15 ± 3 cm H2O and PEEPe, 3.1 ± 1.6 cm H2O. NPSV was able to significantly (p <0.01) improve arterial blood gases independent of the setting applied. When compared with spontaneous breathing, both settings induced a significant increase in minute ventilation (p <0.01). Both settings were able to reduce the diaphragmatic pressure-time product, but the reduction was significantly greater with PHY (by 64{\%}; p <0.01) than with U (56{\%}; p <0.05). Eleven of 23 patients (48{\%}) with U and 7 of 23 patients (30{\%}) with PHY showed ineffective efforts (IE); the prevalence of IE (20 ± 39{\%} vs 6 ± 11{\%} of their respiratory rate with U and PHY, respectively) was statistically different (p <0.05). Conclusion: In COPD patients with chronic hypercapnia, NPSV is effective in improving arterial blood gases and in unloading inspiratory muscles independent of whether it is set on the basis of patient comfort and improvement in arterial blood gases or tailored to a patient's respiratory muscle effort and mechanics. However, setting of inspiratory assistance and PEEPe by the invasive evaluation of lung mechanics and respiratory muscle function may result in reduction in ineffective inspiratory efforts. These short-term results must be confirmed in the long-term clinical setting.",
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T1 - The appropriate setting of noninvasive pressure support ventilation in stable COPD patients

AU - Vitacca, M.

AU - Nava, S.

AU - Confalonieri, M.

AU - Bianchi, L.

AU - Porta, R.

AU - Clini, E.

AU - Ambrosino, N.

PY - 2000

Y1 - 2000

N2 - Study objective: To evaluate the short-term physiologic effects of two settings of nasal pressure-support ventilation (NPSV) in stable COPD patients with chronic hypercapnia. Design: Randomized controlled physiologic study. Setting: Lung function units and outpatient clinic of two affiliated pulmonary rehabilitation centers. Patients: Twenty-three patients receiving domiciliary nocturnal NPSV for a mean (± SD) duration of 31 ± 20 months. Methods: Evaluation of arterial blood gases, breathing pattern, respiratory muscles, and dynamic intrinsic positive end-expiratory pressure (PEEPi,dyn) during both unassisted and assisted ventilation. Two settings of NPSV were randomly applied for 30 min each: (1) usual setting (U), the setting of NPSV actually used by the individual patient at home; and (2) physiologic setting (PHY), the level of inspiratory pressure support (IPS) and external positive end-expiratory pressure (PEEPe) tailored to patient according to invasive evaluation of respiratory muscular function and mechanics. Results: All patients tolerated NPSV well throughout the procedure. Mean U was IPS, 16 ± 3 cm H2O and PEEPe, 3.6 ± 1.4 cm H2O; mean PHY was IPS, 15 ± 3 cm H2O and PEEPe, 3.1 ± 1.6 cm H2O. NPSV was able to significantly (p <0.01) improve arterial blood gases independent of the setting applied. When compared with spontaneous breathing, both settings induced a significant increase in minute ventilation (p <0.01). Both settings were able to reduce the diaphragmatic pressure-time product, but the reduction was significantly greater with PHY (by 64%; p <0.01) than with U (56%; p <0.05). Eleven of 23 patients (48%) with U and 7 of 23 patients (30%) with PHY showed ineffective efforts (IE); the prevalence of IE (20 ± 39% vs 6 ± 11% of their respiratory rate with U and PHY, respectively) was statistically different (p <0.05). Conclusion: In COPD patients with chronic hypercapnia, NPSV is effective in improving arterial blood gases and in unloading inspiratory muscles independent of whether it is set on the basis of patient comfort and improvement in arterial blood gases or tailored to a patient's respiratory muscle effort and mechanics. However, setting of inspiratory assistance and PEEPe by the invasive evaluation of lung mechanics and respiratory muscle function may result in reduction in ineffective inspiratory efforts. These short-term results must be confirmed in the long-term clinical setting.

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KW - Breathing pattern

KW - Hypercapnia

KW - Noninvasive mechanical ventilation

KW - Respiratory failure

KW - Respiratory muscles

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