Non-invasive proportional assist and pressure support ventilation in patients with cystic fibrosis and chronic respiratory failure

A Serra, G Polese, C Braggion, A Rossi, A Serra, G Polese, C Braggion, A Rossi

Abstract

Background: Patients with advanced cystic fibrosis can benefit from non-invasive positive pressure ventilation (NPPV) for the treatment of acute decompensation as well as for the management of chronic respiratory failure. This study was undertaken to compare the physiological effects of non-invasive proportional assist ventilation (PAV) and pressure support ventilation (PSV) on ventilatory pattern, transcutaneous blood gas tensions, and diaphragmatic effort in stable patients with cystic fibrosis and chronic CO2 retention.

Methods: In 12 patients two periods of spontaneous breathing were followed randomly by PSV (12 (3) cm H2O) and PAV (flow assist 4.9 (1.3) cm H2O/l.s, volume assist 18.9 (5.1) cm H2O/l) set for the patient's comfort and administered for 40 minutes with 2 cm H2O continuous positive airway pressure. Ventilatory pattern, transcutaneous blood gas tensions, and surface diaphragmatic electromyography were measured in the last 10 minutes of each application.

Results: On average, both PSV and PAV improved ventilation (+30%), tidal volume (+30%), and transcutaneous CO2 (-7%) while reducing diaphragmatic activity (-30% with PSV, -20% with PAV). Mean inspiratory airway pressure was lower during PAV than during PSV (9.7 (1.9) and 12.9 (2.7) cm H2O, respectively; p<0.05). The mean coefficient of variation of tidal volume was about 20% (range 11-39%) during spontaneous breathing and did not change with either PAV or PSV.

Conclusions: These results show that short term administration of nasal PAV and PSV to patients with stable cystic fibrosis with chronic respiratory insufficiency is well tolerated, improves ventilation and blood gas tensions, and unloads the diaphragm.

References

    1. Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):819-26
    1. Intensive Care Med. 1999 Aug;25(8):790-8
    1. Crit Care Med. 2000 Jun;28(6):1791-7
    1. Eur Respir J. 2000 Sep;16(3):491-8
    1. Eur Respir J. 1991 May;4(5):524-7
    1. Chest. 1992 Sep;102(3):846-50
    1. Am J Respir Crit Care Med. 1994 Jul;150(1):167-73
    1. Am J Respir Crit Care Med. 1995 Apr;151(4):1126-35
    1. Am J Respir Crit Care Med. 1996 Mar;153(3):1005-11
    1. J Appl Physiol (1985). 1996 Jul;81(1):426-36
    1. Eur Respir J. 1997 Sep;10(9):1999-2003
    1. Am J Respir Crit Care Med. 1997 Dec;156(6):1840-5
    1. Eur Respir J. 1997 Dec;10(12):2829-34
    1. Chest. 1998 Apr;113(4):1013-8
    1. Respir Med. 1998 Mar;92(3):523-6
    1. Clin Pediatr (Phila). 1998 Sep;37(9):555-9
    1. Am J Respir Crit Care Med. 1998 Nov;158(5 Pt 1):1471-8
    1. Am J Respir Crit Care Med. 1999 Jun;159(6):1716-25
    1. Intensive Care Med. 1999 Aug;25(8):775-7
    1. Thorax. 2000 Jul;55(7):620-2

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren