Interfaces and ventilator settings for long-term noninvasive ventilation in COPD patients

Jens Callegari, Friederike Sophie Magnet, Steven Taubner, Melanie Berger, Sarah Bettina Schwarz, Wolfram Windisch, Jan Hendrik Storre, Jens Callegari, Friederike Sophie Magnet, Steven Taubner, Melanie Berger, Sarah Bettina Schwarz, Wolfram Windisch, Jan Hendrik Storre

Abstract

Introduction: The establishment of high-intensity (HI) noninvasive ventilation (NIV) that targets elevated PaCO2 has led to an increase in the use of long-term NIV to treat patients with chronic hypercapnic COPD. However, the role of the ventilation interface, especially in more aggressive ventilation strategies, has not been systematically assessed.

Methods: Ventilator settings and NIV compliance were assessed in this prospective cross-sectional monocentric cohort study of COPD patients with pre-existing NIV. Daytime arterialized blood gas analyses and lung function testing were also performed. The primary end point was the distribution among study patients of interfaces (full-face masks [FFMs] vs nasal masks [NMs]) in a real-life setting.

Results: The majority of the 123 patients studied used an FFM (77%), while 23% used an NM. Ventilation settings were as follows: mean ± standard deviation (SD) inspiratory positive airway pressure (IPAP) was 23.2±4.6 mbar and mean ± SD breathing rate was 16.7±2.4/minute. Pressure support ventilation (PSV) mode was used in 52.8% of patients, while assisted pressure-controlled ventilation (aPCV) was used in 47.2% of patients. Higher IPAP levels were associated with an increased use of FFMs (IPAP <21 mbar: 73% vs IPAP >25 mbar: 84%). Mean compliance was 6.5 hours/day, with no differences between FFM (6.4 hours/day) and NM (6.7 hours/day) users. PaCO2 assessment of ventilation quality revealed comparable results among patients with FFMs or NMs.

Conclusion: This real-life trial identified the FFM as the predominantly used interface in COPD patients undergoing long-term NIV. The increased application of FFMs is, therefore, likely to be influenced by higher IPAP levels, which form part of the basis for successful application of HI-NIV in clinical practice.

Keywords: compliance; home mechanical ventilation; interfaces; masks; pressure support; ventilation modes.

Conflict of interest statement

Disclosure JC received speaking fees and travel funding from VitalAire. FSM received speaking/consulting fees from SenTec and Philipps Respironics and travel funding from Vivisol and Heinen und Löwenstein. SBS received speaking/consulting fees from Philipps Respironics and travel funding from SenTec and Heinen und Löwenstein. WW received speaking fees from Heinen und Löwenstein, VitalAire, ResMed, Sentec, Maquet, and Vivisol. JHS received speaking/consulting fees and/or travel funding from Heinen&Löwenstein, VitalAire, ResMed, Linde, Radiometer, Keller Medical, Weinmann, Fisher&Paykel, GHD Gesundheits GmbH, Breas Medical, Respironics, and SenTec AG. MB and ST report no conflicts of interest in this work and JC, FSM, SBS, WW, and JHS report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow chart of study design and patient recruitment. Abbreviation: ABG, arterial blood gas.
Figure 2
Figure 2
Distribution of oro-nasal masks (FFMs, dark gray) and NMs (light gray) in different subgroups of patients. Note: Blue horizontal line indicates overall mean percentage of patients with FFM. Abbreviations: FFM, full-face mask; NM, nasal mask; BMI, body mass index (in kg/m2); CRF, chronic respiratory failure; SAS, sleep apnea syndrome; ARF, acute respiratory failure; IPAP, inspiratory positive airway pressure.
Figure 3
Figure 3
NIV adherence of patients with FFMs or NMs in varying IPAP ranges. Note: NIV adherence is presented in mean hours/day. Abbreviations: NIV, noninvasive ventilation; NM, nasal mask; IPAP, inspiratory positive airway pressure; FFM, full-face mask.
Figure 4
Figure 4
Daytime PaCO2 in relation to different IPAP ranges and interfaces. Note: Patients with acute exacerbation were excluded. Abbreviations: PaCO2, arterial pressure of carbon dioxide; IPAP, inspiratory positive airway pressure; FFM, full-face mask; NM, nasal mask.
Figure 5
Figure 5
Distribution of NIV equipment and settings according to IPAP range. Notes: Group A (A): IPAP <21 mbar, Group B (B): IPAP 21–25 mbar (B) and Group C (C): IPAP >25 mbar. Number of patients with FFMs: A=31, B=32 and C=32; with NMs: A=11, B=12 and C=6; with AV: A=6, B=11 and C=23; with Hum: A=39, B=39 and C=29 and with aPCV: A=9, =22 and C=27. Abbreviations: NIV, noninvasive ventilation; IPAP, inspiratory positive airway pressure; FFM, full-face mask; NM, nasal mask; AV, active valve circuit; Hum, active humidification; aPCV, assisted pressure-controlled ventilation.

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Source: PubMed

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