Background and objective
Average volume‐assured pressure support—automated expiratory positive airway pressure (AVAPS‐AE) combines an automated positive expiratory pressure to maintain upper airway patency to an automated pressure support with a targeted tidal volume. The aim of this study was to compare the effects of 2‐month AVAPS‐AE ventilation versus pressure support (ST) ventilation on objective sleep quality in stable patients with OHS. Secondary outcomes included arterial blood gases, health‐related quality of life, daytime sleepiness, subjective sleep quality and compliance to NIV.
Methods
This is a prospective multicentric randomized controlled trial. Consecutive OHS patients included had daytime PaCO2 > 6 kPa, BMI ≥ 30 kg/m2, clinical stability for more than 2 weeks and were naive from home NIV. PSG were analysed centrally by two independent experts. Primary endpoint was sleep quality improvement at 2 months.
Results
Among 69 trial patients, 60 patients had successful NIV setup. Baseline and follow‐up PSG were available for 26 patients randomized in the ST group and 30 in the AVAPS‐AE group. At baseline, PaCO2 was 6.94 ± 0.71 kPa in the ST group and 6.61 ± 0.71 in the AVAPS‐AE group (P = 0.032). No significant between‐group difference was observed for objective sleep quality indices. Improvement in PaCO2 was similar between groups with a mean reduction of −0.87 kPa (95% CI: −1.12 to −0.46) in the ST group versus −0.87 kPa (95% CI: −1.14 to −0.50) in the AVAPS‐AE group (P = 0.984). Mean NIV use was 6.2 h per night in both groups (P = 0.93). NIV setup duration was shorter in the AVAPS‐AE group (P = 0.012).
Conclusion
AVAPS‐AE and ST ventilation for 2 months had similar impact on sleep quality and gas exchange.
BackgroundWhereas first-line bronchial artery embolisation (BAE) is considered standard of care for the management of severe haemoptysis, it is unknown whether this approach is warranted for non-severe haemoptysis.Research questionTo assess the efficacy on bleeding control and the safety of first-line BAE in non-severe haemoptysis of mild abundance.Study design and methodsThis multicentre, randomised controlled open-label trial enrolled adult patients without major comorbid condition and having mild haemoptysis (onset <72 hours, 100–200 mL estimated bleeding amount), related to a systemic arterial mechanism. Patients were randomly assigned (1:1) to BAE associated with medical therapy or to medical therapy alone.ResultsBleeding recurrence at day 30 after randomisation (primary outcome) occurred in 4 (11.8%) of 34 patients in the BAE strategy and 17 (44.7%) of 38 patients in the medical strategy (difference −33%; 95% CI −13.8% to −52.1%, p=0.002). The 90-day bleeding recurrence-free survival rates were 91.2% (95% CI 75.1% to 97.1%) and 60.2% (95% CI 42.9% to 73.8%), respectively (HR=0.19, 95% CI 0.05 to 0.67, p=0.01). No death occurred during follow-up and no bleeding recurrence needed surgery.Four adverse events (one major with systemic emboli) occurred during hospitalisation, all in the BAE strategy (11.8% vs 0%; difference 11.8%, 95% CI 0.9 to 22.6, p=0.045); all eventually resolved.ConclusionIn non-severe haemoptysis of mild abundance, BAE associated with medical therapy had a superior efficacy for preventing bleeding recurrences at 30 and 90 days, as compared with medical therapy alone. However, it was associated with a higher rate of adverse events.Trial registration numberNCT01278199
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