A randomised controlled trial of CPAP versus non-invasive ventilation for initial treatment of obesity hypoventilation syndrome

Howard, Mark; Piper, Amanda J.; Stevens, Bronwyn; Holland, Anne E; Yee, Brendon J.; Dabscheck, Eli; Mortimer, Duncan; Burge, Angela T; Flunt, Daniel; Buchan, Catherine; Rautela, Linda; Sheers, Nicole; Hillman, David R.; Berlowitz, David J

doi:10.1136/thoraxjnl-2016-208559

Cited by 142 publications

(132 citation statements)

References 27 publications

(43 reference statements)

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“…The contribution of NIV in OHS has also been better defined by the Spanish Sleep Network and others [75, 76]. After an acute OHS episode, a trial of CPAP is warranted in hypercapnic subjects with severe OSA syndrome, while NIV is preferred in subjects without severe OSA.…”

Section: When To Implement Niv: Recent Clarifications and Areas For Fmentioning

confidence: 99%

The Pathophysiology of Respiratory Failure: Control of Breathing, Respiratory Load, and Muscle Capacity

Adler

Janssens²

2018

Respiration

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The purpose of this review is to provide an overview on how interactions between control of breathing, respiratory load, and muscle function may lead to respiratory failure. The mechanisms involved vary according to the underlying pathology, but respiratory failure is most often the result of an imbalance between the muscular pump and the mechanical load placed upon it. Changes in respiratory drive and response to CO₂ seem to be important contributors to the pathophysiology of respiratory failure. Inspiratory muscle dysfunction is also frequent but is not a mandatory prerequisite to respiratory failure since increased load may also be sufficient to precipitate it. It is crucial to recognize these interactions to be able to timeously establish patients on mechanical ventilation and adapt the ventilator settings to their respiratory system physiology.

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Section: When To Implement Niv: Recent Clarifications and Areas For Fmentioning

confidence: 99%

The Pathophysiology of Respiratory Failure: Control of Breathing, Respiratory Load, and Muscle Capacity

Adler

Janssens²

2018

Respiration

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“…vom Spanish Sleep Network weiter geklärt [75,76]. Nach einer akuten OHS-Episode ist bei hyperkapnischen Patienten mit schwerem OSA-Syndrom eine CPAP-Studie gerechtfertigt, während bei Patienten ohne schwere OSA eine NIV zu bevorzugen ist.…”

Section: Der Richtige Zeitpunkt Für Eine Niv: Aktuelle Erkenntnisse Uunclassified

Pathophysiologie der Ateminsuffizienz: Atmungsregulation, Atemlast und Muskelkapazität

Adler¹,

Janssens²

2019

Kompass Pneumol

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Das Ziel dieser Übersichtsarbeit ist es, in Grundzügen darzustellen, wie Wechselwirkungen zwischen der Atmungsregulation, der Atemlast und der Muskelfunktion zu Ateminsuffizienz führen können. Die beteiligten Mechanismen variieren je nach zugrunde liegender Pathologie, aber meist ist eine Ateminsuffizienz das Ergebnis eines Ungleichgewichts zwischen der Muskelpumpe und der auf diese wirkenden mechanischen Belastung. Veränderungen des Atemantriebs und der CO2-Antwort scheinen wichtige Faktoren für die Pathophysiologie der Ateminsuffizienz zu sein. Auch Funktionsstörungen der Einatemmuskeln kommen häufig vor, stellen jedoch keine zwingende Voraussetzung für eine Ateminsuffizienz dar, da diese auch nur durch erhöhte Last herbeigeführt werden kann. Es ist von größter Bedeutung, sich dieser Wechselwirkungen bewusst zu sein, um rechtzeitig eine mechanische Beatmung zu beginnen und ihre Parameter an die individuelle Physiologie des Atmungsapparats des Patienten anzupassen.

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“…In a RCT of patients with OHS, Masa et al 45 showed that NIV and CPAP were more effective than lifestyle modification in improving clinical symptoms and polysomnographic parameters over a two-month follow up period, although NIV lead to better respiratory functional improvements than did CPAP. In a recently published RCT, Howard et al 46 showed that in patients with newly diagnosed severe OHS (PaCO 2 approximately 60 mm Hg) NIV and CPAP resulted in similar improvements in ventilatory failure, quality of life and adherence to therapy. A high PaCO 2 at baseline was the only predictor of persistence of ventilatory failure at three months.…”

Section: Duration Of Nivmentioning

confidence: 99%

Non Invasive Ventilation in Acute Hypercapnic Respiratory Failure

Elliott¹

2021

BRN

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This article reviews the use of non invasive ventilation (NIV) in the management of acute hypercapnic respiratory failure (AHRF). Most of the evidence and experience comes from treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) but this has been extrapolated to other conditions. Patient selection, contraindications, how to monitor and recognise when NIV is failing and what the options are then, are discussed. There are differences in criteria for initiation of NIV and the way that it is applied in patients with neuromuscular disease, chest wall disorders and obesity. The importance of staff experience and training as well as the need for regular audit are stressed.

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A randomised controlled trial of CPAP versus non-invasive ventilation for initial treatment of obesity hypoventilation syndrome

Abstract: ACTRN12611000874910, results.

Cited by 142 publications

References 27 publications

The Pathophysiology of Respiratory Failure: Control of Breathing, Respiratory Load, and Muscle Capacity

The Pathophysiology of Respiratory Failure: Control of Breathing, Respiratory Load, and Muscle Capacity

Pathophysiologie der Ateminsuffizienz: Atmungsregulation, Atemlast und Muskelkapazität

Non Invasive Ventilation in Acute Hypercapnic Respiratory Failure

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