Average Volume-Assured Pressure Support in Obesity Hypoventilation

Storre, Jan Hendrik; Seuthe, B; Fiechter, René; Milioglou, Stavroula; Dreher, Michael; Sorichter, Stephan; Windisch, Wolfram

doi:10.1378/chest.130.3.815

Cited by 274 publications

(218 citation statements)

References 25 publications

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“…In a study which compared home use of BiPAP-S/T and BiPAP-AVAPS-S/T modes in 10 patients diagnosed with obesity hypoventilation syndrome (OHS), Storre et al [14] found that the BiPAP-S/T mode improved oxygenation, sleep quality, and health-related quality of life. However, higher levels of PaCO 2 were not improved by therapy.…”

Section: Discussionmentioning

confidence: 99%

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Türk¹,

Aydoğdu²,

Gürsel³

2018

Turk Thorac J

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OBJECTIVES:Different outcomes and success rates of non-invasive positive pressure ventilation (NPPV) in patients with acute hypercapnic respiratory failure (AHRF) still pose a significant problem in intensive care units. Previous studies investigating different modes, body positioning, and obesity-associated hypoventilation in patients with chronic respiratory failure showed that these factors may affect ventilator mechanics to achieve a better minute ventilation. This study tried to compare pressure support (BiPAP-S) and average volume targeted pressure support (AVAPS-S) modes in patients with acute or acute-on-chronic hypercapnic respiratory failure. In addition, short-term effects of body position and obesity within both modes were analyzed. MATERIAL and METHODS:We conducted a randomized controlled study in a 7-bed intensive care unit. The course of blood gas analysis and differences in ventilation variables were compared between BiPAP-S (n=33) and AVAPS-S (n=29), and between semi-recumbent and lateral positions in both modes. RESULTS:No difference was found in the length of hospital stay and the course of PaCO2, pH, and HCO3 levels between the modes. There was a mean reduction of 5.7±4.1 mmHg in the PaCO2 levels in the AVAPS-S mode, and 2.7±2.3 mmHg in the BiPAP-S mode per session (p<0.05). Obesity didn't have any effect on the course of PaCO2 in both the modes. Body positioning had no notable effect in both modes. CONCLUSION:Although the decrease in the PaCO2 levels in the AVAPS-S mode per session was remarkably high, the course was similar in both modes. Furthermore, obesity and body positioning had no prominent effect on the PaCO2 response and ventilator mechanics. Post hoc power analysis showed that the sample size was not adequate to detect a significant difference between the modes.

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Section: Discussionmentioning

confidence: 99%

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Türk¹,

Aydoğdu²,

Gürsel³

2018

Turk Thorac J

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“…They found that AVAPS resulted in a trend toward improved nocturnal minute ventilation as well as a statistically significant improvement in subjective sleep quality as measured by a questionnaire. Although two previous studies demonstrated an increase in nocturnal minute ventilation with AVAPS in patients with chronic respiratory failure [20] and obesity hypoventilation [21], neither study was able to show an improvement in sleep efficiency as measured by polysomnography. While there are numerous possible explanations for this discrepancy, there is one in particular that bears mentioning.…”

mentioning

confidence: 55%

Can We Improve Sleep Quality by Changing the Way We Ventilate Patients?

Roussos

Parthasarathy

Ayas

2009

Lung

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“…Because AVAPS is a form of adaptive PCV, there is a concern that the ventilator will inappropriately decrease support if respiratory drive increases. 74 There have been reports of the use of AVAPS in patients with obesity hypoventilation syndrome 75 and in stable patients with COPD and hypercapnia. 76 However, to my knowledge there have been no reports of the use of AVAPS in patients with acute respiratory failure.…”

Section: Mode Asynchronymentioning

confidence: 99%

Patient-Ventilator Interaction During Noninvasive Ventilation

Hess

2011

Respir Care

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There is arguably more evidence to support the use of noninvasive ventilation (NIV) than any other practice related to the care of patients with acute respiratory failure. Despite this strong evidence base, NIV seems to be under-utilized and the failure rate (need for intubation) may be as high as 40%. Some of these failures potentially relate to asynchrony, although the relationship between asynchrony and NIV failure has not been well studied. Good NIV tolerance has been associated with success of NIV, and improved comfort has been associated with better synchrony. In one study a high rate of asynchrony occurred in 43% of patients during NIV. Asynchrony is commonly associated with leaks. Thus, reducing the leak related to the interface and using a ventilator with good leak compensation should reduce the rate of asynchrony. Asynchronies can also be related to the underlying disease process. This paper reviews issues related to asynchrony during NIV and suggests strategies that might be used to correct asynchrony when it occurs.

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Average Volume-Assured Pressure Support in Obesity Hypoventilation

Cited by 274 publications

References 25 publications

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Can We Improve Sleep Quality by Changing the Way We Ventilate Patients?

Patient-Ventilator Interaction During Noninvasive Ventilation

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