Comparing effectiveness of intelligent volume‐assured pressure support (iVAPS) vs bi‐level positive airway pressure spontaneous/timed (BPAP S/T) for hypercapnic respiratory failure in chronic obstructive pulmonary disease

Abstract

Background and aim: Intelligent volume-assured pressure support (iVAPS) is a relatively new hybrid mode of non-invasive ventilation (NIV). There is still limited evidence for iVAPS. The aim of this study was to compare the effectiveness of iVAPS to that of bi-level positive airway pressure spontaneous/timed (BPAP S/T) in patients with acute hypercapnic respiratory failure or acute-on-chronic hypercapnic respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the emergency department. Material and methods:This was an observational, retrospective study. Eighty-two patients with hypercapnic respiratory failure caused by AECOPD, who were admitted to our emergency department, were analysed. Arterial blood gas (ABG) parameters, length of hospital stay and rate of intensive care unit (ICU) admission were compared between iVAPS and BPAP S/T.Results: A total of 82 patients (26 females, 56 males, mean age 68.26 ± 11.63 years) who were treated with iVAPS (N = 26) or BPAP S/T (N = 56) were enrolled. There were no significant differences between two modes with respect to demographics such as age, gender, presence of comorbidity, usage of long-term oxygen therapy or NIV, and the baseline ABG parameters. The presence of pneumonia was significantly higher in BPAP S/T (P = .01). The rate of ICU admission was 26.9% in iVAPS vs 25% in BPAP S/T. The mean length of hospital stay was 11.5 ± 12.3 days in iVAPS and 9.7 ± 7.4 days in BPAP S/T (P = .53). The mean values of ABG parameters at the 1st and 24th hours of NIV therapy did not differ in both groups. Conclusion:Both modes were similarly effective in the management of appropriately selected patients with hypercapnic respiratory failure caused by AECOPD. Hence, we underline that NIV mode selection in the emergency department should be performed in line with experiences of clinicians/institutions and accessibility of ventilator devices/modes. How to cite this article: Söyler Y, Akın Kabalak P, Saral Öztürk Z, Uğurman F. Comparing effectiveness of intelligent volumeassured pressure support (iVAPS) vs bi-level positive airway pressure spontaneous/timed (BPAP S/T) for hypercapnic respiratory failure in chronic obstructive pulmonary disease.

The Significance of Implementing Bilevel Positive Airway Pressure under Cluster Nursing in Improving the Survival Possibility of Patients with Severe Pulmonary Infection Complicated by Respiratory Failure

“…Besides, we found better improved BG function and vital signs in groups A and C after treatment, further demonstrating the excellent application effect of BIPAP. Previous studies have suggested that BIPAP therapy can warm and humidify the inhaled gas through the upper respiratory tract, meet the needs of mask mechanical ventilation, shorten the hospitalization time of RF patients, and reduce the rate of tracheal intubation; in SPI, it can also effectively remove a large amount of inflammatory secretions in the airway, reduce airway obstruction, and improve lung ventilation and ventilation function [ 30 , 31 ]. Therefore, under BIPAP, not only the high resistance in the airway can be overcome but also the workload of the respiratory muscles and the oxygen consumption can be reduced, so as to avoid the overwork of the respiratory muscles, improve the compliance of the lungs, and adjust the oxygen partial pressure, ultimately lowering the possibility of damage to the body and other organs.…”

Noninvasive positive pressure in acute exacerbations of chronic obstructive pulmonary disease

“…Examples are ASV, iVAPS and AVAPS (see Table 5). Studies using these algorithms are promising and demonstrate evidence of benefit [35–37], but are yet to be further evaluated and implemented. Other modes focus on improving synchrony and providing proportional support (NAVA and PAV).…”