Impact of Different Backup Respiratory Rates on the Efficacy of Noninvasive Positive Pressure Ventilation in Obesity Hypoventilation Syndrome

Contal, Olivier; Adler, Dan; Borel, Jean‐Christian; Espa, Fabrice; Perrig, Stephan; Rodenstein, Daniel; Pépin, Jean‐Louis; Janssens, Jean–Paul

doi:10.1378/chest.11-2848

Cited by 81 publications

(53 citation statements)

References 30 publications

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“…With apnea being the most severe event, MV is reduced, and hypercapnia deepens during sleep due to respiratory events in this group of patients. Even though our patients received NPPV support during sleep, a study by Contal et al [17] in 10 patients with OHS showed that NPPV used in the spontaneous mode without any back-up respiratory rate was insufficient in preventing these respiratory events. However, it also showed that presence of back-up respiratory rate did not make any change in the transcutaneous PtCO 2 levels measured during sleep.…”

Section: Discussionmentioning

confidence: 75%

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: 75%

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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“…9,23 Briefly, 10 subjects treated with home NIV using the same device for obesity-hypoventilation syndrome were recruited by the Division of Pulmonary Diseases of Geneva University Hospitals. Obesity-hypoventilation syndrome was defined as the association of morbid obesity (body mass index of Ͼ 30 kg/m 2 ) and daytime hypercapnia (P aCO 2 Ͼ 45 mm Hg) without any other obstructive or restrictive pulmonary pathology.…”

Section: Methodsmentioning

confidence: 99%

“…Respiratory events were scored when associated with a drop in S pO 2 of at least 4% and/or a microarousal and classified in 3 previously defined groups 9 : central, mixed, and obstructive events. Patient-ventilator asynchrony was quantified as reported by Guo et al 8 …”

Section: Polysomnography Ventilator Software and Respiratory Eventsmentioning

confidence: 99%

“…7,8 Subtle changes in ventilatory parameters may also result in unwanted respiratory events. 9,10 Expert groups have emphasized the importance of appropriate monitoring of patients treated with NIV to detect and correct undesired nocturnal respiratory events. [11][12][13] Although the American Academy of Sleep Medicine recommends monitoring NIV by polysomnography, this is not technically possible in many countries because of issues such as cost and availability.…”

Section: Introductionmentioning

confidence: 99%

“…Changes in backup breathing frequency led to marked changes in central and obstructive hypopneas and apneas, providing an excellent database for comparing data provided by home ventilators and those simultaneously measured by polysomnography. 9 This comparison was among the end points prespecified in the study design (ClinicalTrials.gov registration NCT01130090). All subjects were equipped with the same NIV device for this study.…”

Section: Introductionmentioning

confidence: 99%

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Reliability of Apnea-Hypopnea Index Measured by a Home Bi-Level Pressure Support Ventilator Versus a Polysomnographic Assessment

et al. 2015

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BACKGROUND: Ventilators designed for home care provide clinicians with built-in software that records items such as compliance, leaks, average tidal volume, total ventilation, and indices of residual apnea and hypopnea. Recent studies have showed, however, an important variability between devices regarding reliability of data provided. In this study, we aimed to compare apneahypopnea indices (AHI) provided by home ventilators (AHI NIV ) versus data scored manually during polysomnography (AHI PSG ) in subjects on noninvasive ventilation (NIV) for obesity-hypoventilation syndrome. METHODS: Stable subjects with obesity-hypoventilation syndrome on NIV, all using the same device, underwent 3 consecutive polysomnographic sleep studies with different backup breathing frequencies (spontaneous mode, low and high backup breathing frequencies). During each recording, AHI NIV was compared with AHI PSG . RESULTS: Ten subjects (30 polysomnogram tracings) were analyzed. For each backup breathing frequency (spontaneous mode, low and high backup breathing frequencies), AHI values were 62 ؎ 7/h, 26 ؎ 7/h, and 17 ؎ 5/h (mean ؎ SD), respectively. Correlation between AHI NIV and AHI PSG was highly significant (r 2 ‫؍‬ 0.89, P < .001). As determined by Bland-Altman analysis, mean bias was 6.5 events/h, and limits of agreement were ؉26.0 and ؊12.9 events/h. Bias increased significantly with higher AHI values. Using a threshold AHI value of 10/h to define appropriate control of respiratory events, the ventilator software had a sensitivity of 90.9%, a specificity and positive predictive value of 100%, and a negative predictive value of 71%. CONCLUSIONS: In stable subjects with obesity-hypoventilation syndrome, the home ventilator software tested was appropriate for determining if control of respiratory events was satisfactory on NIV or if further testing or adjustment of ventilator settings was required. (ClinicalTrials.gov registration NCT01130090.)

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Hypoventilation Syndromes

Piper

Yee

2014

Comprehensive Physiology

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In patients with impaired inspiratory muscle function or altered respiratory system mechanics, an imbalance between load and capacity can arise. The ventilatory control system normally compensates for this by increasing drive to maintain adequate alveolar ventilation levels, thereby keeping arterial CO2 within its normal range. To reduce work of breathing, a pattern of reduced tidal volume and increased respiratory rate occurs. This pattern itself may eventually reduce effective ventilation by increasing dead space ventilation. However, the impact of sleep on breathing and its role in the development of diurnal respiratory failure is often overlooked in this process. Sleep not only reduces respiratory drive, but also diminishes chemoresponsiveness to hypoxia and hypercapnia creating an environment where significant alterations in oxygenation and CO2 can occur. Acute increases in CO2 load especially during rapid eye movement sleep can initiate the process of bicarbonate retention which further depresses ventilatory responsiveness to CO2. Treatment of hypoventilation needs to be directed toward factors underlying its development. Nocturnal noninvasive positive pressure therapy is the most widely used and reliable strategy currently available to manage hypoventilation syndromes. Although this may not consistently alter respiratory muscle strength or the mechanical properties of the respiratory system, it does appear to reset chemosensitivity by reducing bicarbonate, resulting in a more appropriate ventilatory response to CO2 during wakefulness. Not only is diurnal hypoventilation reduced with noninvasive ventilation, but quality of life, functional capacity and survival are also improved. However, close attention to how therapy is set up and used are key factors in achieving clinical benefits.

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Impact of Different Backup Respiratory Rates on the Efficacy of Noninvasive Positive Pressure Ventilation in Obesity Hypoventilation Syndrome

Cited by 81 publications

References 30 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

Reliability of Apnea-Hypopnea Index Measured by a Home Bi-Level Pressure Support Ventilator Versus a Polysomnographic Assessment

Hypoventilation Syndromes

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