Noninvasive auto-titrating ventilation (AVAPS-AE) versus average volume-assured pressure support (AVAPS) ventilation in hypercapnic respiratory failure patients

Abstract

Auto-titrating noninvasive ventilation (NIV) has been developed as a new mode applying variable expiratory-positive airway pressure (EPAP) in addition to variable inspiratory pressures (IPAP), both to deliver targeted tidal volume (VT) and to eliminate upper airway resistance. The purpose of this study is to evaluate whether NIV with auto-titrating mode will decrease more PaCO within a shorter time compared to volume-assured mode in hypercapnic intensive care unit (ICU) patients. The hypercapnic respiratory failure patients treated with average volume assured pressure support- automated EPAP mode (group1) were compared with those treated with average volume-assured pressure support mode (group2). Two groups were matched with each other according to baseline diagnoses, demographic characteristics, arterial blood gas values, target VT settings and daily NIV usage times. Built-in software was used to gather the ventilatory parameters. Twenty-eight patients were included in group 1, and 22 in group 2. The decrease in PaCO had been achieved within a shorter time period in group 1 (p < 0.05). This response was more pronounced within the first 6 h (mean reduction in PaCO was 7 ± 7 mmHg in group 1 and 2 ± 5 mmHg in group 2, p = 0.025), and significantly greater reductions in PaCO (18 ± 11 mmHg in group 1 and 9 ± 8 mmHg in group 2, p = 0.008) and plasma HCO levels (from 32 to 30 mEq and from 35 to 35 mEq, p = 0.007) took place within first 4 days. While mean IPAP was similar in both groups, maximum EPAP, mean VT and leak were significantly higher in group 1 than in group 2 (p < 0.05). Results of this preliminary study suggest that, this new auto-titrating NIV mode may provide additional benefit on volume-assured mode in decreasing PaCO more efficiently and rapidly in hypercapnic ICU patients.

Auto titrating versus fixed EPAP intelligent volume-assured pressure support (iVAPS) Ventilation in Patients with COPD and Hypercapnic Respiratory Failure

“…Actually, target tidal volume of the two groups was set similarly 6-8 ml/ideal kg of the patient; but, the actual tidal volume was significantly higher in auto titrating group. Our findings were supported with several studies [11,12]. This might be explained by better elimination of upper airway resistance and improved lung mechanics.…”

“…In agreement with our results, Gursel et al investigate the efficiency of AVAPS-AE mode in hypercapnic respiratory failure. The authors found 10 mmHg reduction in PaCO2 levels had been achieved within a short time period in autotitrating group [11].The more efficient PaCO2 reduction in Auto titrating mode may be attributed to the higher tidal volume that was achieved. Recently, two further studies reported that this ventilation mode effective and safe in patients with chronic obstructive pulmonary disease (COPD) and hypercapnic respiratory failure [12,13].…”

“…The reason may be due to using a single limb machine that had an intentional leak. Thus, a further investigation is required to observe if higher air leaks may change patientventilator synchrony [11].…”

Advances in non‐invasive positive airway pressure technology

“…81 In a retrospective, cohort-matched trial, Gursel et al evaluated the addition of AutoEPAP to Va-BPAP in a heterogeneous group of hypercapnic patients admitted to ICU. 82 The target tidal volume set for both groups was similar (501 AE 42 mL for Va-BPAP-AutoEPAP vs 497 AE 37 mL for Va-BPAP). A significant difference in the reduction in PaCO 2 in the first 6 h was seen favouring Va-BPAP-AutoEPAP (7 AE 7 vs 2 AE 5 mm Hg), with PaCO 2 falling greater than 5 mm Hg in 93% of those with added AutoEPAP compared to 60% of those using volume assurance alone.…”

“…In a retrospective, cohort‐matched trial, Gursel et al . evaluated the addition of AutoEPAP to Va‐BPAP in a heterogeneous group of hypercapnic patients admitted to ICU . The target tidal volume set for both groups was similar (501 ± 42 mL for Va‐BPAP‐AutoEPAP vs 497 ± 37 mL for Va‐BPAP).…”