Role of Average Volume Assured Pressure Support Mode (AVAPS) in the Management of Acute Exacerbation of Chronic Obstructive Pulmonary Disease With Type 2 Respiratory Failure

Abstract

BackgroundNon-invasive ventilation (NIV) is a well-established approach in the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD) with type 2 respiratory failure. Average volume-assured pressure support (AVAPS) mode integrates the characteristics of both volume and pressure-controlled modes of NIV. In bilevel positive airway pressure (BiPAP) mode, volume is the dependent variable, whereas in AVAPS mode, pressure is the dependent variable. In this study, we aimed to compare the role of AVAPS mode with BiPAP spontaneous/timed (S/T) mode for the management of patients with acute exacerbation of COPD with type 2 respiratory failure. MethodologyA hospital-based comparative and analytical study was carried out on 100 patients with acute exacerbation of COPD with type 2 respiratory failure admitted to respiratory disease hospital, Sardar Patel Medical College, Bikaner (Rajasthan, India). Patients were randomly divided into two groups of 50 patients each. Group A patients were treated with AVAPS mode and group B patients with BiPAP (S/T) mode. Arterial blood gases, average duration of hospital stay, and need for invasive mechanical ventilation were compared between the two groups. ResultsThere was a statistically significant difference in favor of group A in terms of improvement in pH and pCO 2 as compared to group B at 6 h (pH, p=0.027; pCO 2 , p=0.012) and 24 h (pH, p=0.032; pCO 2 , p=0.013).The duration of hospital stay was found to be lower in group A (p=0.003). However, no significant difference was found in terms of need for invasive mechanical ventilation between both groups (p=0.338). ConclusionApplication of AVAPS mode results in more rapid and steady improvement in patients of COPD as compared to BiPAP (S/T) mode. Thus, management through non-invasive ventilation AVAPS mode should be considered in patients with acute exacerbation of COPD with type 2 respiratory failure.

Obesity hypoventilation syndrome, literature review

“…AVAPS integrates the characteristics of both volume and pressure-controlled noninvasive ventilation. In Bi-level PAP mode, volume is the dependent variable, whereas in AVAPS mode, pressure is the dependent variable [ 59 ]. Bi-level PAP substantially improves clinical parameters such as oxygenation, sleep quality, and health-related quality of life in patients with OHS.…”