Comparison of volume- and pressure-limited NPPV at night: a prospective randomized cross-over trial

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• 作者：Wolfram Windisch ; Jan Hendrik Storre ; Stephan Sorichter ; Johann Christian Virchow
• 关键词：Chronic respiratory failure ; Hypercapnia ; leakage ; Non-invasive positive pressure ventilation ; Pressure set ; Sleep ; Volume set
• 刊名：Respiratory Medicine
• 出版年：2005
• 出版时间：January 2005
• 年：2005
• 卷：99
• 期：1
• 页码：52-59
• 全文大小：201 K

文摘

Both pressure- and volume-limited non-invasive positive pressure ventilation (NPPV) have been used in patients with chronic respiratory failure. The aim of the present study was to compare the efficacy of ventilation during nocturnal volume- and pressure-limited NPPV.

Fifteen patients (nine COPD, six non-COPD) were randomly assigned to receive either volume-limited or pressure-limited NPPV and were switched to the complementary mode after 6 weeks.

Ten patients (five COPD, five non-COPD) completed the study. PaCO₂ during sleep comparably decreased from 54.6±8.0 to 46.2±6.1 mmHg during volume-limited NPPV (P<0.05), and to 46.5±6.4 mmHg during pressure-limited NPPV (P<0.05). Improvements in sleep quality assessed by polysomnography were comparable, but less gastrointestinal side effects were reported for pressure-limited NPPV (P<0.05). Using a pneumotachograph the variance of inspiratory volumes was lower, but the variance of peak inspiratory pressures was higher during volume-limited NPPV compared to pressure-limited NPPV. Substantial leak volumes which accounted for 57 % (volume-limited NPPV) and for 58 % (pressure-limited NPPV) of the applied inspiratory volume were independent from the mode of ventilation.

In conclusion, nocturnal volume- and pressure-limited NPPV have similar effects on gas exchange and sleep quality in patients with hypercapnic chronic respiratory failure, but volume-limited NPPV is associated with more gastrointestinal side effects.