Spontaneous-timed versus controlled noninvasive ventilation in chronic hypercapnia – a crossover trial

Spontaneous-timed versus controlled noninvasive ventilation in chronic hypercapnia – a crossover trial

Jens Kerl, Ekkehard Höhn, Dieter Köhler, Dominic DellwegDepartment for Pulmonary Medicine, Intensive Care Medicine and Sleep Medicine, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg, 57392, GermanyBackground: There is an ongoing debate about optimal ventilator modes and set...

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Autores principales: Kerl J, Höhn E, Köhler D, Dellweg D
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2019
Materias:
noninvasive mechanical ventilation
clinical trials
respiratory failure
reversible hypercapnia
ventilator mode
controlled ventilation
Medical technology
R855-855.5
Acceso en línea:https://doaj.org/article/d359f9fe9c614582ae79c9d0816e46d8
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spelling oai:doaj.org-article:d359f9fe9c614582ae79c9d0816e46d82021-12-02T07:11:06ZSpontaneous-timed versus controlled noninvasive ventilation in chronic hypercapnia – a crossover trial1179-1470https://doaj.org/article/d359f9fe9c614582ae79c9d0816e46d82019-05-01T00:00:00Zhttps://www.dovepress.com/spontaneous-timed-versus-controlled-noninvasive-ventilation-in-chronic-peer-reviewed-article-MDERhttps://doaj.org/toc/1179-1470Jens Kerl, Ekkehard Höhn, Dieter Köhler, Dominic DellwegDepartment for Pulmonary Medicine, Intensive Care Medicine and Sleep Medicine, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg, 57392, GermanyBackground: There is an ongoing debate about optimal ventilator modes and settings during noninvasive ventilation (NIV).Objectives: To compare the effect of spontaneous-timed (ST) and controlled NIV on carbon dioxide reduction in patients suffering from chronic hypercapnia.Methods: Night and daytime blood gas analysis, lung function tests and 6 minute walking distance tests (6MWD) were done before and after every 6-week treatment.Results: This randomized prospective crossover trial included 42 patients. Pooled data analysis showed a decrease of nocturnal CO2 from 54.8±5.9 mmHg to 41.6±5.5 mmHg during ST ventilation (p<0.01) and from 56.2±7.5 mmHg to 42.7±5.4 mmHg during controlled NIV (p<0.01) with no difference between treatment forms (p=0.30). Daytime CO2 levels decreased from 49.3±5.5 mmHg to 45.6±4.5 mmHg when spontaneous timed ventilation was applied (p<0.01) and from 52.2±6.8 mmHg to 44.9±21114.4 mmHg in case of controlled ventilation (p<0.01) The amount of CO2 reduction was 3.8±5.6 mmHg after ST mode and 7.3±6.8 mmHg controlled ventilation (p<0.05). Nocturnal ventilator use was 5.7±2.1 and 6.7±2.3 hours for ST and controlled ventilation respectively (p=0.02). There was no effect on walking distance and lung function.Conclusion: Controlled NIV showed improved compliance compared to ST ventilation. We observed similar CO2 reductions during nocturnal ventilation, however controlled ventilation achieved a higher reduction of daytime CO2 levels.Keywords: noninvasive mechanical ventilation, clinical trials, respiratory failure, reversible hypercapnia, ventilator mode, controlled ventilationKerl JHöhn EKöhler DDellweg DDove Medical Pressarticlenoninvasive mechanical ventilationclinical trialsrespiratory failurereversible hypercapniaventilator modecontrolled ventilationMedical technologyR855-855.5ENMedical Devices: Evidence and Research, Vol Volume 12, Pp 173-181 (2019)
institution DOAJ
collection DOAJ
language EN
topic noninvasive mechanical ventilation
clinical trials
respiratory failure
reversible hypercapnia
ventilator mode
controlled ventilation
Medical technology
R855-855.5
spellingShingle noninvasive mechanical ventilation
clinical trials
respiratory failure
reversible hypercapnia
ventilator mode
controlled ventilation
Medical technology
R855-855.5
Kerl J
Höhn E
Köhler D
Dellweg D
Spontaneous-timed versus controlled noninvasive ventilation in chronic hypercapnia – a crossover trial
description Jens Kerl, Ekkehard Höhn, Dieter Köhler, Dominic DellwegDepartment for Pulmonary Medicine, Intensive Care Medicine and Sleep Medicine, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg, 57392, GermanyBackground: There is an ongoing debate about optimal ventilator modes and settings during noninvasive ventilation (NIV).Objectives: To compare the effect of spontaneous-timed (ST) and controlled NIV on carbon dioxide reduction in patients suffering from chronic hypercapnia.Methods: Night and daytime blood gas analysis, lung function tests and 6 minute walking distance tests (6MWD) were done before and after every 6-week treatment.Results: This randomized prospective crossover trial included 42 patients. Pooled data analysis showed a decrease of nocturnal CO2 from 54.8±5.9 mmHg to 41.6±5.5 mmHg during ST ventilation (p<0.01) and from 56.2±7.5 mmHg to 42.7±5.4 mmHg during controlled NIV (p<0.01) with no difference between treatment forms (p=0.30). Daytime CO2 levels decreased from 49.3±5.5 mmHg to 45.6±4.5 mmHg when spontaneous timed ventilation was applied (p<0.01) and from 52.2±6.8 mmHg to 44.9±21114.4 mmHg in case of controlled ventilation (p<0.01) The amount of CO2 reduction was 3.8±5.6 mmHg after ST mode and 7.3±6.8 mmHg controlled ventilation (p<0.05). Nocturnal ventilator use was 5.7±2.1 and 6.7±2.3 hours for ST and controlled ventilation respectively (p=0.02). There was no effect on walking distance and lung function.Conclusion: Controlled NIV showed improved compliance compared to ST ventilation. We observed similar CO2 reductions during nocturnal ventilation, however controlled ventilation achieved a higher reduction of daytime CO2 levels.Keywords: noninvasive mechanical ventilation, clinical trials, respiratory failure, reversible hypercapnia, ventilator mode, controlled ventilation
format article
author Kerl J
Höhn E
Köhler D
Dellweg D
author_facet Kerl J
Höhn E
Köhler D
Dellweg D
author_sort Kerl J
title Spontaneous-timed versus controlled noninvasive ventilation in chronic hypercapnia – a crossover trial
title_short Spontaneous-timed versus controlled noninvasive ventilation in chronic hypercapnia – a crossover trial
title_full Spontaneous-timed versus controlled noninvasive ventilation in chronic hypercapnia – a crossover trial
title_fullStr Spontaneous-timed versus controlled noninvasive ventilation in chronic hypercapnia – a crossover trial
title_full_unstemmed Spontaneous-timed versus controlled noninvasive ventilation in chronic hypercapnia – a crossover trial
title_sort spontaneous-timed versus controlled noninvasive ventilation in chronic hypercapnia – a crossover trial
publisher Dove Medical Press
publishDate 2019
url https://doaj.org/article/d359f9fe9c614582ae79c9d0816e46d8
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AT hohne spontaneoustimedversuscontrollednoninvasiveventilationinchronichypercapniandashacrossovertrial
AT kohlerd spontaneoustimedversuscontrollednoninvasiveventilationinchronichypercapniandashacrossovertrial
AT dellwegd spontaneoustimedversuscontrollednoninvasiveventilationinchronichypercapniandashacrossovertrial
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