Comparison of volume- and pressure-limited NPPV at night: a prospective randomized cross-over trial.
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.
Windisch
Wolfram
W
Department of Pneumology,University Hospital Freiburg, Killianstrasse 5, 79106 Freiburg, Germany. windisch@med1.ukl.uni-freiburg.de
Storre
Jan Hendrik
JH
Sorichter
Stephan
S
Virchow
Johann Christian
JC
D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D002940:Circadian Rhythm; D018592:Cross-Over Studies; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D011659:Pulmonary Gas Exchange; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012890:Sleep; D016896:Treatment Outcome
D002245:Carbon Dioxide; D010100:Oxygen