title: Bi-level positive airway pressure ventilation reduces the oxygen cost of breathing in long-standing post-polio patients on invasive home mechanical ventilation.
abstract: BACKGROUND
  Today, patients with chronic respiratory failure are commonly treated with non-invasive bi-level positive airway pressure ventilation, supporting spontaneous breathing. However, in conformity with previous clinical routine, many post-polio patients with chronic respiratory failure are still treated with invasive (i.e. via a tracheostomy) controlled mechanical ventilation (CMV). The aim of the study was to investigate the effect of invasive bi-level positive airway pressure ventilation on the work of breathing compared with that during the patients' ordinary CMV and spontaneous breathing without mechanical support.
  
  
  METHODS
  Nine post-polio patients on invasive (tracheostomy) nocturnal CMV were investigated. Work of breathing was analysed by assessing differences in oxygen consumption (VO2) using indirect calorimetry. Hereby, the oxygen cost of breathing during the various ventilatory modes could be estimated and related to one another. Data on energy expenditure were also obtained.
  
  
  RESULTS
  The oxygen cost of breathing decreased by approximately 15% during bi-level positive airway pressure ventilation compared with CMV and spontaneous breathing. There was no difference between predicted (Harris-Benedict equation) and measured energy expenditure.
  
  
  CONCLUSIONS
  Invasive bi-level positive airway pressure ventilation reduces the oxygen cost of breathing in long-standing tracheostomized post-polio patients, compared with CMV. Furthermore, the Harris-Benedict equation provides a reasonable prediction of energy expenditure in this group of patients.
authors.affiliation: Department of Anesthesiology/Intensive Care, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. hans.barle@ds.se
authors.forename: H
authors.initials: H
authors.lastname: Barle
authors.forename: P
authors.initials: P
authors.lastname: Söderberg
authors.forename: C
authors.initials: C
authors.lastname: Haegerstrand
authors.forename: A
authors.initials: A
authors.lastname: Markström
mesh_terms: D000368:Aged; D002153:Calorimetry, Indirect / Q000379:methods; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D006699:Home Care Services; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology*; D016262:Postpoliomyelitis Syndrome / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*; D013548:Sweden; D013997:Time Factors; D014139:Tracheostomy; D014939:Work of Breathing / Q000502:physiology*