Pressure support versus assisted controlled noninvasive ventilation in neuromuscular disease.
BACKGROUND
Noninvasive ventilation (NIV) is being increasingly used in patients with chronic neuromuscular disorders, but the optimal ventilation mode remains unknown. We compared physiological short-term effects of assist/controlled ventilation (ACV) and two pressure-limited modes (pressure-support ventilation [PSV] and assist pressure-controlled ventilation [ACPV]) in patients with neuromuscular disease who needed NIV.


METHODS
Tidal volume was 10 to 12 mL/kg. The ACPV mode used the same respiratory cycle timing as the volume-limited mode. The level of inspiratory support was set to achieve the same tidal volume during the other ventilatory modes.


RESULTS
Thirteen patients with neuromuscular disease who met international criteria for NIV were included. The three ventilatory modes increased alveolar ventilation and decreased respiratory effort indices. However, no difference in breathing or respiratory effort was found among the three modes, with the exception that inspiratory peak flow and percentage of triggered cycles were higher during PSV than volume-limited ventilation. Interestingly, no relationship was observed between subjective patient preference and inspiratory effort indices or percentage of triggered cycles.


CONCLUSIONS
In chronic, stable patients with neuromuscular disease, both noninvasive ACV, ACPV, and PSV had similar effects on alveolar ventilation and respiratory muscle unloading, despite some differences in the pattern of breathing and percentage of triggered cycles.
Chadda
Karim
K
Services de Réanimation Médicale de Physiologie-Explorations Fonctionnelles, Centre d'Innovations Technologiques, Hôpital Raymond Poincaré AP-HP, 92380 Garches, France.
Clair
Bernard
B
Orlikowski
David
D
Macadoux
Gilles
G
Raphael
Jean Claude
JC
Lofaso
Frédéric
F
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008451:Maximal Voluntary Ventilation; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000628:therapy*; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000379:methods*