title: Noninvasive proportional assist ventilation and pressure support ventilation during arm elevation in patients with chronic respiratory failure. A preliminary, physiologic study.
abstract: BACKGROUND
  It has been shown that upper limbs activity increases the respiratory workload in patients with chronic respiratory failure (CRF). The object of the present study was to investigate whether, in these patients: (i) noninvasive positive pressure ventilation (NPPV) could sustain the inspiratory muscles to meet the greater ventilatory demand during upper limbs activity with the arm elevation test (AE); (ii) proportional assist ventilation (PAV) might be superior to pressure support ventilation (PSV) during AE, because of its potential more adaptable response to sudden changes in the ventilatory pattern.
  
  
  METHODS
  The study was performed in the pulmonary function laboratory of the Pulmonary Division in Verona General Hospital, Verona, Italy. We studied 8 male patients with CRF due to chronic obstructive pulmonary disease (COPD). Each patient received 2 treatment in random order with a crossover design: spontaneous breathing (SB), SB with AE, either PSV or PAV without and with AE, SB without and with AE, either PSV or PAV without and with AE. We measured: lung function tests, lung mechanics, ventilatory pattern and diaphragmatic effort (pressure time product, PTP(di)).
  
  
  RESULTS
  (i) AE increases minute ventilation (+14%) and PTP(di) (+64%); (ii) ventilatory support, both with PSV and PAV unloads the diaphragm both at rest (PTP(di) -77% and -54%, respectively) and during arm elevation (PTP(di) -54% and -44%, respectively).
  
  
  CONCLUSIONS
  PAV and PSV unloads the diaphragm in patients with CRF due to COPD both during SB and AE; PAV can be more efficient than PSV in assisting the diaphragm during AE in producing a greater level of minute ventilation for a similar rise in PTP(di) compared to PSV. Noninvasive ventilatory support should be considered in rehabilitation programs for training of upper limbs activity.
authors.affiliation: Respiratory Division, Ospedali Riuniti, L.go Barozzi, 1, 24128 Bergamo, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Poggi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Appendini
authors.forename: Guido
authors.initials: G
authors.lastname: Polese
authors.forename: Roberto
authors.initials: R
authors.lastname: Colombo
authors.forename: Claudio F
authors.initials: CF
authors.lastname: Donner
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001132:Arm; D018592:Cross-Over Studies; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011187:Posture; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D012123:Pulmonary Ventilation; D012129:Respiratory Function Tests; D012132:Respiratory Muscles / Q000503:physiopathology; D014939:Work of Breathing