title: Home mechanical ventilation for COPD: high-intensity versus target volume noninvasive ventilation.
abstract: BACKGROUND
  High-intensity noninvasive ventilation (HI-NIV) is the most effective means of improving several physiological and clinical parameters in subjects with chronic hypercapnic COPD. Whether the newer hybrid mode using target tidal volume noninvasive ventilation (target V(T) NIV) provides additional benefits remains unclear.
  
  
  METHODS
  Subjects with COPD successfully established on long-term HI-NIV were switched to target V(T) NIV. Optimal target V(T) settings according to nocturnal transcutaneous P(CO2) measurements were achieved following a randomized crossover trial using 8 mL/kg ideal body weight and 110% of individual V(T) during HI-NIV, respectively. The following parameters were compared at the beginning of the trial while subjects were on HI-NIV, and after 3 months on optimal target V(T) NIV: sleep quality by polysomnography, overnight gas exchange, subjects' tolerance, overnight pneumotachygraphic measurements during NIV, health-related quality of life (severe respiratory insufficiency questionnaire), exercise capacity (6-min walk test), and lung function.
  
  
  RESULTS
  Ten of 14 subjects completed the study. There were no differences between HI-NIV and target V(T) NIV in any of the above-mentioned parameters. Specifically, the mean overnight transcutaneous P(CO2) was equivalent under each form of ventilation (both 45 ± 5 mm Hg, P = .75).
  
  
  CONCLUSIONS
  Switching subjects from well-established HI-NIV to target V(T) NIV shows no clinical benefits in chronic hypercapnic COPD. In particular, sleep quality, the control of nocturnal hypoventilation, daytime hypercapnia, overnight ventilation patterns, subjects' tolerance, health-related quality of life, lung function, and exercise capability were all similar in subjects who underwent HI-NIV and target V(T) NIV. Nevertheless, target V(T) NIV might offer some physiological advantages in breathing pattern and might be beneficial in some individual patients. (German Clinical Trials Register [www.drks.de] Registration DRKS00000450.).
authors: Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne Department of Pneumology, University Hospital Freiburg, Freiburg storrej@kliniken-koeln.de.
authors: Jan H
authors: JH
authors: Storre
authors: Department of Pneumology, University Hospital Freiburg, Freiburg Department of Internal Medicine, Klinikum Nuremberg Nord, Nuremberg.
authors: Elena
authors: E
authors: Matrosovich
authors: Department of Pneumology, University Hospital Freiburg, Freiburg.
authors: Emelie
authors: E
authors: Ekkernkamp
authors: Department of Pneumology, University Hospital Freiburg, Freiburg.
authors: David J
authors: DJ
authors: Walker
authors: Clinical Trials Unit, University Medical Center, Freiburg.
authors: Claudia
authors: C
authors: Schmoor
authors: Department of Pneumology, University Hospital Freiburg, Freiburg Department of Cardiology, Pneumology, and Vascular Medicine, University Hospital, Aachen, Germany.
authors: Michael
authors: M
authors: Dreher
authors: Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne Department of Pneumology, University Hospital Freiburg, Freiburg.
authors: Wolfram
authors: W
authors: Windisch
mesh_terms: D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D018592:Cross-Over Studies; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006699:Home Care Services; D006801:Humans; D006935:Hypercapnia / Q000097:blood / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods*; D010313:Partial Pressure; D017286:Polysomnography; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D011659:Pulmonary Gas Exchange; D011788:Quality of Life; D012890:Sleep / Q000502:physiology*; D013990:Tidal Volume; D016138:Walking / Q000502:physiology
chemical_list: D002245:Carbon Dioxide
keywords: Chronic obstructive pulmonary disease; mechanical ventilation; sleep quality; target volume; ventilation mode