title: The use of volume-assured pressure support noninvasive ventilation in acute and chronic respiratory failure: a practical guide and literature review.
abstract: Noninvasive positive pressure ventilation (NPPV) is an important tool in the management of acute and chronic respiratory failure. Traditionally, continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP) have been the most commonly utilized modes for these purposes. Newer hybrid modes of NPPV, such as average volume-assured pressure support (VAPS), combine the properties of both volume- and pressure-controlled NPPV and represent another tool in the treatment of acute and chronic respiratory failure. Evidence demonstrating the superiority of VAPS over BPAP is sparse, but there have been studies that have demonstrated comparable efficacy between the two modes. The use of VAPS in acute hypercapnic respiratory failure has shown better clearance of CO2 compared to BPAP, due to its property of delivering a more assured tidal volume. This, however, did not lead to a decrease in hospital-days or improved mortality, relative to BPAP. The studies evaluating VAPS for chronic respiratory failure involve small sample sizes but have shown some promise. The benefits noted with VAPS, however, did not translate into increased survival, decreased hospitalizations or improved quality of life compared to BPAP. The limited evidence available suggests that VAPS is equally effective in treating acute and chronic respiratory failure compared to BPAP. Overall, the evidence to suggest superiority of one mode over the other is lacking. There is a need for larger studies before firm conclusions can be made.
authors.affiliation: a Internal Medicine , University of Missouri Kansas City , Kansas City , MO , USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Pluym
authors.affiliation: b Department of Pulmonary and Critical Care , University of Missouri Kansas City , Kansas City , MO , USA.
authors.forename: Asad Waseem
authors.initials: AW
authors.lastname: Kabir
authors.affiliation: c Pulmonary and Critical Care Medicine , University of Missouri Kansas City , Kansas City , MO , USA.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Gohar
mesh_terms: D006801:Humans; D006935:Hypercapnia / Q000517:prevention & control; D063087:Noninvasive Ventilation / Q000379:methods* / Q000592:standards; D010102:Oxygen Inhalation Therapy / Q000379:methods* / Q000592:standards; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control; D011175:Positive-Pressure Respiration / Q000379:methods* / Q000592:standards; D012131:Respiratory Insufficiency / Q000628:therapy*
keywords: Acute respiratory failure; Chronic obstructive pulmonary disease; Chronic respiratory failure; Noninvasive ventilation; Obesity hypoventilation syndrome; Volume-assured pressure support; Volume-targeted pressure support