title: Volume-Targeted Versus Pressure-Limited Noninvasive Ventilation in Subjects With Acute Hypercapnic Respiratory Failure: A Multicenter Randomized Controlled Trial.
abstract: BACKGROUND
  Volume-targeted noninvasive ventilation (VT-NIV), a hybrid mode that delivers a preset target tidal volume (VT) through the automated adjustment of pressure support, could guarantee a relatively constant target VTover pressure-limited noninvasive ventilation (PL-NIV) with fixed-level pressure support. Whether VT-NIV is more effective in improving ventilatory status in subjects with acute hypercapnic respiratory failure (AHRF) remains unclear. Our aim was to verify whether, in comparison with PL-NIV, VT-NIV would be more effective in correcting hypercapnia, hence reducing the need for intubation and improving survival in subjects with AHRF.
  
  
  METHODS
  We performed a prospective randomized controlled trial in the general respiratory wards of 8 university-affiliated hospitals in China over a 12-month period. Subjects with AHRF, defined as arterial pH <7.35 and ≥7.25 and PaCO2>45 mm Hg, were randomly assigned to undergo PL-NIV or VT-NIV. The primary end point was the decrement of PaCO2from baseline to 6 h after randomization. Secondary end points included the decrement of PaCO2from baseline to 2 h after randomization as well as outcomes of subjects (eg, need for intubation, in-hospital mortality).
  
  
  RESULTS
  A total of 58 subjects were assigned to PL-NIV (29 subjects) or VT-NIV (29 subjects) and included in the analyses. The decrement of PaCO2from baseline to 6 h after randomization was not statistically different between the PL-NIV group and the VT-NIV group (9.3 ± 12.6 mm Hg vs 11.7 ± 12.9 mm Hg, P = .48). There were no differences between the PL-NIV group and the VT-NIV group in the decrement of PaCO2from baseline to 2 h after randomization (6.4 ± 12.7 mm Hg vs 5.0 ± 15.8 mm Hg, P = .71) as well as in the need for intubation (17.2% vs 10.3%, P = .70), and in-hospital mortality (10.3% vs 6.9%, P > .99).
  
  
  CONCLUSIONS
  Regardless of whether a VT- or PL-NIV strategy is employed, it is possible to provide similar support to subjects with AHRF. (ClinicalTrials.gov registration NCT02538263.).
authors: Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. caozhixinicu@126.com ma.yingmin@163.com.
authors: Zhixin
authors: Z
authors: Cao
authors: Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
authors: Zujin
authors: Z
authors: Luo
authors: Department of Respiratory and Critical Care Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
authors: Anna
authors: A
authors: Hou
authors: Department of Respiratory Medicine, Liangxiang Hospital of Beijing Fangshan District, Beijing, China.
authors: Qingrong
authors: Q
authors: Nie
authors: Department of Respiratory Medicine, Liangxiang Hospital of Beijing Fangshan District, Beijing, China.
authors: Baoyuan
authors: B
authors: Xie
authors: Department of Respiratory Medicine, Liangxiang Hospital of Beijing Fangshan District, Beijing, China.
authors: Xiaojie
authors: X
authors: An
authors: Department of Respiratory and Critical Care Medicine, The People's Hospital of Guizhou Province, Guiyang, Guizhou, China.
authors: Zifen
authors: Z
authors: Wan
authors: Department of Respiratory and Critical Care Medicine, The People's Hospital of Guizhou Province, Guiyang, Guizhou, China.
authors: Xianwei
authors: X
authors: Ye
authors: Department of Respiratory and Critical Care Medicine, The People's Hospital of Guizhou Province, Guiyang, Guizhou, China.
authors: Yanju
authors: Y
authors: Xu
authors: Department of Respiratory Medicine, Beijing Shunyi District Hospital, Beijing, China.
authors: Xisheng
authors: X
authors: Chen
authors: Department of Respiratory Medicine, Beijing Shunyi District Hospital, Beijing, China.
authors: Honghai
authors: H
authors: Zhang
authors: Department of Respiratory and Critical Care Medicine, The People's Hospital of Guizhou Province, Guiyang, Guizhou, China.
authors: Zhenyang
authors: Z
authors: Xu
authors: Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
authors: Jinxiang
authors: J
authors: Wang
authors: Department of Respiratory Medicine, Beijing Mentougou District Hospital, Beijing, China.
authors: Fucheng
authors: F
authors: An
authors: Department of Respiratory Medicine, Beijing Mentougou District Hospital, Beijing, China.
authors: Pengfei
authors: P
authors: Li
authors: Department of Respiratory Medicine, Beijing Jingmei Group General Hospital, Beijing, China.
authors: Chunxiao
authors: C
authors: Yu
authors: Department of Respiratory Medicine, Beijing Jingmei Group General Hospital, Beijing, China.
authors: Yandong
authors: Y
authors: Liang
authors: Department of Respiratory Medicine, Daxing Teaching Hospital, Capital Medical University, Beijing, China.
authors: Yongxiang
authors: Y
authors: Zhang
authors: Department of Respiratory Medicine, Daxing Teaching Hospital, Capital Medical University, Beijing, China. caozhixinicu@126.com ma.yingmin@163.com.
authors: Yingmin
authors: Y
authors: Ma
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006935:Hypercapnia / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods* / Q000401:mortality; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D013990:Tidal Volume; D016896:Treatment Outcome
keywords: acute hypercapnic respiratory failure; hypercapnia; noninvasive ventilation; pressure-limited; target tidal volume; volume-targeted