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Interfaces and ventilator settings for long-term noninvasive ventilation in COPD patients

Authors Callegari J, Magnet FS, Taubner S, Berger M, Schwarz SB, Windisch W, Storre JH

Received 8 March 2017

Accepted for publication 15 May 2017

Published 28 June 2017 Volume 2017:12 Pages 1883—1889

DOI https://doi.org/10.2147/COPD.S132170

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Jens Callegari,1 Friederike Sophie Magnet,1 Steven Taubner,1 Melanie Berger,2 Sarah Bettina Schwarz,1 Wolfram Windisch,1 Jan Hendrik Storre3,4

1Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Koeln, Witten/Herdecke University Hospital, 2Department of Pneumology, Malteser Hospital St Hildegardis, Cologne, 3Department of Pneumology, University Medical Hospital, Freiburg, 4Department of Intensive Care, Sleep Medicine and Mechanical Ventilation, Asklepios Fachkliniken Munich-Gauting, Gauting, Germany

Introduction:
The establishment of high-intensity (HI) noninvasive ventilation (NIV) that targets elevated PaCO2 has led to an increase in the use of long-term NIV to treat patients with chronic hypercapnic COPD. However, the role of the ventilation interface, especially in more aggressive ventilation strategies, has not been systematically assessed.
Methods: Ventilator settings and NIV compliance were assessed in this prospective cross-sectional monocentric cohort study of COPD patients with pre-existing NIV. Daytime ­arterialized blood gas analyses and lung function testing were also performed. The primary end point was the distribution among study patients of interfaces (full-face masks [FFMs] vs nasal masks [NMs]) in a real-life setting.
Results: The majority of the 123 patients studied used an FFM (77%), while 23% used an NM. Ventilation settings were as follows: mean ± standard deviation (SD) inspiratory positive airway pressure (IPAP) was 23.2±4.6 mbar and mean ± SD breathing rate was 16.7±2.4/minute. Pressure support ventilation (PSV) mode was used in 52.8% of patients, while assisted pressure-controlled ventilation (aPCV) was used in 47.2% of patients. Higher IPAP levels were associated with an increased use of FFMs (IPAP <21 mbar: 73% vs IPAP >25 mbar: 84%). Mean compliance was 6.5 hours/day, with no differences between FFM (6.4 hours/day) and NM (6.7 hours/day) users. PaCO2 assessment of ventilation quality revealed comparable results among patients with FFMs or NMs.
Conclusion: This real-life trial identified the FFM as the predominantly used interface in COPD patients undergoing long-term NIV. The increased application of FFMs is, therefore, likely to be influenced by higher IPAP levels, which form part of the basis for successful application of HI-NIV in clinical practice.

Keywords: compliance, home mechanical ventilation, interfaces, masks, pressure support, ventilation modes

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Other article by this author:

Capillary PO2 does not adequately reflect arterial PO2 in hypoxemic COPD patients

Magnet FS, Majorski DS, Callegari J, Schwarz SB, Schmoor C, Windisch W, Storre JH

International Journal of Chronic Obstructive Pulmonary Disease 2017, 12:2647-2653

Published Date: 6 September 2017