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Respiratory muscle activity and patient–ventilator asynchrony during different settings of noninvasive ventilation in stable hypercapnic COPD: does high inspiratory pressure lead to respiratory muscle unloading?

Authors Duiverman ML, Huberts AS, van Eykern LA, Bladder G, Wijkstra PJ

Received 17 August 2016

Accepted for publication 10 October 2016

Published 11 January 2017 Volume 2017:12 Pages 243—257


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Marieke L Duiverman,1 Anouk S Huberts,2 Leo A van Eykern,3 Gerrie Bladder,1 Peter J Wijkstra1

1Department of Pulmonary Diseases and Home Mechanical Ventilation, University Medical Centre Groningen, 2Faculty of Medical Sciences, University of Groningen, 3Inbiolab B.V., Groningen, the Netherlands

Introduction: High-intensity noninvasive ventilation (NIV) has been shown to improve outcomes in stable chronic obstructive pulmonary disease patients. However, there is insufficient knowledge about whether with this more controlled ventilatory mode optimal respiratory muscle unloading is provided without an increase in patient–ventilator asynchrony (PVA).
Patients and methods: Ten chronic obstructive pulmonary disease patients on home mechanical ventilation were included. Four different ventilatory settings were investigated in each patient in random order, each for 15 min, varying the inspiratory positive airway pressure and backup breathing frequency. With surface electromyography (EMG), activities of the intercostal muscles, diaphragm, and scalene muscles were determined. Furthermore, pressure tracings were derived simultaneously in order to assess PVA.
Compared to spontaneous breathing, the most pronounced decrease in EMG activity was achieved with the high-pressure settings. Adding a high breathing frequency did reduce EMG activity per breath, while the decrease in EMG activity over 1 min was comparable with the high-pressure, low-frequency setting. With high backup breathing frequencies less breaths were pressure supported (25% vs 97%). PVAs occurred more frequently with the low-frequency settings (P=0.017).
High-intensity NIV might provide optimal unloading of respiratory muscles, without undue increases in PVA.

Keywords: electromyography, high-intensity NIV, chronic obstructive pulmonary disease, ineffective efforts

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