Spontaneous-timed versus controlled noninvasive ventilation in chronic hypercapnia – a crossover trial
Authors Kerl J, Höhn E, Köhler D, Dellweg D
Received 14 October 2018
Accepted for publication 18 February 2019
Published 8 May 2019 Volume 2019:12 Pages 173—181
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Jens Kerl, Ekkehard Höhn, Dieter Köhler, Dominic Dellweg
Department for Pulmonary Medicine, Intensive Care Medicine and Sleep Medicine, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg, 57392, Germany
Background: There is an ongoing debate about optimal ventilator modes and settings during noninvasive ventilation (NIV).
Objectives: To compare the effect of spontaneous-timed (ST) and controlled NIV on carbon dioxide reduction in patients suffering from chronic hypercapnia.
Methods: Night and daytime blood gas analysis, lung function tests and 6 minute walking distance tests (6MWD) were done before and after every 6-week treatment.
Results: This randomized prospective crossover trial included 42 patients. Pooled data analysis showed a decrease of nocturnal CO2 from 54.8±5.9 mmHg to 41.6±5.5 mmHg during ST ventilation (p<0.01) and from 56.2±7.5 mmHg to 42.7±5.4 mmHg during controlled NIV (p<0.01) with no difference between treatment forms (p=0.30). Daytime CO2 levels decreased from 49.3±5.5 mmHg to 45.6±4.5 mmHg when spontaneous timed ventilation was applied (p<0.01) and from 52.2±6.8 mmHg to 44.9±21114.4 mmHg in case of controlled ventilation (p<0.01) The amount of CO2 reduction was 3.8±5.6 mmHg after ST mode and 7.3±6.8 mmHg controlled ventilation (p<0.05). Nocturnal ventilator use was 5.7±2.1 and 6.7±2.3 hours for ST and controlled ventilation respectively (p=0.02). There was no effect on walking distance and lung function.
Conclusion: Controlled NIV showed improved compliance compared to ST ventilation. We observed similar CO2 reductions during nocturnal ventilation, however controlled ventilation achieved a higher reduction of daytime CO2 levels.
Keywords: noninvasive mechanical ventilation, clinical trials, respiratory failure, reversible hypercapnia, ventilator mode, controlled ventilation
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]