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. 2002 Jan;57(1):50–54. doi: 10.1136/thorax.57.1.50

Non-invasive proportional assist and pressure support ventilation in patients with cystic fibrosis and chronic respiratory failure

A Serra 1, G Polese 1, C Braggion 1, A Rossi 1
PMCID: PMC1746175  PMID: 11809990

Abstract

Background: Patients with advanced cystic fibrosis can benefit from non-invasive positive pressure ventilation (NPPV) for the treatment of acute decompensation as well as for the management of chronic respiratory failure. This study was undertaken to compare the physiological effects of non-invasive proportional assist ventilation (PAV) and pressure support ventilation (PSV) on ventilatory pattern, transcutaneous blood gas tensions, and diaphragmatic effort in stable patients with cystic fibrosis and chronic CO2 retention.

Methods: In 12 patients two periods of spontaneous breathing were followed randomly by PSV (12 (3) cm H2O) and PAV (flow assist 4.9 (1.3) cm H2O/l.s, volume assist 18.9 (5.1) cm H2O/l) set for the patient's comfort and administered for 40 minutes with 2 cm H2O continuous positive airway pressure. Ventilatory pattern, transcutaneous blood gas tensions, and surface diaphragmatic electromyography were measured in the last 10 minutes of each application.

Results: On average, both PSV and PAV improved ventilation (+30%), tidal volume (+30%), and transcutaneous CO2 (-7%) while reducing diaphragmatic activity (-30% with PSV, -20% with PAV). Mean inspiratory airway pressure was lower during PAV than during PSV (9.7 (1.9) and 12.9 (2.7) cm H2O, respectively; p<0.05). The mean coefficient of variation of tidal volume was about 20% (range 11–39%) during spontaneous breathing and did not change with either PAV or PSV.

Conclusions: These results show that short term administration of nasal PAV and PSV to patients with stable cystic fibrosis with chronic respiratory insufficiency is well tolerated, improves ventilation and blood gas tensions, and unloads the diaphragm.

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Selected References

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  1. Ambrosino N. Apples and oranges. Comparing different modalities of mechanical ventilation. Intensive Care Med. 1999 Aug;25(8):775–777. doi: 10.1007/s001340050951. [DOI] [PubMed] [Google Scholar]
  2. Ambrosino N., Vitacca M., Polese G., Pagani M., Foglio K., Rossi A. Short-term effects of nasal proportional assist ventilation in patients with chronic hypercapnic respiratory insufficiency. Eur Respir J. 1997 Dec;10(12):2829–2834. doi: 10.1183/09031936.97.10122829. [DOI] [PubMed] [Google Scholar]
  3. Caronia C. G., Silver P., Nimkoff L., Gorvoy J., Quinn C., Sagy M. Use of bilevel positive airway pressure (BIPAP) in end-stage patients with cystic fibrosis awaiting lung transplantation. Clin Pediatr (Phila) 1998 Sep;37(9):555–559. doi: 10.1177/000992289803700906. [DOI] [PubMed] [Google Scholar]
  4. Diaz O., Iglesia R., Ferrer M., Zavala E., Santos C., Wagner P. D., Roca J., Rodriguez-Roisin R. Effects of noninvasive ventilation on pulmonary gas exchange and hemodynamics during acute hypercapnic exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1997 Dec;156(6):1840–1845. doi: 10.1164/ajrccm.156.6.9701027. [DOI] [PubMed] [Google Scholar]
  5. Ferguson G. T., Gilmartin M. CO2 rebreathing during BiPAP ventilatory assistance. Am J Respir Crit Care Med. 1995 Apr;151(4):1126–1135. doi: 10.1164/ajrccm/151.4.1126. [DOI] [PubMed] [Google Scholar]
  6. Giannouli E., Webster K., Roberts D., Younes M. Response of ventilator-dependent patients to different levels of pressure support and proportional assist. Am J Respir Crit Care Med. 1999 Jun;159(6):1716–1725. doi: 10.1164/ajrccm.159.6.9704025. [DOI] [PubMed] [Google Scholar]
  7. Gozal D. Nocturnal ventilatory support in patients with cystic fibrosis: comparison with supplemental oxygen. Eur Respir J. 1997 Sep;10(9):1999–2003. doi: 10.1183/09031936.97.10091999. [DOI] [PubMed] [Google Scholar]
  8. Granton J. T., Kesten S. The acute effects of nasal positive pressure ventilation in patients with advanced cystic fibrosis. Chest. 1998 Apr;113(4):1013–1018. doi: 10.1378/chest.113.4.1013. [DOI] [PubMed] [Google Scholar]
  9. Grasso S., Puntillo F., Mascia L., Ancona G., Fiore T., Bruno F., Slutsky A. S., Ranieri V. M. Compensation for increase in respiratory workload during mechanical ventilation. Pressure-support versus proportional-assist ventilation. Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):819–826. doi: 10.1164/ajrccm.161.3.9902065. [DOI] [PubMed] [Google Scholar]
  10. Haworth C. S., Dodd M. E., Atkins M., Woodcock A. A., Webb A. K. Pneumothorax in adults with cystic fibrosis dependent on nasal intermittent positive pressure ventilation (NIPPV): a management dilemma. Thorax. 2000 Jul;55(7):620–622. doi: 10.1136/thorax.55.7.620. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hill A. T., Edenborough F. P., Cayton R. M., Stableforth D. E. Long-term nasal intermittent positive pressure ventilation in patients with cystic fibrosis and hypercapnic respiratory failure (1991-1996). Respir Med. 1998 Mar;92(3):523–526. doi: 10.1016/s0954-6111(98)90302-x. [DOI] [PubMed] [Google Scholar]
  12. Hodson M. E., Madden B. P., Steven M. H., Tsang V. T., Yacoub M. H. Non-invasive mechanical ventilation for cystic fibrosis patients--a potential bridge to transplantation. Eur Respir J. 1991 May;4(5):524–527. [PubMed] [Google Scholar]
  13. Parthasarathy S., Jubran A., Tobin M. J. Cycling of inspiratory and expiratory muscle groups with the ventilator in airflow limitation. Am J Respir Crit Care Med. 1998 Nov;158(5 Pt 1):1471–1478. doi: 10.1164/ajrccm.158.5.9802014. [DOI] [PubMed] [Google Scholar]
  14. Patrick W., Webster K., Ludwig L., Roberts D., Wiebe P., Younes M. Noninvasive positive-pressure ventilation in acute respiratory distress without prior chronic respiratory failure. Am J Respir Crit Care Med. 1996 Mar;153(3):1005–1011. doi: 10.1164/ajrccm.153.3.8630538. [DOI] [PubMed] [Google Scholar]
  15. Piper A. J., Parker S., Torzillo P. J., Sullivan C. E., Bye P. T. Nocturnal nasal IPPV stabilizes patients with cystic fibrosis and hypercapnic respiratory failure. Chest. 1992 Sep;102(3):846–850. doi: 10.1378/chest.102.3.846. [DOI] [PubMed] [Google Scholar]
  16. Polese G., Vitacca M., Bianchi L., Rossi A., Ambrosino N. Nasal proportional assist ventilation unloads the inspiratory muscles of stable patients with hypercapnia due to COPD. Eur Respir J. 2000 Sep;16(3):491–498. doi: 10.1034/j.1399-3003.2000.016003491.x. [DOI] [PubMed] [Google Scholar]
  17. Pradal U., Polese G., Braggion C., Poggi R., Zanolla L., Mastella G., Rossi A. Determinants of maximal transdiaphragmatic pressure in adults with cystic fibrosis. Am J Respir Crit Care Med. 1994 Jul;150(1):167–173. doi: 10.1164/ajrccm.150.1.8025744. [DOI] [PubMed] [Google Scholar]
  18. Ranieri V. M., Giuliani R., Mascia L., Grasso S., Petruzzelli V., Puntillo N., Perchiazzi G., Fiore T., Brienza A. Patient-ventilator interaction during acute hypercapnia: pressure-support vs. proportional-assist ventilation. J Appl Physiol (1985) 1996 Jul;81(1):426–436. doi: 10.1152/jappl.1996.81.1.426. [DOI] [PubMed] [Google Scholar]
  19. Vitacca M., Clini E., Pagani M., Bianchi L., Rossi A., Ambrosino N. Physiologic effects of early administered mask proportional assist ventilation in patients with chronic obstructive pulmonary disease and acute respiratory failure. Crit Care Med. 2000 Jun;28(6):1791–1797. doi: 10.1097/00003246-200006000-00016. [DOI] [PubMed] [Google Scholar]
  20. Wrigge H., Golisch W., Zinserling J., Sydow M., Almeling G., Burchardi H. Proportional assist versus pressure support ventilation: effects on breathing pattern and respiratory work of patients with chronic obstructive pulmonary disease. Intensive Care Med. 1999 Aug;25(8):790–798. doi: 10.1007/s001340050954. [DOI] [PubMed] [Google Scholar]

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