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Abstract
Background: High-intensity noninvasive positive pressure ventilation (HI-NPPV) is an effective treatment option in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD). However, the effect of HI-NPPV compared with spontaneous breathing (SB) on minute ventilation (MV) in patients receiving long-term treatment remains to be determined. This study compared MV during HI-NPPV and SB. In addition, the ability of intelligent volume assured pressure support (iVAPS) to increase MV to the same extent as HI-NPPV was determined. Methods: Daytime pneumotachographic measurements were performed during SB, HI-NPPV and iVAPS. Results: Twenty-seven stable hypercapnic COPD patients (mean FEV1 34 ± 15% predicted) who had been treated with HI-NPPV for a median of 22 months (interquartile range 8.5–84 months) were enrolled. Mean MV was 9.5 ± 1.7 L/min during SB and 12.1 ± 2.8 L/min during HI-NPPV, an increase of 2.5 L/min (95% CI [1.5–3.6] p < 0.001), or 26%. MV during iVAPS was 11.7 ± 3.6 L/min, an increase of 1.8 L/min (95%CI [0.7–3.0], p = 0.003) compared with SB. There was no difference in MV between HI-NPPV and iVAPS (p = 0.25). Conclusion: Long-term HI-NPPV increased MV by an average of 26% compared with SB in stable hypercapnic COPD patients. A similar increase in MV was observed during use of iVAPS.
Acknowledgments
The study was supported by an unrestricted research grant from ResMed Ltd., Sydney. The study devices were provided by ResMed GmbH& Co KG, Martinsried, Germany. The authors state that the sponsor had no input into the study design, results or interpretation, or manuscript preparation.
English language editing assistance was provided by Nicola Ryan. This assistance was funded by Resmed.