Does the Efficacy of High Intensity Ventilation in Stable COPD Depend on the Ventilator Model? A Bench-to-Bedside Study

Abstract

Purpose

The European Task Force for chronic non-invasive ventilation in stable COPD recommends the use of high pressure-support (PS) level to maximize the decrease in PaCO2. It is possible that the ventilator model can influence the need for higher or lower pressure levels.

Research Question

To determine the differences between ventilators in a bench model with an increased inspiratory demand; and to compare the degree of muscular unloading measured by parasternal electromyogram (EMGpara) provided by the different ventilators in real patients with stable COPD.

Patients and Methods

Bench: four levels of increasing progressive effort were programmed. The response of nine ventilators to four levels of PS and EPAP of 5 cm H2O was studied. The pressure-time product was determined at 300 and 500 msec (PTP 300/500).

Clinical Study

The ventilators were divided into two groups, based on the result of the bench test. Severe COPD patients with non-invasive ventilation (NIV) were studied, randomly comparing the performance of one ventilator from each group. Muscle unloading was measured by the decrease in EMGpara from its baseline value.

Results

There were significant differences in PTP 300 and PTP 500 in the bench study. Based on these results, home ventilators were classified into two groups; group 1 included four models with higher PTP 300. Ten COPD patients were recruited for the clinical study. Group 1 ventilators showed greater muscle unloading at the same PS than group 2.

Conclusion

The scale of pressure support in NIV for high intensity ventilation may be influenced by the ventilator model.

Clinical Trials.gov

NCT03373175.

Keywords:

• chronic obstructive pulmonary disease
• parasternal electromyogram
• pressure support
• pressure-time product
• respiratory muscle unloading
• rise time

Data Sharing Statement

Data of the clinical and bench study, including database and tracings will be available upon request for six months from the publication date. The authors with access to the data were: Cristina Lalmolda, [email protected]; Javier Sayas, [email protected].

Disclosure

Dr Javier Sayas reports personal fees, non-financial support from Resmed, Philips Respironics, grants from Menarini, non-financial support from Breas, during the conduct of the study. The authors report no other conflicts of interest in this work.