Abstract
The aim of this short-term, single-blind, randomized, crossover study was to evaluate night-time efficacy of and compliance and physiological responses to Average Volume Assured Pressure Support (AVAPS) versus Pressure Support (PS) ventilation. AVAPS or PS ventilation was delivered to nine stable hypercapnic COPD patients via a mask over two 5-day periods during consecutive weeks. The Synchrony® ventilator was used to deliver mask ventilation as follows: 8 ml/kg of ideal body weight (as the targeted inspiratory tidal volume) with IPAP ranging from EPAP up to 30 cmH2O for AVAPS, and the patient’s highest tolerated IPAP level for PS. EPAP was set at the minimum level for both modalities and oxygen was added at a fixed inspiratory fraction to maintain SaO2 above 90%. Arterial blood gases, comfort (by VAS), and perceived sleep efficiency (SE by questionnaire) were measured at baseline (T0) and after three (T1) and five (T2) nights over the two periods. Compliance to ventilation, as measured by mean usage (hours/night), was also recorded. Measurements were similar between the two treatment periods at baseline. PaCO2 and comfort VAS similarly improved for both modalities, whereas the SE score significantly improved at T2 with AVAPS (from 5.1 ± 2.0 to 4.1 ± 2.2, P = 0.001) but not with PS (from 5.1 ± 1.7 to 4.7 ± 1.3, P = 0.219). No difference in mean usage was found between the two modalities. Mask AVAPS is as comfortable and effective as PS at reducing respiratory acidosis but produces better perceived sleep efficiency in stable hypercapnic COPD patients.
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Acknowledgment
This study was supported by an unrestricted grant from Philips-Respironics Inc. We thank Mr. Steven Coughlin, PhD (Clinical Research Manager, EAME International Group), Mr. Bill Gaussa (Director Global Product Manager, Home Respiratory Care Division), and Mrs. Delphine Leboulanger (Prodict Manager, International Division) for their support by granting our proposal and approving the study in its final version.
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An erratum to this article can be found at http://dx.doi.org/10.1007/s00408-009-9194-y
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Crisafulli, E., Manni, G., Kidonias, M. et al. Subjective Sleep Quality During Average Volume Assured Pressure Support (AVAPS) Ventilation in Patients with Hypercapnic COPD: A Physiological Pilot Study. Lung 187, 299–305 (2009). https://doi.org/10.1007/s00408-009-9167-1
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DOI: https://doi.org/10.1007/s00408-009-9167-1