在肌萎缩侧索硬化症中，压力支持和容量保证压力支持的呼吸模式和潮气量不同。
Respiratory Pattern and Tidal Volumes Differ for Pressure Support and Volume-assured Pressure Support in Amyotrophic Lateral Sclerosis.
机构信息
1 Division of Pulmonary and Critical Care Medicine and.
2 Division of Neuromuscular Medicine, Ken and Ruth Davee Department of Neurology and Clinical Neurosciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
出版信息
Ann Am Thorac Soc. 2017 Jul;14(7):1139-1146. doi: 10.1513/AnnalsATS.201605-346OC.
RATIONALE
Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease resulting in respiratory failure and death. Use of noninvasive ventilation (NIV) improves survival. However, use of volume-assured pressure support (VAPS) has not been extensively studied in ALS.
OBJECTIVES
To explore the clinical usefulness of a detailed evaluation of device-recorded NIV data in the management of chronic respiratory failure in ALS, and to determine whether there are differences in efficacy between patients using VAPS or PS.
METHODS
We performed a retrospective chart review of 271 patients with ALS using either PS or VAPS, along with an evaluation of device-recorded data to explore differences in attainment of goal tidal volumes (Vt) and ratio of respiratory rate to tidal volume (f/Vt), in addition to triggering and cycling ability.
RESULTS
Two hundred and fifteen patients were using PS, while 56 were using VAPS. There were no significant differences in demographic data, symptoms, pulmonary function, or patient compliance. Compared with VAPS, achieved Vt was significantly lower for PS while f/Vt was significantly higher. Percent spontaneous triggering was relatively preserved in both cohorts, whereas percent spontaneous cycling was considerably decreased in both. Furthermore, there was no association found between spontaneous triggering or cycling, and pulmonary function, indicating the presence of low spontaneous breath cycling or triggering ability is difficult to predict.
CONCLUSIONS
Examination of device data for exhaled tidal volumes and f/Vt may be of use in evaluating efficacy of NIV in ALS. VAPS provides more reliable goal Vt than does PS, and is associated with decreased f/Vt. Spontaneous cycling is decreased in ALS despite preservation of triggering ability. Although a set backup rate may address decreased triggering, perhaps more importantly, setting a sufficient fixed inspiratory time would address the issue of decreased cycling.
背景
肌萎缩侧索硬化症（ALS）是一种进行性神经肌肉疾病，可导致呼吸衰竭和死亡。使用无创通气（NIV）可提高生存率。但是，在 ALS 中，尚未广泛研究使用容量保证压力支持（VAPS）。
目的
探索详细评估设备记录的 NIV 数据在 ALS 慢性呼吸衰竭管理中的临床实用性，并确定使用 VAPS 或 PS 的患者在疗效上是否存在差异。
方法
我们对 271 例使用 PS 或 VAPS 的 ALS 患者进行了回顾性图表审查，并对设备记录的数据进行了评估，以探讨目标潮气量（Vt）和呼吸频率与潮气量之比（f/Vt）的达成差异，以及触发和循环能力。
结果
215 例患者使用 PS，56 例患者使用 VAPS。两组患者的人口统计学数据、症状、肺功能或患者依从性均无显著差异。与 VAPS 相比，PS 的实际 Vt 明显较低，而 f/Vt 明显较高。自发触发的百分比在两个队列中相对保留，而自发循环的百分比在两个队列中都显著降低。此外，自发触发或循环与肺功能之间没有发现关联，表明低自发呼吸循环或触发能力难以预测。
结论
检查设备数据中的呼出潮气量和 f/Vt 可能有助于评估 ALS 中 NIV 的疗效。VAPS 比 PS 提供更可靠的目标 Vt，并且与降低的 f/Vt 相关。尽管触发能力得以保留，但 ALS 中的自发循环仍减少。尽管设置备用频率可能会解决触发减少的问题，但更重要的是，设置足够的固定吸气时间将解决循环减少的问题。
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