智能容量保证压力支持通气（iVAPS）自动滴定与固定 EPAP 治疗 COPD 合并高碳酸血症呼吸衰竭患者的比较。

Auto-titrating versus fixed-EPAP intelligent volume-assured pressure support (iVAPS) ventilation in patients with COPD and hypercapnic respiratory failure.

机构信息

Department of Chest Diseases, Faculty of Medicine, Assuit University, Egypt.

出版信息

Adv Respir Med. 2021;89(3):277-283. doi: 10.5603/ARM.a2021.0056.

DOI:10.5603/ARM.a2021.0056

PMID:34196380

Abstract

BACKGROUND

Intelligent volume-assured pressure support (iVAPS) is a new noninvasive ventilation (NIV) mode that can automatically adjust pressure support to deliver effective ventilation. Our aim was to compare treatment efficacy and level of satisfaction between auto-titrating expiratory positive airway pressure (auto-EPAP) and fixed expiratory positive airway pressure (fixed-EPAP) during iVAPS treatment in stable hypercapnic chronic obstructive pulmonary disease (COPD) patients.

MATERIAL AND METHODS

In this prospective single-blinded, randomized study, 50 patients with chronic stable hypercapnia (COPD) who met the study criteria were randomized into a group I treated with auto-EPAP and a group II who received fixed-EPAP during iVAPS treatment for 5 consecutive days. The patients' characteristics, arterial blood gases, and lung function test were recorded. Numeric rating scale (NRS), dyspnea and comfort scale were obtained. The study subjects were evaluated and followed up after initiating therapy for 5 consecutive days. Outcome measures were recorded at baseline (T0) and after three (T1) and five (T2) days of each consecutive period All parameters were collected and statistically analyzed.

RESULT

No significant differences were found regarding age, sex, or BMI between the both groups. It was noted that daytime PaCO2 decreased significantly over the follow-up period in the group I patients treated with auto-EPAP as compared with fixed-EPAP. Regarding the patient comfort and dyspnea during iVAPS treatment, dyspnea sensation was significantly lower with auto-EPAP 7.9 ± 1.8 (T0) vs 3.5 ± 1.1 (T2), p = 0.001 and fixed-EPAP 7.7 ± 1.9 (T0) vs 3.4 ± 1.6 (T2), p = 0.001, but no significance was reached between the both groups. However, auto-EPAP demonstrated significant improvement in comfort when compared with fixed-EPAP modality. However, the overall satisfaction of the patients receiving auto-EPAP modality was significantly increased. Mean tidal volume tended to be higher in auto-EPAP 698 ± 213 mL compared with 628 ± 178 mL in fixed-EPAP (p = 0.001). The air leak was significantly lower in auto-adjusting mode (2.5 ± 1.3 vs 3.7 ± 2.2 L/ min) in fixed-EPAP modality.

CONCLUSION

Auto-titrating NIV mode may provide additional benefit in decreasing PaCO2 more efficiently and improve patient comfort and satisfaction.

摘要

背景

智能容量保证压力支持（iVAPS）是一种新的无创通气（NIV）模式，可自动调整压力支持以提供有效通气。我们的目的是比较在稳定的高碳酸血症慢性阻塞性肺疾病（COPD）患者中使用智能容量保证压力支持（iVAPS）治疗时，自动滴定呼气末正压（auto-EPAP）和固定呼气末正压（fixed-EPAP）的治疗效果和满意度。

材料和方法

在这项前瞻性、单盲、随机研究中，将符合研究标准的 50 例慢性稳定期高碳酸血症（COPD）患者随机分为 I 组，接受自动滴定 EPAP 治疗，II 组在 iVAPS 治疗期间接受固定 EPAP 治疗，连续 5 天。记录患者的一般特征、动脉血气和肺功能检查。采用数字评分量表（NRS）、呼吸困难和舒适度量表进行评估。在连续 5 天治疗开始后对研究对象进行评估和随访。记录基线（T0）、第 3 天（T1）和第 5 天（T2）的所有参数，并进行统计学分析。

结果

两组患者在年龄、性别或 BMI 方面无显著差异。与固定-EPAP 相比，接受自动-EPAP 治疗的 I 组患者白天 PaCO2 在随访期间显著降低。关于 iVAPS 治疗期间患者的舒适度和呼吸困难，自动-EPAP 组的呼吸困难感觉明显低于固定-EPAP 组，分别为 7.9±1.8（T0）和 3.5±1.1（T2），p=0.001，7.7±1.9（T0）和 3.4±1.6（T2），p=0.001，但两组之间无显著差异。然而，自动-EPAP 组在舒适度方面有显著改善。然而，接受自动-EPAP 模式的患者的整体满意度显著增加。与固定-EPAP 模式相比，自动-EPAP 组的平均潮气量（698±213mL）较高（628±178mL），差异有统计学意义（p=0.001）。自动调节模式的空气泄漏（2.5±1.3L/min）明显低于固定调节模式（3.7±2.2L/min）。