Italian National Research Council, Institute for Biomedical Research and Innovation, Palermo, Italy.
Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases, Villa Sofia-Cervello Hospital, Palermo, Italy.
Respir Care. 2021 Oct;66(10):1593-1600. doi: 10.4187/respcare.09021. Epub 2021 Aug 17.
Comparison of the effects of pressure controlled and volume controlled noninvasive ventilations (NIV) has usually been limited to the degree of improvement in blood gases. We compared sleep quality, abnormal respiratory events, and patient-ventilator asynchronies during administration of pressure controlled continuous mandatory ventilation (PC-CMV) and volume controlled continuous mandatory ventilation (VC-CMV) in subjects with amyotrophic lateral sclerosis naive to NIV after titration aimed at maximally improving nocturnal arterial blood gases.
A crossover evaluation of PC-CMV and VC-CMV was performed in 27 subjects with amyotrophic lateral sclerosis. After baseline polysomnography, ventilators were set in random order so as to warrant similar and satisfactory oxygen saturation and transcutaneous [Formula: see text] in both NIV modalities during day and night. Soon after titration, polysomnography was repeated during administration of each type of NIV.
With respect to the baseline night, non-rapid eye movement 3, and rapid eye movement sleep stages increased, and the arousal index decreased during PC-CMV ( = .005, = .02, and = .01, PC-CMV vs VC-CMV, respectively) but not during VC-CMV. The arousal index during NIV was correlated to the peak pressure delivered by the ventilators (ρ = 0.47, < .001). Few abnormal respiratory events were observed in both NIV modes. Patient-ventilator asynchronies were more frequent during VC-CMV (median [IQR] 20.8 [0.0 - 22.0] vs 31.8 [30.1 - 34.0] no./h, PC-CMV vs VC-CMV; = .002). Twenty-one subjects declared that they preferred PC-CMV therapy.
In the short term, PC-CMV may be a preferred NIV modality to VC-CMV for patients with amyotrophic lateral sclerosis, even when both NIV modes are similarly effective in the correction of hypoventilation. Evaluation of the effectiveness of NIV should not be limited to the assessment of blood gas correction.
压力控制和容量控制无创通气（NIV）的效果比较通常仅限于血气改善程度。我们比较了在经过滴定以最大程度改善夜间动脉血气后，对 NIV 无经验的肌萎缩侧索硬化症患者给予压力控制持续强制通气（PC-CMV）和容量控制持续强制通气（VC-CMV）时的睡眠质量、异常呼吸事件和人机不同步。
对 27 例肌萎缩侧索硬化症患者进行 PC-CMV 和 VC-CMV 的交叉评估。在基线多导睡眠图后，随机设置通气机，以保证两种 NIV 模式在白天和夜间均具有相似且令人满意的氧饱和度和经皮[Formula: see text]。滴定后不久，在每种 NIV 模式下重复进行多导睡眠图检查。
与基线夜间、非快速眼动 3 期和快速眼动睡眠期相比，PC-CMV 时增加，而觉醒指数降低（=.005、=.02 和=.01，PC-CMV 与 VC-CMV 相比），但 VC-CMV 时无变化。NIV 期间的觉醒指数与通气机提供的峰压相关（ρ=0.47， <.001）。两种 NIV 模式下观察到的异常呼吸事件很少。VC-CMV 时人机不同步更频繁（中位数[IQR]20.8[0.0-22.0]与 31.8[30.1-34.0]次/小时，PC-CMV 与 VC-CMV；=.002）。21 例患者表示他们更喜欢 PC-CMV 治疗。
在短期内，即使两种 NIV 模式在纠正通气不足方面同样有效，PC-CMV 也可能是肌萎缩侧索硬化症患者更倾向的 NIV 模式。对 NIV 效果的评估不应仅限于血气纠正的评估。
