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. 2022 Jan 14:17:155-164.
doi: 10.2147/COPD.S327994. eCollection 2022.

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

Cristina Lalmolda  1   2 , Pablo Flórez  1 , Marta Corral  3 , Ana Hernández Voth  3 , Carles Grimau  1 , Javier Sayas  2 , Manel Luján  1   2   4
Affiliations

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

Cristina Lalmolda et al. Int J Chron Obstruct Pulmon Dis. .

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 trialsgov: NCT03373175.

Keywords: chronic obstructive pulmonary disease; parasternal electromyogram; pressure support; pressure-time product; respiratory muscle unloading; rise time.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Setup of the bench test.
Figure 2
Figure 2
Absolute mean value of PTP 300 as a function of the programmed PS level (p <0.01 between ventilator models, general linear model for repeated measures).
Figure 3
Figure 3
Percentage for each ventilator with respect to the ideal PTP 300 (p <0.01 between ventilator models, general linear model for repeated measures).
Figure 4
Figure 4
Absolute mean value of PTP 300 as a function of the programmed PS level, including only cycles with high demand and fastest ramp (p <0.01 between models, general linear model for repeated measures).
Figure 5
Figure 5
Respiratory muscle unloading measured by median maximum value of parasternal EMG (root mean square) for both groups of ventilators (p <0.001 between groups, Mann Whitney U-test). Baseline activity was taken as the reference.
Figure 6
Figure 6
Respiratory muscle unloading measured by median area under the curve of parasternal EMG (root mean square) for both groups of ventilators (p <0.001 between groups, Mann Whitney U-test). Baseline activity was taken as the reference.
See this image and copyright information in PMC

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