• Respiratory medicine · Oct 2014

    Randomized Controlled Trial

    Volume assured versus pressure preset non-invasive ventilation for compensated ventilatory failure in COPD.

    • Nicholas S Oscroft, Rebecca Chadwick, Michael G Davies, Timothy G Quinnell, and Ian E Smith.
    • Respiratory Support & Sleep Centre, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridgeshire CB23 3RE, United Kingdom. Electronic address: nicholas.oscroft@papworth.nhs.uk.
    • Respir Med. 2014 Oct 1;108(10):1508-15.

    BackgroundThe addition of domiciliary non-invasive ventilation (NIV) to standard therapy in chronic obstructive pulmonary disease (COPD) patients with compensated ventilatory failure (CVF) is reported to have beneficial effects. Compliance with NIV is an important factor. Volume assured NIV (va-NIV) may improve compliance and ventilation during sleep by automatically titrating ventilatory pressures.MethodsA prospective single centre, randomised, parallel group trial comparing va-NIV and pressure preset NIV (pp-NIV) in COPD patients with CVF naïve to domiciliary NIV was performed (ISCRTN91892415). The primary outcomes were arterial blood gases, mean overnight oximetry (mSpO2) and compliance after three months. Secondary outcomes included pulmonary function, exercise capacity and health-related quality of life assessment.ResultsForty patients were randomised in a 1:1 ratio. The va-NIV median target minute ventilation was 8.4 L/min and pp-NIV median inspiratory pressure was 28 cmH2O. There were no significant differences between groups in primary or secondary outcomes after three months. Mean (SD) PaO2 8.7 (1.7) versus 7.9 (1.7) kPa (p = 0.19), PaCO2 6.7 (0.5) versus 7.3 (1.1) kPa (p = 0.1), mSpO2 89.7 (4.2) versus 89.8 (3.9) % (p = 0.95), compliance 5.0 (3.1) versus 4.7 (3.2) hours (p = 0.8) in va-NIV versus pp-NIV respectively. Patients allocated va-NIV spent fewer days in hospital initiating therapy 3.3 (1.6) versus 5.2 (2.8) (p = 0.02). Both groups showed significant improvements in PaCO2 and mSpO2 after three months treatment.ConclusionsDomiciliary va-NIV and pp-NIV have similar effects on physiological outcomes in COPD patients with CVF and both are well tolerated.Copyright © 2014 Elsevier Ltd. All rights reserved.

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