• Cenk Kirakli, Tutku Cerci, Zeynep Zeren Ucar, Onur Fevzi Erer, Hakan Alp Bodur, Semra Bilaceroglu, and Serir Aktogu Ozkan.
• Intensive Care Unit, Izmir Training and Research Hospital for Thoracic Medicine and Surgery, Izmir, Turkey. ckirakli@hotmail.com
• Respiration. 2008 Jan 1;75(4):402-10.

BackgroundNoninvasive ventilation (NIV) is being increasingly used in hypercapnic chronic obstructive pulmonary disease (COPD) patients but the most appropriate ventilation mode is still not known.ObjectivesThe aim of this study was to investigate if assisted pressure-controlled ventilation (APCV) can be a better alternative to pressure-support ventilation (PSV) for NIV in COPD patients with acute hypercapnic respiratory failure (AHRF).MethodsIn this prospective randomized study, we evaluated the early effects of noninvasive APCV and PSV in 34 consecutive COPD patients with AHRF. Patients were randomized into 1 of the 2 modes, and respiratory and hemodynamic values were compared before and after 1 h of NIV.ResultsBaseline values did not differ between the 2 groups. There were significant improvements in partial arterial carbon dioxide pressure and pH levels in the APCV group when compared with baseline (p < 0.05). Cardiac output and cardiac index decreased in both groups (p < 0.05) but more significantly in the PSV group (p < 0.0001). The decreases in stroke volume index and increases in arterial oxygen content after NIV were also considerable in both groups (p < 0.05). Central venous pressure and systemic vascular resistance index values increased notably only after PSV (p < 0.05).ConclusionsFrom these data, we deduce that APCV can be a better alternative to PSV for NIV in COPD patients with AHRF owing to its more beneficial physiological effects.(c) 2007 S. Karger AG, Basel.

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