International Journal of COPD (Jan 2022)
Does the Efficacy of High Intensity Ventilation in Stable COPD Depend on the Ventilator Model? A Bench-to-Bedside Study
Abstract
Cristina Lalmolda,1,2 Pablo Flórez,1 Marta Corral,3 Ana Hernández Voth,3 Carles Grimau,1 Javier Sayas,2 Manel Luján1,2,4 1Pneumology Department, Corporació Sanitària I Universitària Parc Taulí, Sabadell, Barcelona, Spain; 2CIBERES, Centro de Investigación Biomédica en red, Mallorca, Spain; 3Pneumology Department, Hospital 12 de Octubre, Madrid, Spain; 4Universitat Autònoma de Barcelona, Bellaterra, Barcelona, SpainCorrespondence: Manel LujánPneumology Department, Corporació Parc Taulí, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Campus de la UAB, Plaça Cívica, Bellaterra, 08193, Barcelona, SpainTel +34937231010Email [email protected]: 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 Trials.gov: NCT03373175.Keywords: chronic obstructive pulmonary disease, parasternal electromyogram, pressure support, pressure-time product, respiratory muscle unloading, rise time
