BACKGROUND: Patients who require home non-invasive ventilation (NIV) during sleep normally have the ventilation settings adjusted empirically during daytime wakefulness. However, patient-ventilator asynchrony may occur during sleep. To detect the incidence of ineffective efforts (IE) during the sleep compared to wakefulness, we studied 48 patients already enrolled in a long-term home NIV programme. METHODS: We evaluated arterial blood gases, breathing pattern during spontaneous breathing (SB) and ventilation during wakefulness. In addition, we assessed the breathing pattern and oxygen gas exchange during night-time NIV. RESULTS: Daytime NIV significantly improved blood gases compared to SB (PaO2 NIV 10.2 +/- 1.95 kPa vs PaO2 SB 8 +/- 1.37, p < 0.001; PaCO2 NIV 5.75 +/- 1.08 kPa, vs PaCO2 SB 6.5 +/- 1.25, p < 0.001). The IE index was higher during sleep compared to wakefulness (48 +/- 39.5 events/h versus 0 +/- 0). The IE index was correlated with the time spent with SaO2 < 90% (r = 0.39, p < 0.01), but not with ventilator parameters, underlying disease, ventilation mode or type of mask. Eight patients had an IE index >100 events/h; these patients had a faster respiratory rate, required a higher level of inspiratory assistance and had poor gas exchange during sleep. CONCLUSIONS: We conclude that IE to breath are common during nocturnal NIV and that they may be associated with desaturations even in patients who are considered compliant and effectively treated.
BACKGROUND:Patients who require home non-invasive ventilation (NIV) during sleep normally have the ventilation settings adjusted empirically during daytime wakefulness. However, patient-ventilator asynchrony may occur during sleep. To detect the incidence of ineffective efforts (IE) during the sleep compared to wakefulness, we studied 48 patients already enrolled in a long-term home NIV programme. METHODS: We evaluated arterial blood gases, breathing pattern during spontaneous breathing (SB) and ventilation during wakefulness. In addition, we assessed the breathing pattern and oxygen gas exchange during night-time NIV. RESULTS: Daytime NIV significantly improved blood gases compared to SB (PaO2 NIV 10.2 +/- 1.95 kPa vs PaO2 SB 8 +/- 1.37, p < 0.001; PaCO2 NIV 5.75 +/- 1.08 kPa, vs PaCO2 SB 6.5 +/- 1.25, p < 0.001). The IE index was higher during sleep compared to wakefulness (48 +/- 39.5 events/h versus 0 +/- 0). The IE index was correlated with the time spent with SaO2 < 90% (r = 0.39, p < 0.01), but not with ventilator parameters, underlying disease, ventilation mode or type of mask. Eight patients had an IE index >100 events/h; these patients had a faster respiratory rate, required a higher level of inspiratory assistance and had poor gas exchange during sleep. CONCLUSIONS: We conclude that IE to breath are common during nocturnal NIV and that they may be associated with desaturations even in patients who are considered compliant and effectively treated.
Authors: Brigitte Fauroux; Karl Leroux; Jean-Louis Pépin; Frédéric Lofaso; Bruno Louis Journal: Intensive Care Med Date: 2010-03-09 Impact factor: 17.440
Authors: Lluís Blanch; Ana Villagra; Bernat Sales; Jaume Montanya; Umberto Lucangelo; Manel Luján; Oscar García-Esquirol; Encarna Chacón; Anna Estruga; Joan C Oliva; Alberto Hernández-Abadia; Guillermo M Albaiceta; Enrique Fernández-Mondejar; Rafael Fernández; Josefina Lopez-Aguilar; Jesús Villar; Gastón Murias; Robert M Kacmarek Journal: Intensive Care Med Date: 2015-02-19 Impact factor: 17.440
Authors: Richard B Berry; Alejandro Chediak; Lee K Brown; Jonathan Finder; David Gozal; Conrad Iber; Clete A Kushida; Timothy Morgenthaler; James A Rowley; Sally L Davidson-Ward Journal: J Clin Sleep Med Date: 2010-10-15 Impact factor: 4.062