Olivier Contal1, Dan Adler2, Jean-Christian Borel3, Fabrice Espa4, Stephen Perrig4, Daniel Rodenstein5, Jean-Louis Pépin6, Jean-Paul Janssens2. 1. Division of Pulmonary Diseases, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland. Electronic address: olivier.contal@hcuge.ch. 2. Division of Pulmonary Diseases, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland. 3. AGIR a dom, Recherche et Développement, Meylan, France. 4. Sleep Laboratory, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland. 5. Service de pneumologie et Centre de médecine du sommeil, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium. 6. Sleep Laboratory, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Institut National de la Santé et de la Recherche Médical, University Hospital, Grenoble, France; Service de pneumologie et Centre de médecine du sommeil, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium.
Abstract
BACKGROUND:Unintentional leaks, patient-ventilatory asynchrony, and obstructive or central events (either residual or induced by noninvasive positive pressure ventilation [NPPV]) occur in patients treated withNPPV, but the impact of ventilator settings on these disturbances has been little explored. The objective of this study was to investigate the impact of backup respiratory rate (BURR) settings on the efficacy of ventilation, sleep structure, subjective sleep quality, and respiratory events in a group of patients with obesity hypoventilation syndrome (OHS). METHODS:Ten stable patients with OHS treated with long-term nocturnal NPPV underwentpolysomnographic recordings and transcutaneous capnography on 3 consecutive nights with three different settings for BURR in random order: spontaneous (S) mode, low BURR, and high BURR. No other ventilator parameter was modified. RESULTS: The S mode was associated with the occurrence of a highly significant increase in respiratory events, mainly of central and mixed origin, when compared with both spontaneous/timed (S/T) modes. Accordingly, the oxygen desaturation index was significantly higher in the S mode than in either of the S/T modes. The results of nocturnal transcutaneous P(CO(2)) (Ptc(CO(2))) (mean value and time spent with Ptc(CO(2)) > 50 mm Hg) were similar over the three consecutive nocturnal recordings. The quality of sleep was perceived as slightly better, and the number of perceived arousals as lower with the low- vs high-BURR (S/T) mode. CONCLUSIONS: In a homogenous group of patients treated with long-term NPPV for obesity-hypoventilation, changing BURR from an S/T mode with a high or low BURR to an S mode was associated with the occurrence of a highly significant increase in respiratory events, of mainly central and mixed origin. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01130090; URL: www.clinicaltrials.gov
RCT Entities:
BACKGROUND: Unintentional leaks, patient-ventilatory asynchrony, and obstructive or central events (either residual or induced by noninvasive positive pressure ventilation [NPPV]) occur in patients treated with NPPV, but the impact of ventilator settings on these disturbances has been little explored. The objective of this study was to investigate the impact of backup respiratory rate (BURR) settings on the efficacy of ventilation, sleep structure, subjective sleep quality, and respiratory events in a group of patients with obesity hypoventilation syndrome (OHS). METHODS: Ten stable patients with OHS treated with long-term nocturnal NPPV underwent polysomnographic recordings and transcutaneous capnography on 3 consecutive nights with three different settings for BURR in random order: spontaneous (S) mode, low BURR, and high BURR. No other ventilator parameter was modified. RESULTS: The S mode was associated with the occurrence of a highly significant increase in respiratory events, mainly of central and mixed origin, when compared with both spontaneous/timed (S/T) modes. Accordingly, the oxygen desaturation index was significantly higher in the S mode than in either of the S/T modes. The results of nocturnal transcutaneous P(CO(2)) (Ptc(CO(2))) (mean value and time spent with Ptc(CO(2)) > 50 mm Hg) were similar over the three consecutive nocturnal recordings. The quality of sleep was perceived as slightly better, and the number of perceived arousals as lower with the low- vs high-BURR (S/T) mode. CONCLUSIONS: In a homogenous group of patients treated with long-term NPPV for obesity-hypoventilation, changing BURR from an S/T mode with a high or low BURR to an S mode was associated with the occurrence of a highly significant increase in respiratory events, of mainly central and mixed origin. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01130090; URL: www.clinicaltrials.gov
Authors: Chithra Poongkunran; Santosh G John; Arun S Kannan; Safal Shetty; Christian Bime; Sairam Parthasarathy Journal: Am J Med Date: 2015-06-11 Impact factor: 4.965