Obstructive Lung Diseases: COPD I |

Physiological Effect of the Pressure Support Set by the Chronic Obstructive Pulmonary Disease Patient's Comfort During Noninvasive Pressure Support Ventilation FREE TO VIEW

Jianheng Zhang, MD; Qun Luo, MD; Huijin Zhang, BS; Rongchang Chen, MMed
Author and Funding Information

The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A372. doi:10.1016/j.chest.2016.02.387
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE:Background: The inspiratory pressure is often set by COPD patient’s comfort to promote the success rate during noninvasive positive pressure ventilation. However, the physiological responds of this setting is not clear. Objectives: To assess the effect of the comfortable level (baseline PS) of the COPD patient during noninvasive pressure support ventilation (PSV).

METHODS: 15 severe COPD patients with hypercapnia were placed on the three levels (PS, PS-, PS+) of mask -PSV in random sequence, after the assessment of unassisted spontaneous breathing (SB). The PS level was titrated by patient’s comfort before the experiment. To further demonstrate the physiological responds of the varying pressure, 25% decrease and increase by baseline PS were applied. (PS-=75%PS PS+=125%PS). Each level lasted at least 20 minutes. Respiratory rate (RR), tidal volume (Vt), inspiratory effort (PTPin/min), neuro-ventilatory coupling (VE/RMS%) were measured.

RESULTS: During PS, Vt was increased significantly (PS:561±102ml vs SB: 455±139 ml, p<0.05) with the RR slightly decreased (P>0.05). VE/RMS% was improved significantly (PS:1.06±0.42 L/% vs SB: 0.29±0.12 L/%), with the inspiratory muscles sufficiently unloaded (PS:56.67±32.71 cmH2O.S/min vs SB: 278. 42±72.49 cmH2O.S/min.). The neuro-ventilatory coupling (VE/RMS%) during the “comfortable” level (baseline PS) is similar to that of healthy contemporary subject during SB reported by YM. Luo et al (PS: 1.06±0.42 L/% vs healthy 1.0±0.7L/%). Asynchrony was not observed. Compared to PS, reducing 25% of the pressure support (PS-), Vt was not decreased significantly. But, inspiratory muscles burden was significantly increased with a remarkable deterioration in neuro-ventilatory coupling. Increasing 25% of the pressure support (PS+), Vt was remarkably increased. The VE/RMS% was improved significantly with the PTPin/min slightly decreased. The pressure support may be excessive in 4 patients with asynchrony during PS+

CONCLUSIONS: The pressure support set by comfort can appropriately improve the neuro-ventilatory coupling, significantly enhance tidal volume and sufficiently unload the inspiratory muscles in COPD patients with hypercapnia, and at the same time, obtain a good synchrony

CLINICAL IMPLICATIONS: Realizing the physiological responds of the COPD patients with hypercapnia to the most tolerated PS, we can be more confident in setting the NPPV by COPD patient’s comfort in ICU and emergency room.

DISCLOSURE: The following authors have nothing to disclose: Jianheng Zhang, Qun Luo, Huijin Zhang, Rongchang Chen

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