Characteristics of the deventilation syndrome in COPD patients treated with non-invasive ventilation: a prospective, controlled, non-blinded study

2021 ◽  
Author(s):  
Mareike Lüthgen ◽  
Stephan Rüller ◽  
Christian Herzmann
Keyword(s):  
Side Effect ◽  
Airway Resistance ◽  
Vital Capacity ◽  
Blood Gas ◽  
Invasive Ventilation ◽  
Borg Scale ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation ◽  
Blinded Study

Abstract Background Non-invasive ventilation (NIV) is a recommended treatment for COPD patients suffering from chronic hypercapnic respiratory failure. Prolonged dyspnea after mask removal in the morning, often referred to as deventilation syndrome, is a common side effect but has been poorly characterized yet. This study aimed to explore the pathomechanism, identify risk factors and possible treatment strategies for the deventilation syndrome. Methods A prospective, controlled, non-blinded study was conducted. After a night with established NIV therapy, the patients underwent spirometry, blood gas analyses and 6-minute walking tests (6MWT) directly, at two and four hours after mask removal. Dyspnea was measured by the modified Borg scale. Bodyplethysmography and health-related quality of life (HRQoL) questionnaires were used. Patients suffering from deventilation syndrome (defined as dyspnea of at least three points on the Borg scale after mask removal) were treated with non-invasive pursed lip breathing ventilation (PLBV) during the second night of the study. Results Eleven of 31 patients included (35%) met the given criteria for a deventilation syndrome. They reported significantly more dyspnea on the Borg scale directly after mask removal (mean: 7.2 ± 1.0) compared to measurement after two hours (4.8 ± 2.6; p = 0.003). Initially, mean inspiratory vital capacity was significantly reduced (VCmax: 46 ± 16%) compared to two hours later (54 ± 15%; p = 0.002), while no changes in pulse oximetry or blood gas analysis were observed. Patients who suffered from a deventilation syndrome had a significantly higher mean airway resistance (Reff: 320 ± 88.5%) than the patients in the control group (253 ± 147%; p = 0.021). They also scored significantly lower on the Severe Respiratory Insufficiency Questionnaire (SRI; mean: 37.6 ± 10.1 vs 50.6 ± 16.7, p = 0.027). After one night of ventilation in PLBV mode, mean morning dyspnea decreased significantly to 5.6 ± 2.0 compared to 7.2 ± 1.0 after established treatment (p = 0.019) and mean inspiratory vital capacity increased from 44 ± 16.0% to 48 ± 16.3 (p = 0.040). Conclusions The deventilation syndrome is a serious side effect of NIV in COPD patients, associated with lower HRQoL. Our data suggests that it is most likely caused by dynamic hyperinflation. Patients with high airway resistance are at greater risk of suffering from morning dyspnea. Ventilation in PLBV mode may prevent or improve the deventilation syndrome. Trial registration The study was registered in the German Clinical Trials Register (DRKS00016941) at 04 April 2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS

scholarly journals Acute Dyspnea After Use of Non-Invasive Ventilation in COPD Patients: The Deventilation Syndrome

2021 ◽  
Author(s):  
Mavi Schellenberg ◽  
Sandra Imach ◽  
Gabriele Iberl ◽  
Marietta Kirchner ◽  
Felix Herth ◽  
...  
Keyword(s):  
Early Onset ◽  
Side Effect ◽  
Demographic Data ◽  
Bronchial Obstruction ◽  
Daily Routine ◽  
Borg Scale ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation

Abstract Background: In daily routine, many COPD patients lament early onset augmented dyspnea following use of NIV (Deventilation Syndrome, DVS) as a negative side-effect. This is the first study to this date to quantify and characterize DVS. MethodsThis monocenter prospective observational study collected demographic, physiologic and symptomatic data from 67 in-patients with severe COPD Gold III-IV and chronic hypercapnic failure before, during and after use of an established NIV.During their inpatient follow-up, we examined patients during the first hour after termination of nocturnal NIV. DVS was defined by the authors as an increase of ≥ 2 points on the Borg scale during the first 30 minutes. We monitored cardiovascular and respiratory data and measured diaphragm excursion. Subjective dyspnea was documented by use of the Borg scale and questionnaires. In addition, respirator and demographic data were collected.ResultsDVS occurred in 58% of our COPD patients. Patients with DVS were more severely ill than non-DVS concerning bronchial obstruction (FEV1 0.6 vs 0.8l, p<0.05) and hypercapnia during spontaneous breathing (pre NIV pCO2: 54.5 vs 49.3mmHg, p<0.02). DVS patients showed significantly higher respiratory rates (RR) (20.1 vs 18.1/min p<0.05) after termination of NIV.ConclusionsThis is the first trial quantifying and characterizing early onset augmented dyspnea after the use of NIV, referred to as DVS. It is now brought to attention as a frequent side effect of long-term home ventilation and possible pathophysiologic mechanisms are elucidated.

Walking with Non-Invasive Ventilation Does Not Prevent Exercise-Induced Hypoxaemia in Stable Hypercapnic COPD Patients

2015 ◽  
Vol 12 (5) ◽  
pp. 546-551 ◽  
Author(s):  
David Johannes Walker ◽  
Stephan Walterspacher ◽  
Emelie Ekkernkamp ◽  
Jan Hendrik Storre ◽  
Wolfram Windisch ◽  
...  
Keyword(s):  
Invasive Ventilation ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation ◽  
Exercise Induced

scholarly journals Detection of early nocturnal hypoventilation in neuromuscular disorders

2017 ◽  
Vol 46 (3) ◽  
pp. 1153-1161 ◽  
Author(s):  
Federica Trucco ◽  
Marina Pedemonte ◽  
Chiara Fiorillo ◽  
Hui-leng Tan ◽  
Annalisa Carlucci ◽  
...  
Keyword(s):  
Vital Capacity ◽  
Clinical Symptoms ◽  
Neuromuscular Disorders ◽  
Invasive Ventilation ◽  
Additional Tool ◽  
Non Invasive ◽  
Respiratory Involvement ◽  
Nocturnal Hypoxemia ◽  
Nocturnal Hypoventilation ◽  
Non Invasive Ventilation

Objective Nocturnal hypoventilation (NH) is a complication of respiratory involvement in neuromuscular disorders (NMD) that can evolve into symptomatic daytime hypercapnia if not treated proactively with non-invasive ventilation. This study aimed to assess whether NH can be detected in the absence of other signs of nocturnal altered gas exchange. Methods We performed nocturnal transcutaneous coupled (tc) pCO2/SpO2 monitoring in 46 consecutive cases of paediatric-onset NMD with a restrictive respiratory defect (forced vital capacity < 60%). Nocturnal hypoventilation was defined as tcPCO2 > 50 mmHg for > 25% of recorded time, and hypoxemia as tcSpO2 < 88% for > 5 minutes. Daytime symptoms and bicarbonate were recorded after overnight monitoring. Results Twenty-nine of 46 consecutive patients showed NH. Twenty-three patients did not have nocturnal hypoxemia and 18 were clinically asymptomatic. In 20 patients, PaCO2 in daytime blood samples was normal. Finally, 13/29 patients with NH had isolated nocturnal hypercapnia without nocturnal hypoxia, clinical NH symptoms, or daytime hypercapnia. Conclusions Paediatric patients with NMD can develop NH in the absence of clinical symptoms or significant nocturnal desaturation. Therefore, monitoring of NH should be included among nocturnal respiratory assessments of these patients as an additional tool to determine when to commence non-invasive ventilation.

Acute severe asthma

2020 ◽  
pp. 55-66
Author(s):  
Andrew Nyman ◽  
Andrew Durward
Keyword(s):  
Severe Asthma ◽  
Airway Resistance ◽  
Acute Severe Asthma ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Risk Of Mortality ◽  
Non Invasive Ventilation ◽  
Ventilation Strategies ◽  
Outcomes For Children ◽  
Induction Of Anaesthesia

Children with acute severe asthma requiring invasive ventilation are among the most difficult to manage in the Intensive Care Unit (ICU). This chapter begins by explaining the pathophysiology of asthma before examining the approaches to its management on the ICU—starting with the evidence for the use of non-invasive ventilation and bronchodilators. Indications for invasive ventilation in acute severe asthma are discussed and important considerations in the conduct of induction of anaesthesia and intubation in this patient group. Ventilation strategies are explored, with particular reference to the concepts of airway resistance, driving pressure, inspiratory flow limitation, and auto-positive end expiratory pressure (PEEP). The use of the mucolytic therapy intratracheal DNAse is discussed, and indications for the use of extracorporeal membrane oxygenation in refractory cases. Finally, the chapter reports on outcomes for children with acute severe asthma and factors associated with higher risk of mortality.

scholarly journals Home initiation of chronic non-invasive ventilation in COPD patients with chronic hypercapnic respiratory failure: a randomised controlled trial

Thorax ◽  
2019 ◽  
Vol 75 (3) ◽  
pp. 244-252 ◽  
Author(s):  
Marieke L Duiverman ◽  
Judith M Vonk ◽  
Gerrie Bladder ◽  
Joost P van Melle ◽  
Jellie Nieuwenhuis ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Mean Difference ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation ◽  
Number Of Patients ◽  
Related Quality ◽  
Registration Number ◽  
Randomised Controlled

IntroductionChronic non-invasive ventilation (NIV) has become evidence-based care for stable hypercapnic COPD patients. While the number of patients increases, home initiation of NIV would greatly alleviate the healthcare burden. We hypothesise that home initiation of NIV with the use of telemedicine in stable hypercapnic COPD is non-inferior to in-hospital NIV initiation.MethodsSixty-seven stable hypercapnic COPD patients were randomised to initiation of NIV in the hospital or at home using telemedicine. Primary outcome was daytime arterial carbon dioxide pressure (PaCO2) reduction after 6 months NIV, with a non-inferiority margin of 0.4 kPa. Secondary outcomes were health-related quality of life (HRQoL) and costs.ResultsHome NIV initiation was non-inferior to in-hospital initiation (adjusted mean difference in PaCO2 change home vs in-hospital: 0.04 kPa (95% CI −0.31 to 0.38 kPa), with both groups showing a PaCO2 reduction at 6 months compared with baseline (home: from 7.3±0.9 to 6.4±0.8 kPa (p<0.001) and in-hospital: from 7.4±1.0 to 6.4±0.6 kPa (p<0.001)). In both groups, HRQoL improved without a difference in change between groups (Clinical COPD Questionnaire total score-adjusted mean difference 0.0 (95% CI −0.4 to 0.5)). Furthermore, home NIV initiation was significantly cheaper (home: median €3768 (IQR €3546–€4163) vs in-hospital: median €8537 (IQR €7540–€9175); p<0.001).DiscussionThis is the first study showing that home initiation of chronic NIV in stable hypercapnic COPD patients, with the use of telemedicine, is non-inferior to in-hospital initiation, safe and reduces costs by over 50%.Trial registration numberNCT02652559.

scholarly journals Intermittent Use of Portable NIV Increases Exercise Tolerance in COPD: A Randomised, Cross-Over Trial

2019 ◽  
Vol 8 (1) ◽  
pp. 94 ◽  
Author(s):  
Ioannis Vogiatzis ◽  
Nikolaos Chynkiamis ◽  
Matthew Armstrong ◽  
Nicholas Lane ◽  
Tom Hartley ◽  
...  
Keyword(s):  
Exercise Tolerance ◽  
Moderate Intensity ◽  
Chronic Obstructive ◽  
Dynamic Hyperinflation ◽  
Invasive Ventilation ◽  
Inspiratory Capacity ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation

During exercise, non-invasive ventilation (NIV) prolongs endurance in chronic obstructive pulmonary disease (COPD), but routine use is impractical. The VitaBreath device provides portable NIV (pNIV); however, it can only be used during recovery. We assessed the effect of pNIV compared to pursed lip breathing (PLB) on exercise tolerance. Twenty-four COPD patients were randomised to a high-intensity (HI: 2-min at 80% peak work rate (WRpeak) alternated with 2-min recovery; n = 13), or a moderate-intensity (MOD: 6-min at 60% WRpeak alternated with 2-min recovery; n = 11) protocol, and within these groups two tests were performed using pNIV and PLB during recovery in balanced order. Upon completion, patients were provided with pNIV; use over 12 weeks was assessed. Compared to PLB, pNIV increased exercise tolerance (HI: by 5.2 ± 6.0 min; MOD: by 5.8 ± 6.7 min) (p < 0.05). With pNIV, mean inspiratory capacity increased and breathlessness decreased by clinically meaningful margins during recovery compared to the end of exercise (HI: by 140 ± 110 mL and 1.2 ± 1.7; MOD: by 170 ± 80 mL and 1.0 ± 0.7). At 12 weeks, patients reported that pNIV reduced anxiety (median: 7.5/10 versus 4/10, p = 0.001) and recovery time from breathlessness (17/24 patients; p = 0.002); 23/24 used the device at least weekly. pNIV increased exercise tolerance by reducing dynamic hyperinflation and breathlessness in COPD patients.

scholarly journals Respiratory support in COPD patients after acute exacerbation with monitoring the quality of support (Rescue2-monitor): an open-label, prospective randomized, controlled, superiority clinical trial comparing hospital- versus home-based acute non-invasive ventilation for patients with hypercapnic chronic obstructive pulmonary disease

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Keyword(s):  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Open Label ◽  
Obstructive Pulmonary Disease ◽  
Free Survival ◽  
Non Invasive ◽  
Randomized Controlled ◽  
Copd Patients ◽  
Non Invasive Ventilation

AbstractChronic obstructive pulmonary disease (COPD) is expected to be the 3rd leading cause of death worldwide by 2020. Despite improvements in survival by using acute non-invasive ventilation (NIV) to treat patients with exacerbations of COPD complicated by acute hypercapnic respiratory failure (AHRF), these patients are at high risk of readmission and further life-threatening events, including death. Recent studies suggested that NIV at home can reduce readmissions, but in a small proportion of patients, and with a high level of expertise. Other studies, however, do not show any benefit of home NIV. This could be related to the fact that respiratory failure in patients with stable COPD and their response to mechanical ventilation are influenced by several pathophysiological factors which frequently coexist in the same patient to varying degrees. These pathophysiological factors might influence the success of home NIV in stable COPD, thus long-term NIV specifically adapted to a patient’s “phenotype” is likely to improve prognosis, reduce readmission to hospital, and prevent death. In view of this conundrum, Rescue2-monitor (R2M), an open-label, prospective randomized, controlled study performed in patients with hypercapnic COPD post-AHRF, will investigate the impact of the quality of nocturnal NIV on the readmission-free survival. The primary objective is to show that any of 3 home NIV strategies (“rescue,” “non-targeted,” and “targeted”) will improve readmission-free survival in comparison to no-home NIV. The “targeted” group of patients will receive a treatment with personalized (targeted) ventilation settings and extensive monitoring. Furthermore, the influence of comorbidities typical for COPD patients, such as cardiac insufficiency, OSA, or associated asthma, on ventilation outcomes will be taken into consideration and reasons for non-inclusion of patients will be recorded in order to evaluate the percentage of ventilated COPD patients that are screening failures. ClinicalTrials.gov NCT03890224. Registered on March 26, 2019.

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