Patient-Ventilator Interaction During Noninvasive Ventilation in Subjects With Exacerbation of COPD: Effect of Support Level and Ventilator Mode

• Published in: Respiratory care Vol. 65; no. 9; p. 1315
• Main Authors: Oppersma, Eline, Doorduin, Jonne, Roesthuis, Lisanne H, van der Hoeven, Johannes G, Veltink, Peter H, Heunks, Leo Ma
• Format: Journal Article
• Language: English
• Published: United States 01.09.2020
• Subjects: Humans; Interactive Ventilatory Support; Noninvasive Ventilation; Positive-Pressure Respiration; Pulmonary Disease, Chronic Obstructive - therapy; Ventilators, Mechanical; patient-ventilator asynchrony; NAVA; noninvasive ventilation; COPD
• ISSN: 1943-3654
• DOI: 10.4187/respcare.07159

Patient-ventilator synchrony in patients with COPD is at risk during noninvasive ventilation (NIV). NIV in neurally-adjusted ventilatory assist (NAVA) mode improves synchrony compared to pressure support ventilation (PSV). The current study investigated patient-ventilator interaction at 2 levels of NAVA and PSV mode in subjects with COPD exacerbation. NIV was randomly applied at 2 levels (5 and 15 cm H O) of PSV and NAVA. Patient-ventilator interaction was evaluated by comparing airway pressure and electrical activity of the diaphragm waveforms with automated computer algorithms. 8 subjects were included. Trigger delay was longer in PSV high (268 ± 112 ms) than in PSV low (161 ± 118 ms, = .043), and trigger delay during NAVA was shorter than PSV for both low support (49 ± 24 ms for NAVA, = .035) and high support (79 ± 276 ms for NAVA, = .003). No difference in cycling error for low and high levels of PSV (PSV low -100 ± 114 ms and PSV high 56 ± 315 ms) or NAVA (NAVA low -5 ± 18 ms, NAVA high 12 ± 36 ms) and no difference between PSV and NAVA was found. Increasing PSV levels during NIV caused a progressive mismatch between neural effort and pneumatic timing. Patient-ventilator interaction during NAVA was more synchronous than during PSV, independent of inspiratory support level. (ClinicalTrials.gov registration NCT01791335.).