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Physiological effects of high-intensity versus low-intensity noninvasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease: a randomised controlled trial.

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机构： [1]Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China. [2]Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China. [3]Department of Clinical Research and Epidemiology, Fuwai Hospital Chinese Academy of Medical Sciences, No. 12 Lanshan Road, Nanshan District, Shenzhen, 518057, Guangdong Province, China. [4]Department of Emergency Medicine, Beijing Chao-Yang Hospital Western Branch, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China. [5]Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, No. 8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China. [6]Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China. cyh-birm@263.net. [7]National Clinical Research Center for Respiratory Diseases, Beijing, China. cyh-birm@263.net. [8]Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. cyh-birm@263.net. [9]Department of Respiratory Medicine, Capital Medical University, Beijing, China. cyh-birm@263.net.

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关键词： Noninvasive positive pressure ventilation High intensity Low intensity Chronic obstructive pulmonary disease Exacerbation Hypercapnia Normocapnia Physiological effects

摘要：

High-intensity noninvasive positive pressure ventilation (NPPV) is a novel ventilatory approach to maximally decreasing elevated arterial carbon dioxide tension (PaCO2) toward normocapnia with stepwise up-titration of pressure support. We tested whether high-intensity NPPV is more effective than low-intensity NPPV at decreasing PaCO2, reducing inspiratory effort, alleviating dyspnoea, improving consciousness, and improving NPPV tolerance in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).In this physiological, randomised controlled trial, we assigned 24 AECOPD patients to undergo either high-intensity NPPV (n = 12) or low-intensity NPPV (n = 12). The primary outcome was PaCO2 24 h after randomisation. Secondary outcomes included gas exchange other than PaCO2 24 h after randomisation, inspiratory effort, dyspnoea, consciousness, NPPV tolerance, patient-ventilator asynchrony, cardiac function, ventilator-induced lung injury (VILI), and NPPV-related adverse events.Inspiratory positive airway pressure 24 h after randomisation was significantly higher (28.0 [26.0-28.0] vs. 15.5 [15.0-17.5] cmH2O; p = 0.000) and NPPV duration within the first 24 h was significantly longer (21.8 ± 2.1 vs. 15.3 ± 4.7 h; p = 0.001) in the high-intensity NPPV group. PaCO2 24 h after randomisation decreased to 54.0 ± 11.6 mmHg in the high-intensity NPPV group but only decreased to 67.4 ± 10.6 mmHg in the low-intensity NPPV group (p = 0.008). Inspiratory oesophageal pressure swing, oesophageal pressure-time product (PTPes)/breath, PTPes/min, and PTPes/L were significantly lower in the high-intensity group. Accessory muscle use and dyspnoea score 24 h after randomisation were also significantly lower in that group. No significant between-groups differences were observed in consciousness, NPPV tolerance, patient-ventilator asynchrony, cardiac function, VILI, or NPPV-related adverse events.High-intensity NPPV is more effective than low-intensity NPPV at decreasing elevated PaCO2, reducing inspiratory effort, and alleviating dyspnoea in AECOPD patients.ClinicalTrials.gov (NCT04044625; registered 5 August 2019).© 2022. The Author(s).

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出版当年[2021]版：

大类 | 2 区医学

小类 | 2 区危重病医学

最新[2023]版：

大类 | 1 区

医学

小类 | 2 区危重病医学

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出版当年[2020]版：

Q1 CRITICAL CARE MEDICINE

最新[2023]版：

Q1 CRITICAL CARE MEDICINE

影响因子： 5.7 最新[2023版] 6 最新五年平均 6.925 出版当年[2020版] 6.068 出版当年五年平均 4.124 出版前一年[2019版] 10.318 出版后一年[2021版]

第一作者：

第一作者机构： [1]Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China. [2]Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China.

通讯作者：

通讯机构： [6]Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China. cyh-birm@263.net. [7]National Clinical Research Center for Respiratory Diseases, Beijing, China. cyh-birm@263.net. [8]Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. cyh-birm@263.net. [9]Department of Respiratory Medicine, Capital Medical University, Beijing, China. cyh-birm@263.net.

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Physiological effects of high-intensity versus low-intensity noninvasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease: a randomised controlled trial.

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