Volume-targeted versus pressure-limited noninvasive ventilation in subjects with acute hypercapnic respiratory failure: a multicenter randomized controlled trial

• Published in: Respiratory Care 2016, p.1440
• Main Authors: Cao, Zhixin, Luo, Zujin, Hou, Anna, Nie, Qingrong, Xie, Baoyuan, An, Xiaojie, Wan, Zifen, Ye, Xianwei, Xu, Yanju, Chen, Xisheng, Zhang, Honghai, Xu, Zhenyang, Wang, Jinxiang, An, Fucheng, Li, Pengfei, Yu, Chunxiao, Liang, Yandong, Zhang, Yongxiang, Ma, Yingmin
• Format: Report
• Language: English
• Subjects: Analysis; Artificial respiration; Care and treatment; Health aspects; Respiratory insufficiency
• ISSN: 0020-1324
• DOI: 10.4187/Respcare.04619

BACKGROUND: Volume-targeted noninvasive ventilation (VT-NIV), a hybrid mode that delivers a preset target tidal volume ([V.sub.T]) through the automated adjustment of pressure support, could guarantee a relatively constant target [V.sub.T] over pressure-limited noninvasive ventilation (PL-NIV) with fixed-level pressure support. Whether VT-NIV is more effective in improving ventilatory status in subjects with acute hypercapnic respiratory failure (AHRF) remains unclear. Our aim was to verify whether, in comparison with PL-NIV, VT-NIV would be more effective in correcting hypercapnia, hence reducing the need for intubation and improving survival in subjects with AHRF. METHODS: We performed a prospective randomized controlled trial in the general respiratory wards of 8 university-affiliated hospitals in China over a 12-month period. Subjects with AHRF, defined as arterial pH < 7.35 and ≥ 7.25 and [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] > 45 mm Hg, were randomly assigned to undergo PL-NIV or VT-NIV. The primary end point was the decrement of [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] from baseline to 6 h after randomization. Secondary end points included the decrement of [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] from baseline to 2 h after randomization as well as outcomes of subjects (eg, need for intubation, in-hospital mortality). RESULTS: A total of 58 subjects were assigned to PL-NIV (29 subjects) or VT-NIV (29 subjects) and included in the analyses. The decrement of [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] from baseline to 6 h after randomization was not statistically different between the PL-NIV group and the VT-NIV group (9.3 ± 12.6 mm Hg vs 11.7 [+ or -] 12.9 mm Hg, P =.48). There were no differences between the PL-NIV group and the VT-NIV group in the decrement of [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] from baseline to 2 h after randomization (6.4 ± 12.7 mm Hg vs 5.0 ± 15.8 mm Hg, P =.71) as well as in the need for intubation (17.2% vs 10.3%, P =.70), and in-hospital mortality (10.3% vs 6.9%, P >.99). CONCLUSIONS: Regardless of whether a VT- or PL-NIV strategy is employed, it is possible to provide similar support to subjects with AHRF. (ClinicalTrials.gov registration NCT02538263.) Key words: acute hypercapnic respiratory failure; noninvasive ventilation; volume-targeted; pressure-limited; target tidal volume; hypercapnia. [Respir Care 2016;61(11):1440-1450. [C] 2016 Daedalus Enterprises]